The reason for the title to this paper is principally to create a discussion to enlighten the reader as well as others who might be in a quandary to decide which symptoms are of any importance and which symptoms are to be thrown out.
When we speak of symptoms in homoeopathy it reminds me so much of the diathermy machines, the short wave machines that are now so much in vogue. I was always under the impression that there were but a few of them and that they all accomplished the same thing, but much to my surprise I learned that there are many thousands of machines being sold in the country and it oftentimes taxes ones mind to decide which one is the most important one. This, by way of analogy, applies to symptoms in homoeopathy.
Many of our failures, I fee sure, are purely due to the lack of evaluation of symptoms, and I have often been led in that same mistake, so I will endeavor to expound the subject in a few words here so as to create a general discussion, in view of the fact that many authors, in compiling their books, have adopted classification for symptoms, such as basic, determinative, characteristic, unusual, and so on, so that one oftentimes becomes confused as to which symptoms he should select in order to properly repertorize his case.
Accompanying a change from the state of health in an individual, is a group of symptoms exhibited in a certain order, which collectively constitute a disease. Certain diseases are so well known that they may be instantly recognized by the constant picture they present. However, there are other diseases, and many of them, that must be diagnosed by the symptomatology presented.
A symptom which appears trifling to the careless or superficial examiner, may become, in the hands of the expert, the key which unlocks a difficult problem in therapeutics. Hahnemann defined symptoms broadly as “any manifestation of a deviation from a former state of health, perceptible by the patient and the individuals around him, or the physician.” These symptoms have been divided into two groups — objective and subjective.
To quote Hahnemann again, objective symptoms are: “Expressions of disease in the sensations and functions of that side of the organism exposed to the senses of the physicians and bystander.” They are the outward manifestations observed by the physician. Subjective symptoms are discovered by the patient himself, and other morbid sensations of the body and mind, which present no outward indications.
The subjective class of symptoms was practically ignored by the profession until Hahnemanns announcement of the Totality of Symptoms doctrine, the basis of homoeopathy. The practitioner of medicine was little interested in the subjective symptoms, and they played but a small part in governing the practical treatment of his case. To him, they were merely inarticulate cries of suffering—the subjective expression of the patient to indicate the variance of his body from the state of health, and served only to suggest the direction in which to make investigations by physical and laboratory methods for discovering the cause of the disease and the location and character of its lesions.
We know that pains, or subjective (sensational) symptoms come before functional derangements, just as these precede the structural or organic changes, all of which are but the extension and ultimate development of the morbific influences of those subjective symptoms.
The constitutional factor in disease is being considered more and more by modern medicine. Hahnemann and Hering recognized the factor dealing with diathesis, temperaments, cachexias and reactions. They learned that certain drugs, as well as disease, are more active in a certain type of individual, and if the patient happened to be of this makeup, it was considered presumptive evidence that his symptoms would be relieved by this drug. Dr. Ellis Barker, of Johns Hopkins, recently lectured in this city on the subject of The Constitutional Factor in Disease. He identified perhaps a half dozen constitutional types of people, as well as the allergies, sensitivities, and mental characteristics of these types as well as disease tendencies in each.
He insisted that modern medicine in its advance must learn to identify these constitutions, and to consider this factor in treatment. The homoeopath recognizes the classical flabby and sweaty Calcarea baby, the sympathy craving blonde Pulsatilla, the Arsenic anguish and cachexia, the full blooded, plethoric Belladonna, and countless other constitution-drug types.
In our search for cure, we cannot ignore these symptoms, and when we find no satisfactory objective symptoms, assure the patient that his health is not in a bad state, and quiet him with opiates until the objective symptoms do appear. By that time, the sufferer is usually beyond cure. The physician would be far more sure of healing the sick if he would pay strict attention to the subjective, the sensational and the constitutional factors, in addition to the attendant circumstances and conditions, than if he directed his attention solely to the external and ultimate symptoms or forms of the disease. Until the recognition of all these existing symptoms, the adult in disease will be treated with the same difficulty as are infants and animals. Fortunately, the illnesses of the latter are not so complicated.
After being identified, these symptoms must be further evaluated. Many of our findings will prove valueless in our search for a cure. Many diseases have certain manifestations in common, such as fevers, and for that reason, any one symptom in disease will prove valueless in the search for a cure. What is needs is a clinical picture of the whole disease, and that is obtained only by summing up and considering the “totality of symptoms”, expressed by the disease.
The symptoms of pain, felt by the patient besides being of pain, portray the accompanying changes of psychic and mental states, all of which bear the same invariable characteristics of disease as do the accompanying objective findings. A group of patients may give manifestations of a disease, yet may not all be cured by a certain drug. In the homoeopathic materia medica are more than fifty-six drugs for diphtheria, but due to individual differences and the personal factor, there is a very small number of drugs corresponding to all the symptoms of the patient.
The drugs for any disease are indicated only after considering all the symptoms of the disease and matching the symptoms of the disease with the curative drug having the greatest number of similar characteristic symptoms.
The science of symptomatology is the consideration of completed symptoms with their relations to conditions and circumstances, to cause, family history, the history of the sick individual, his environment and every feature that can affect the sick condition of the patient. The term symptom is like charity, in that it “covers a multitude of sins”. One of the first realizations of homoeopathy is the importance of symptoms. One is led into what seems a perfect wilderness of symptoms, the density and extent of which is both confusing and discouraging. After a little study of the situation, however, openings appear.
Entering, he finds the openings becoming paths, tortuous at first, but soon becoming wider, straighter and more orderly, until at last one steps upon broad spaces and under clear skies with beautiful avenues along which he may travel cheerfully in search of the correct remedy. It is through symptoms that we become acquainted with the sphere of action of any drug, hence one cannot ignore the right understanding of all symptoms, whether they be natural or artificial.
The true success of homoeopathy lies in the fact that we deal with man as something higher than a mass of muscles, nerves and bones. Man today is only the sum total of everything good, bad, indifferent and diseased, in his parents and his ancestors. Disease is mainly the results of transgressions of laws of life; results accumulated and transmitted from generation to generation, forming “miasms”or constitutional tendencies to physical or mental degeneration in one of another direction.
A symptom is a demonstration of the condition of the tissues and organs of an individual, of a personality. Man is made up of the physical, the intellectual, and the spiritual forces. Success in homoeopathy depends on understanding the relation of these three units of force to each other.
Every individual has certain qualities which give him an individuality. These peculiarities he retains when he is sick. In whatever sickness he may have, a few of his old peculiarities will be present. These we may call constitutional symptoms. These symptom serve us more readily to detect disease in the variation from the healthy standard of that individual.
A scientific homoeopath avails himself of every means by which he may gain a better knowledge of a case he is to treat. To select our indicated remedy is no “boys play”, but rather a task requiring all the commonsense, ingenuity, skill and study and time of the keenest brain to be done properly and successfully. Making a diagnosis assists us in using our knowledge of the selective affinity of our drugs and remedies, and therefore is of the greatest importance in determining the totality of symptoms in selecting the indicated remedy. It is ridiculous, however, to regard the number of symptoms in determining the remedy in any given case, without the character of the symptom which should always be the real factor in deciding upon the similimum.
It is by no means a disregard of pathology when Hahnemann advises always to give the remedy according to the symptoms in each case, and not according to the names of diseases. Hahnemann, according to the strictest method which he rigorously followed during his life, wanted us to look to the reality; to the real sick individual; to take an image of all the symptoms, and compare such a picture of the one reality with the other, that is, with the real symptoms of a drug. All who follow Hahnemanns advice are much more successful, though of course never pretending to be infallible.
CAMDEN, N. J.
DR. BAKER: I think that point of the evaluation of symptoms is an awfully strong one. You might have a whole bunch of symptoms and it doesnt mean anything. It is ability to select the symptom that really means something that enables one to give a good prescription.
DR. MC LAREN: Evaluation of symptoms is the stumbling block for the younger homoeopaths and for the older ones, too. You get a number of symptoms, and if these symptoms seem to us important we may put the wrong value on them, and in doing that and working out the case in the repertory we arrive at the wrong remedy, so that too much stress can not be placed upon the proper evaluation of the symptoms.
In some cases, when we see them, we have no trouble at all in deciding on the remedy. You know that case is a Belladonna case. These are usually the acute cases and we dont have much trouble with them, but the chronic cases require a great deal of study, and before you start to make your repertory study at all you should clearly put the symptoms in order, the ones which you feel are of the greatest value in selecting the remedy, the ones which are going to really point the remedy, and then start in on your repertorial analysis, and you will have some real success, but if you start it off in a haphazard way you are lost.
DR. BELLOKOSSY: I find it is impossible to evaluate the symptoms without continuous study of the materia medica, and studying the materia medica it is best to studying Herings Guiding Symptoms, and then only the textbooks, and to repeat that constantly. Then only can you evaluate the symptoms. Having only the repertory and having the symptoms of the patient, and evaluating the symptoms according to the repertory rubrics is not enough. One never can evaluate symptoms by the repertory rubrics.
DR. DIXON: In taking a new case I assume we all write out a history. I have a habit, in taking that history, of underscoring symptoms that appear to be significant. It helps me in making the selection of the important rubrics and I have often run a check on that after the case was complete, to see if those scored symptoms were always important, and they dont always work through. Some of those that I have underscored as I took the history I have found were really common symptoms of the condition pointed out, and we dont like to underscore the common symptoms; it is the particulars.
DR. HAYES: I agree with Dr. Bellokossy on the value of the study of the materia medica, studying the evaluation there in comparison with the evaluations of the repertory. I think the materia medica is much more valuable.
It seemed to me that one of the most thoughtful points of Dr. Lewandowskis paper was in the first part of it, the study of the order of the symptoms and their relation to each other throughout the whole individual case. I wish somebody more competent than myself would discuss that very point.
DR. MC LAREN: I would like to just say another word. As we say such and such a case is Belladonna case or an Arsenicum case, the better we know our materia medica the greater the number of cases which will fall into these classifications.
DR. LEWANDOWSKI: May I permitted to state that oftentimes we have accused of being called symptom seekers, symptom finders, and we have been accused of not knowing enough about pathology and diagnosis. I want to impress upon the audience that we certainly should not be ignorant of the fact that first of all we must be students, we must be academic enough to bring out thoughts before the allopathic school that we know what we are talking about.
Besides naming a patient a Belladonna or Pulsatilla case, we can just as well say that this is a case of scarlet fever, so that we may be on the same footing, notwithstanding the fact that we graduate first as Doctors of Medicine and then as special Doctors of Homoeopathic Medicine.
I have often been confused, in taking histories, to depend upon the totality symptoms, notwithstanding what we mean by totality symptoms. Many times I have gathered pages and pages of symptoms, and couldnt make a case out of it, purely because I failed to realize that Hahnemann meant, by the totality symptoms, the characteristic symptoms, not merely the numerical value of the symptoms, which oftentimes leads one off the track; and in addition, as regards diagnosis in treating cases, we must first diagnose because that helps us to select remedies that have a special interest. For instance, if we select Chelidonium or Podophyllum and we suspect the case is purely one of gall-bladder disturbance, it immediately confines our attention to a set number of remedies which helps us in a quick fashion to define our case and select our peculiar number of remedies.