Whatever the emphasis or valuation put on any special symptom or group of symptoms, it first must be fundamentally agreed that the totality alone is essential to the selection of a remedy homoeopathic to the diseased state of the patient. No detail is too insignificant. Scrupulous and painstaking care in case taking is paramount. No values must be written into the record, nor over emphasis placed on any division of the symptom total; the mind kept open until all the evidence carefully weighted is in.
To possess actual value symptoms must be reliable and definite, of the very warp and woof, unaffected by their appearance or use in other case; in short, symptoms that clearly individualize the case under consideration- a totality that sets the case apart from any other previously observed. Until this totality is on paper before us there can be no ranking or ascribing or values. Hence the need, however tedious, of sound case taking, for it is fundamental and not to be compromised by bias or past clinical experience.
In order to match the genius of the disease with the genius of the remedy we then seek to rearrange and rank individual symptoms to better discern the remedial agent. Of the symptoms related or observed many may not particularly distinguish. What are some of these?.
Pathological symptoms, so-called, indicative of the results of disease were described as ultimates by Kent. These evidences of tissue changes are helpful in diagnosis or prognosis, but because they are effects, not causes, they do not become of primary importance in pointing to a curative remedy. All processes have an origin, and it is their beginnings to which a similar drug pathogenesy may be comparable, Likewise in epilepsy, the remedy is not seen in the actual seizure, but rather in what has preceded perhaps long before.
Symptoms common to all cases of a certain disease are little indicative of a similar remedy. There is nothing here to be found individual and compelling our choice. Symptoms common to many drugs likewise do not stand out in the selection of a similar drug picture.
Symptoms due to drugging, or improperly chosen remedies, or too early repetition do not present the individual nature of the disease as manifested in the changed state and hinder differentiation. Again the long list given by a hysterical patient is difficult to value.
The predomination “my” symptoms in reference to particular parts of the body also belong in the class of lesser values, unless these are striking, or becoming general because they are similarly evidenced throughout the various parts of the patient. Particulars rarely distinguish the individual and to that extent are weak in value.
So are common symptoms, such as loss of appetite, headache, exhaustion, discomfort, etc., often indefinite and therefore not to be emphasized unless qualified further to really individualize the case.
What symptoms, then, stand forth, compelling and of major rank, pointing more directly toward what is essential for cure? A consideration of homoeopathic philosophy antedates proper symptoms valuation. Very briefly, it is not be body of man that expresses disease, but the reaction of this vital force against invasion. Natures response is in the way of symptoms experienced through sensation, etc.
Individualisation means the reaction to any morbific agent as evidenced in the patient under our care. When this is clear to the prescriber, there is no thought of remedies based other than on the patient himself. Not the present symptoms alone, but those detectable from birth, show the conflict which has harassed the inner real life in its bid for mortal existence.
The mind of man is prior to all else, and therefore first values are ascribed to symptoms which show a change in the mental state. The masters have pointed out these differentiations far better than I could attempt. But basic values must be constantly brought before th beginners in homoeopathy, and more experienced prescribers tolerant of their repetition. Mental changes are predicated of the patient as a whole and therefore take precedence among the generals, if well marked.
The dream state especially if persistent, is of close relation here. Emphasis is put on change in the mental state and temperament owing to the disturbed harmony. As has been pointed out, the will and understanding are prior to mans action. Here is the inner nature of the patient, for what he thinks and loves is personal. Altered states here are of highest importance.
Second to definite mentals come the reactions of the patient as a whole to environment, if outstanding, such as to time, seasons, temperature, weather, position, posture, motion, pressure, jar, touch and the like. Their description is usually predicated of the patient by the use of “I”, instead of “My” in relating. Also important are desires and aversions, aggravations and ameliorations, particularly if strongly expressed. Menstrual conditions, and discharges whenever affecting the general condition of the patient have added values.
Symptoms characteristic of a drug as shown in the provings, and again and again curatively applied in clinical experience rank high on the list. The locality may be characteristic; likewise conditions; times of the day; by concomitance; by cause; or a mental state. The personality of the patient by these may qualify disease.
Paragraph 153 of the Organon stresses the “striking, remarkable, and peculiar signs and symptoms which are to be especially and almost exclusively brought before the eye, for these especially must be very like the drug that is being searched for in the symptom lists, if this is to be most suitable for the cure.” To the beginner, the words strange, rare, and peculiar are often perplexing. He wants definite examples, and such an answer as fever without thirst-while he readily admits as peculiar-fails to satisfy the emphasis on the paragraph mentioned.
But when he realizes that a common symptom, particular, or even general, if uncommon, unexpected, unaccountable, or a symptom peculiar to a certain remedy, or the absence of striking features of a disease is to be classified as striking, remarkable, and peculiar he begins to see light. It then appears not so much as a new kind of symptom to be sought for, as a more careful observation of what individualizes the patient. Individual peculiarities are to be found because not two cases present the same constitution or personality which are affected by the disturbance of the economy in disease.
He more readily separates, then, the symptoms of the disease from those of the individual suffering from disease. If some of the master prescribers would elaborate the principles in Paragraph 153 it would be a most helpful contribution to the early student in homoeopathy.
To briefly summarize, we need a totality that is not a total list of complaints, but a totality of every single symptom, to understand the relation and position if fills in the whole totality. No circumstances of life and habit, with full details as to modifications and modalities can be omitted, the emphasis being placed on what is well marked. With such a totality at hand, we must see where we have minutely individualized our patient. These factors interpreted through a background of the philosophy of Hahnemann lead to a proper estimation of symptoms values.
DR. ELIZABETH WRIGHT-HUBBARD: The value of symptoms is, in my opinion, the most important factor in homoeopathic prescribing. Dr. Spalding has taken the bull by the horns. One may grasp the basic postulates of our art, one may take a perfect case, one may be conversation with the technique of repertorizing, and a storehouse of materia medica knowledge, but if one lacks the ability to sift symptoms, it profiteth but little. In the masters this sixth sense for the important in symptomatology is unconscious, intuitive. They will read a case having hundreds of symptoms, and infallibly select five or so, which are salient enough to show the remedy.
I have often wondered upon what are this ability of editing symptoms is based: Not wholly upon experience, nor yet upon such valuable schemata as Gibson Miller and others have given us. One element in this judgment is psychological perception, a knowledge of human nature, and wherein it exaggerates or moderates. another is a certain purism in language, the power to translate the groping and inexact words of the patient into precise meaning, a sense of synonym. A third is that particular precious, inner balance which grasps that which is most vital to the patient even though they may not realize the relative importance to themselves, a kind of artistic sense of proportion and perspective.
A fourth is the keeping in mind of the fact that not only must a symptom be of importance in the abstract hierarchy of symptoms, but it must be stressed and urgent in the patients particular picture; for instance “suicidal thoughts” rank at the top if they are persistent, yet a patient may admit to occasional weakness in that direction which may be much less characteristic than other symptoms as “amelioration in wet weather”, which, in the abstract ranks lower. Balance the value to the patient with the theoretical value of the symptom, and with the prominence of the symptom under the drugs in consideration.
A fifth element is the knack of ferreting out causes of symptoms; for instance, a patient once struck by lightening is timid to a subsequent fear of electric storms, as is a child frightened by a timid nurse, whereas an adult without unpleasant experience who fears them has a true symptom. A sixth factor unpleasant experience who fears them has a true symptom. A sixth factor is the capacity for weeding out psychological causes for symptoms due to definitely traceable influence.
Dr. Spalding has, we feel, covered the ground admirably. The two points that we would comment on are his omission of the “ailments from” class of symptoms, for which even good prescriber so often fail to search, and his cursory regard for particular symptoms. In this latter connection it must never be forgotten that though generals are the frame, and the picture must go into it, many remedies may coincide by and large with both the mentals and physical generals and yet not be the similimum, but if the individualizing, strange particulars, especially as regards vital functions, fits, our outline is clearer, and our remedy clinched.
One of our wise prescribers suggest that we select always one mental- if available-one pathological-if it represents a definite tendency of the vital force-and one objective-which cannot lie-as well as our all important generals and salient particulars. Especially did we like Dr. Spaldings summary that “a totality is not a total list of the complaints”. We have seen a list of rubrics chosen, not one of which was mentioned by the patient consciously, which, notwithstanding, led to a brilliant cure.
Dr. E. UNDERHILL, JR.: I think the question of totality of symptoms has been a stumbling block, to a great many homoeopathists. Just what is meant by the term “totality”? There are two ways of taking that. One is the numerical total which would include every possible symptom of every kind and description that could include every possible symptom of every kind and description that could be elicited in given case. The other would be an artistic totality which could be gathered from the numerical totality if one went about it correctly.
I have used the illustration of a photograph as compared with a portrait. the photographic lens will make an imprint on the film of every defect and every line that is exposed to it, whereas a good artist can sketch in with a few lines an exact likeness that will do the person just as much justice as the photograph, perhaps more. That would be an artistic totality. Personally I like to have a case taken as completely as possible, and I like to have it all typed before I go over it. I dont like to go over hand-writing because it annoys me. With each symptom typed on a line by itself I will take a pencil or a pen, and as I read down the typewritten page I check each symptom that I intend to use. It doesnt matter then how large a symptom list you have. You can have a numerical totality if you want it and I am glad to have it, and from that you can select the artistic totality, which will include the essential generals of the case, and from which you can select your remedy.
Dr. R.E.S. HAUES: some years ago I read a short article before this Association. The title was Totality versus Personality. For my own benefit I used the phrase “personality of symptoms” in preference to “totality.” I dont know whether or not that is suggestive to anyone else.
Dr. B.C. WOODBURY: When is a totality not a totality? I notice that Dr. Spalding hasnt mentioned the subject of key-note symptoms. Key-note symptom is more or less identical, I think, with what Dr. Hubbard mentioned as having used in a cursory way. Most key-notes are of particular symptoms, but they have a very strong relation to the case.
I have a very definite recollection of hearing my father tell the story of Dr. Guernsey, of Philadelphia, who is supposed to have been the originator of the key-note symptom, although I think Lippe was fully as much so as Guernsey. In fact, he was an older teacher than Guernsey. Guernsey used it as a basis for a collection of very definite symptoms that could be used in prescribing. My father told of having been in Dr. Guernseys house one time. Dr. Guernsey has two sons, as you will recall, William Jefferson Guernsey and Joseph C. Guernsey. One of these little boys was on the rack, and his father was teaching him key- notes. I cant recall which of the boys it was, but one of the boy stuttered.
The boy who stuttered came into the room when my father was there, and his father said, “Have you learned anything today?” He said, “Yes, I have learned two key-notes today.” so that Guernsey evidently put his boys to work early on that key- note method. Key-notes are all right if they are not used to the exclusion of general symptoms. I think that the proper evaluation of symptoms cannot be too strongly stressed, whether they be key- note symptoms, so-called, or whether they be just the general symptoms, mental or environments or temperature reaction, whatever they may be.
DR. H.A ROBERTS: I think Dr. Spalding has produced a wonderful paper, and I wonder if it isnt an answers to the idea that you can learn homoeopathy from symptoms alone. I think the philosophy that goes with the teaching of homoeopathy is just as important as the materia medica and the knowledge of it. Unless we have that we are lost, and when we get that as Dr. SPALDING has presented it in ths admirable article, I look upon it with considerable pleasure, for the reason that although article, I look upon it with considerable pleasure, for the reason that although Dr. Spalding was a pretty good student or homoeopathy before last summer, I think he got a considerable amount of homoeopathy at the post-graduate school. There are several other here who also got work along the philosophical lines that helps so much in our prescribing, and helps us to evaluate symptoms and to make our prescribing more as it should be.
DR. C.M. BOGER: This very thoughtful paper deserves only admiration. However, I wish to stress ideas that were only faintly touched upon. We should try as much as possible to trace out the origin of all symptoms with which we have to deal. Sometime that is a very deep program. For instance, the young lady who has been repressed from the time she was big enough to talk until now, repressed in this direction and in that direction and in the other direction, until a few years after having reached young womanhood an explosion takes place.
She begins to realize what she has missed, what has been done to her, and she goes off on a tangent and perhaps lands in an insane asylum because she was repressed, because her mentality was held done, her mentality was warped and turned to one side. We dont always suppress symptoms by rubbing on salves and doing other devilish tricks like that. You can suppress symptoms and suppress nature by mental processes. If you treat that kind of a case and do not take into consideration the origin of the symptoms you will fail utterly and ridiculously.
I have a case of that kind on my mind now. I promised a girl that I would cure her in two or three years perhaps, that I would work away all of these repressions. She has had attacks of acute mania a number of times, but she is slowly improving. As proof that she is improving a wart that she had burned off with a Roentgen ray, or, or some other way, I have forgotten how now, has started to come back. She has only had Lachesis and Belladonna.
The point I want to stress is that you have to unload that kind to burden. You must get rid of the burden that is there. That will decide whether your remedy is the proper kind, or whether the unloading has cured the patient and brought about a reaction. It is quite hard to make a certain decision, but personally i think a patient needs both. She needs an unloading and a remedy. She needs an unloading to place her on a footing with the rest of us, and she needs a remedy to harmonize her mental and her physical nature.
DR. R. W. SPALDING: There is really noting more that I can add. I appreciate the discussion given the paper. My object wasnt to limit the particular symptoms as Dr. Hubbard suggested. I was trying more particularly to get a little more reaction for myself, through the discussion, in regard to strange, rare, and peculiar symptoms. Evidently my paper has emphasized totality more than the paragraph I really wished to emphasize, but that is a personal matter.
I am glad to express my appreciation of the post-graduate school of Boston. I am sure it did me a great deal of good last summer.
In closing I would ask that sometime some one elucidate more particularly on paragraph 153 of the Organon, not for the experienced prescriber but so that the beginner will understand it, the student, perhaps, in the school. I think often times there has been rather a large order to fill as opposed to the so- called key-note characteristics and then the totality as well.