In a world that is rapidly undergoing radical changes, where values in every sphere of life, in every department of science, are upset and inadequate,it might be fit to consider again the problem of the comparative value of symptoms in homoeopathy. The object of this paper is to stir up a constructive discussion and to get the opinions of the most competent and experienced workers in our profession. Success or failure in homoeopathic prescribing depends mainly on the physicians knowledge and skill in ranking the symptom picture; and the correct picture of depends of the proper case taking and the careful examination of the patient, i.e., the gathering of all data susceptible to give the right understanding of every symptoms.
It this the so-called “totality of the symptoms”- the only absolute and definite basis for the homoeopathic prescription? No, it is not. What S. Hahnemann meant by the totality of the symptoms is the complete symptom picture of the NATURAL disease. Therefore, as a first step, the symptoms due to extrinsic factors-whether mechanical, chemical or physical-due to faulty habits, improper diet, etc., should be carefully excluded from the picture because the removing of he exciting or maintaining cause eradicates them ipso facto, and because they do not belong to the disease per se. This should be strongly emphasized; too often such symptoms are overlooked and not properly taken care of, although they do exist in practically every patient.
In other words, without a thorough investigation of the case, a record of its history,etiology, physio-pathology, without he knowledge of what is curable in the patient and what is curative in the similar remedy, the physician can do no scientific work, he cannot properly classify and rank the symptoms according to their significance and relative value.
He cannot possibly become a successful prescriber.
Now suppose we have a case: we have collected the full picture of the natural disease. HOw are we to proceed? It is obvious that it is practically impossible to find a remedy that will cover integrally every symptoms of the picture. Only comparatively few symptoms have to be picked out from the picture as particularly typical of the patient and therefore of the remedy. That is what is meant by ranking the symptoms.Now what method of valuation or ranking the symptoms. Now what method of valuation or ranking is to be followed?.
Hahnemann does not go into details on this particular question. THe essential points are stated in Paragraph 153 of the Organon:.
In this search for a homoeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to be disease to be cured, the more striking,singular,uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and almost solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure.
It has been J.T.Kents invaluable contribution to homoeopathy to precise and developed the question of the value of the symptoms, based on the philosophy of individualization and of the vital force, which he called simple substance. His conception and ideas have been commented and worked out mainly by English and American authors, notably R. Gibson-Miller, M. Tyler, J. Weir, etc., and more recently by the master of the postgraduate courses of the American Foundation for Homoeopathy.
Let me quote form E.B. Lyles article of Repertory Analysis (see Homoeopathic Recorder, Vol. 46, No. 1, p.43), the following resume of the Kentian method of symptoms valuation:.
For a brief reminder, the symptoms are ranked in the following order: the mental being highest in value as most indicative of the patient, followed by physical general as indicative of the tendencies of the body as a whole.
I. MENTAL SYMPTOMS.
(a) The will symptoms.
(b) The understanding: delusion, hallucinations, delirium, mental confusion, etc.;
(c) The intellect : memory, concentration, mistakes in writing and speaking.
(a) Sexual conditions, menses, etc.
(c) Food desires and aversion.
(d) Aggravations and amelioration of the whole body by time, seasons, temperature, air, weather, climate, etc.
(f) General type: restlessness, weakness, prostration, chill, fever, etc.
(g) objective symptoms applying to the whole body.
(a) Strange, rare and peculiar.
(b) Modalities of particulars…
Well, so far so good.. But is this the only method? Is it universally accepted? Is it applicable in every case of a busy daily practices? In a paper entitled Main Symptoms and Histological Specificity, presented at the International Homoeopathic Congress of Berlin (1937), Dr. Alexander Margittai of Budapest defends an opposite thesis, that is in fact the one almost universally accepted and followed on the European continent. He attacks, namely, Professor George Royals method of ranking the symptoms, which is very similar to the Kentian method , to wit:.
1. Mental Symptoms.
4. Pathological symptoms.
5. Functional disturbances.
Against this classification he reports a number of cures obtained by the prescription of remedies based on tissular specificity, where mental symptoms and modalities strongly contraindicated the successfully prescribed remedy.
He states that the “old American method” is purely empirical and that the new orientation is that of Theodore Bakodys tissular specificity. He proposed the following scale:.
1.Specificity of organs.
2.Specificity of tissues.
3.Specificity of function.
5. Psychic syndromes.
The German method, as we can see, considers the objective symptoms as paramount, whereas the Kentian method gives more importance to the subjective symptoms. The German has always opposed Kents ideas and ignored his philosophy; that is the reason why they criticized so bitterly and rejected the German edition of the Repertory a few years ago. Lately they show a growing interest in Paracelsus, whom they consider a national genius (although he was a Swiss); no doubt the spagyrist philosophy will bring them to a better understanding of Kents conceptions.
Now, it is interesting and significant to see that Dr. George Royal, ten years after the publication of the above mentioned method in his Textbook of Materia Medica (1920) rallies the German school. Indeed, in his Handy Book of Reference (1930), page 82, he summarized the question thus:.
Select that remedy from the class of drugs which the provers have demonstrated possesses the following:
1.The Strongest “elective affinity” for the affected tissues or organ;
2.Which has the power of the producing any of the four conditions found in the affected tissue or organ (whether inflamed, irritated, or changed functionally or structurally);
3. Which has the ranking subjective symptoms and modalities of the individual patient.
Although I am personally convinced by experience that Kents method is the best, I have nevertheless to admit that, aside from all theoretical controversy, it is not applicable to every case, and that the German scale seems to be apply to such cases where the subjective symptoms are absent or not available, and this is rather frequent in practice. Also in other instance where the seemingly well indicated remedy is inefficient.
As an illustration,let me report briefly the following case: I was called to see a 68 years old woman who was in great and constant pain from an extensive herpes zoster of the left hemi-thorax. For two days and nights she had been unceasingly walking the floor to the point of exhaustion. To sit or to lie down was an impossibility even for the time of my examination: She had to keep moving. This condition started with a cold, she said, about a week ago. She still had a dry cough and some sneezing with a scanty nasal discharge. Then a constant pain, burning and stitching in character, accompanied by itching, along the lower ribs on the left side.
She kept rubbing and applying heat to get a little relief. The condition grew worse, she got more and more restless, sleepless, with pain in the head and abdomen, nausea and vomiting-mostly in the morning-and an aversion for food and liquids. The tongue was dirty, cracked and dry with a red tip. THere was a deep red belt, about six inches wide from the spine, at the level of the fourth to the ninth dorsal vertebrae, following the left ribs to the middle line in the front, covered with crops of pinhead pinkish vesicles filled with cloudy fluid. The heart, normal in size, was quite irregular with numerous extra systoles and a soft pre-systolic murmur at the apex. B. P. 170/90. The urine, deep colored and cloudy, showed a specific gravity of 1.028, pH 6.0 and marked traces albumin and acetone. The rest of the examination was otherwise negative.
It seemed to me that this was a clear cut case of Rhus tox., which was administered in the 200th potency, which was administered in 1/2 glass of water, advising two teaspoonfuls every three hours. The next morning, to my dismay, the situation was unchanged, the poor wretch had had no sleep, no relief. Well, it could not be Arsenicum, which is right sided and has a prostration, a thirst, a chilliness that did not exist; furthermore the restlessness of Arsenicum is mainly due to anxiety. Lachesis, Mezereum and Graphites did not seem to fit the picture.
There is one remedy, however, that is frequently indicated for thoracic herpes zoster of the left side and that is Ranunculus bulbosus. One dose of the 10M. was given on the tongue in spite of the fact that it is aggravated by motion, that there is no such restlessness nor such a peculiar tongue. The effect, though, was dramatic. Greeting me the next day the patient said: “I never felt so wonderful in my life; I slept fine the whole night,” and from that time on the recovery was rapid, everything cleared up nicely, zona, heart, urine and all.
Now, why is it that Rhus tox., which seemed to fit the picture pretty well, especially the subjective symptoms, failed, whereas Ran. b., apparently contraindicated by the modalities, worked so well?.
Ranking the symptoms according to the classical method, leading straight to Rhus, failed in finding the similimum, whereas the tissular elective affinity, the objective signs and clinical experience indicated Ran. b., in this case at least, as strongly as Rhus t. . . However, there are four remedies mentioned in Kents Repertory for Zona of the chest, and 42 in the Skin chapter.
Well, a swallow does not mean the spring, and an exception is said to confirm the rule; however, such cases are by no means rare and you all have had them in your practice.
Now, what should we conclude from all this? First : That no method of ranking the symptoms as an approach of the similimum is a hundred per cent. Second: Both the Kentian and German scales–although opposite–are successful in selected cases.
Even if all roads lead to Rome, wouldnt it be highly desirable to equip the student with a good chart that should be a clear synthesis of the various methods in use, at least those that have been confirmed by experience. A very important step toward the perfecting of our art of healing would be a standardization of our materia medica. The student who explores the inextricable jungle of the symptoms of the materia medica needs a guide, a manual, bringing out a correct and universally accepted grading or ranking of the symptoms of each remedy.
There are many contradictions between the different authors of our materia medica and this is a real handicap for the beginners. This may be more apparent in the European materia medicas, where the ranking of the symptoms differs greatly from one author to the other. What we really need is a synthesis of materia medicas like Pulfords excellent Key to the Materia Medica, combined with Bogers Synoptic Key–which emphasizes the organic, tissular and functional specificity so highly praised by the German school–and the precious clinical notes of J. H. Clarkes Dictionary.
This is no single mans job. Why not attack such a tremendous task to so worthy as end under a permanent committee, something like the French Academy whose job is the building of the dictionary?.
At a time where our school is threatened in its very existence by socialized medicine, I feel that it would go a long way to attract the physician of the “old school” if we could make our materia medica more practicable and translate it in a “scientific terminology” that is more understandable to him.
SAN FRANCISCO, CALIF.
DR. SHERWOOD: I want to say something regarding the situation in Germany and Kents Repertory. At the time that Repertory was translated into the German, or shortly after, I had quite a lengthy correspondence with Dr. Schlegel.
By the way, have you Schlegels book on cancer?.
DR. MOORE: Has it ever been translated to our languages?.
DR. SHERWOOD: No. I had considerable correspondence with Dr. Schlegel after the criticism, and it was more or less an apology from Dr. Schlegel because he told me it was often very difficult to get certain remedies in Germany and that most of the prescribers were those who used very low potencies, in most instances the combination tablets, and they knew nothing of the Organon, Kents Philosophy, and books of that class.
The man who translated the Repertory used the wrong words to express himself many times, since he didnt know just exactly what we meant in our language. For instance, under the mental symptoms another word was used for “confusion,” and many similar things, so that when they tried to use the Repertory it was doubly foreign to them. That apology and explanation was made.
DR. MOORE: We certainly have had lots of trouble in our translations. What are we getting from Margaret Tyler in the last while seems to me very fine in simplifying and cutting down somewhat the Organon.
DR. GRIMMER: I like Dr. Schmidts appeal to simplify the materia medica, but it is not a simple job. As we all know, anybody who commences working with the materia medica is in deep. Who shall say what in the materia medica is to be thrown out and what is to be kept? Most of our materia medica has been built up by proving–perhaps not complete in all cases–and to that have been added many valuable confirmations of cure by unquestionably good men, confirmations that have been repeated.
The idea to incorporate some of the things that the doctor suggests is very good, and again it would take a genius to do those things. He will have to have the ability to discriminate between that which is really valuable and that which is not so valuable. I suppose a man like Dr. Schmidt, who is widely read and has had fine experience, would be able to do that very well, and I would like to have him try it.
DR. TAPLEY: Experience has taught me that the mental symptoms are of the greatest importance in the selection of the remedy. Bach, of London, with his ten or twelve remedies, depends upon the mental symptoms altogether.
To illustrate: This case had cut her foot and tetanus was supposed to have set in. That was the diagnosis of the doctor treating her, and he wanted to give her the innoculation. I was called about midnight, and I could hear her screaming as I drove up. At the bedside, I found the torso was like a cement post. She couldnt bear the least bit of covering. When her mother attempted to throw the sheet over her, she slapped her mother in the face, and you could have heard it a block.
When her father, at the foot or of the bed attempted to cover the body with the sheet, she kicked him in the stomach and tied him up in a knot. He couldnt get his breath for a few minutes. She could use her arms and feet, but she was so sensitive to pain she couldnt stand it. She could not have any covers on her body and, oh, such ugliness I never saw in any case for which I ever prescribed!.
The diagnosis was supposed to be tetanus, but there was one remedy called for by the mental symptoms, and that was Chamomilla. What was I to do? I couldnt ask her all the questions. Chamomilla might possibly do something for her, so I put 1M. of Chamomilla in about six teaspoonfuls of water, and she was to have a teaspoonful every fifteen minutes. She took the first teaspoonful, and before I could give her the next teaspoonful she was sound asleep and she slept until morning.
From then on, Christian Science got the credit for the whole business.
DR. BELLOKOSSY: This discrepancy about which Dr. Schmidts paper tells us between the Kentian and the German philosophy is, I think, a kind of conceitedness on the side of the German homoeopaths. The German homoeopaths dont know any philosophy. They have only pathogenesis, and that is in all the German literature today, except what Hahnemann wrote. They dont even read. It is most difficult for a doctor in Germany to study homoeopathy, because he just cant learn how to practice it.
It is hard to understand how the Germans can have the courage to criticize Kent, because the dont know him. They have translated Farringtons Materia Medica, and even that is very poorly translated.
In the case of Dr. Schmidt, I think it does not contradict Kent. It is a matter of interpretation. The restlessness of the case probably came only from the pains, nor because of being a Rhus tox. symptom. The deeper change of the tissues may have been only indicative of Ranunculus bulbosus and not of Rhus tox.
DR. SHERWOOD: I think you need an indicator other than Rhus. tox. or any other in herpes.
DR. SCHMIDT: I thank you very much for the interesting discussion my paper brought, and I think maybe that is the most valuable part of it.
It is true that if they had had a Kentian in Germany
to translate Kents Repertory, it would most likely have been a very different thing. I knew only one there, and that was Dr. Schlegel. Unfortunately, he was an old man with a tremendous practice, and could not start such a work. Dr. Manning was the one who started that work, but he was really not familiar enough with English to be able to cope with it. It is a very unfortunate thing.
The fact that Paracelsus is now so highly regarded by the Nazi government may induce the medical profession to investigate Kents philosophy.