In taking such a position, however, they themselves necessarily commit the glaring absurdity of ignoring that great law of physics, viz., “action and reaction are equal.” Further, they ignore the added vital resistance against all things inimical; and still further, the fact that all drugs are, per se, thus inimical in their primary influence. The materialistic and the vitalistic philosophies alike, and throughout, support our view in this matter. The secondary is the permanent and final-the curative effect.
Natural law, however, as generally recognized, is rarely unconditional, and this “law of reaction” is conditioned by an important proviso, viz., that the preceding “action” be neither destructive nor disabling.
The Homoeopathic law submits to this self-same proviso, and hence it implies “the minimum dose,” with conservative repetition, according to the medical idea. So far as we know, it submits to but one other, viz., the curability of the given case. With these provisons, surely “likes are cured by likes”.
3. Diagnostic and pathognomonic symptomatology are too well valued and understood to need more than mention here, but a thorough course of instruction must specifically include them; only, the physician should be able always to distinguish drug- symptoms from those proper to the “natural history” of the disease per se.
4. Pharmacodynamic symptomatology is the capital city to which, in Homoeopathic practice, all roads lead; and the “totality” is the measure of the study. The physiological and pathological significances, previously studied, here find their higher illustration in the proving records of the materia medica. Indeed, a prover is doubly equipped for his important work if he has had this previous study; but he must avoid the error of writing down his subjective pathological opinions in pace of giving a faithful statement of the observed phenomena. Still, symptoms understood are symptoms remembered, and both prover and student should understand all that is possible. Even single symptoms, understood, illuminate the totality, as above shown.
The diagnostic powers of the mind will here find a most difficult yet most remunerative employment.
Here, again, the Repertory of Jahr and Possart affords a practical analytic handbook. Each chapter, indeed, is full of points for parallel or for consecutive study of all the subdivisions of symptomatology.
The strictly Hahnemannian and the final use of a repertory is an an index to the materia medica, where, only, the salient symptoms are found in their fulness, and thence the totality; consulting the provings proper under some one, and then others, of the several remedies therein suggested-examining the various drugs, one after the other, in the order of their apparent similarity, until the most similar is found.
These provings are the sanctum sanctorum of symptomatology.
5. Prognostic Symptomatology.-“Dealing in futures” is a business phrase which applies well to the physician’s work. It requires close study. In the evolution of disease the outcome is of absorbing interest, and this is judged by: 1. The natural tendency of the malady. 2. The intensity of the particular attack of the same. 3. THe importance of the specially affected organs and the amount of their involvement. 4. The amount of physiological error. 5. Heredity, age, sex. 6. Vital force, and the means at hand of sustaining it, by food and other hygienic conditions. (And here, be it observed, that to the followers of Hahnemann, the constitutional status is ever paramount, and its symptoms of the highest rank).
7. The environment, as a whole, is to each patient an individual factor, intensely bearing upon prognosis. This, too, has its symptoms, mainly in the sphere of “conditions” of aggravation and amelioration, and nowhere is there a wider field for interpretative study. 8. Lastly, prognosis rests, in large measure, upon the character of the treatment, a fact to which our school is fully alive.
However, the mere outcome of the disease itself is not the whole of the subject. The action of every prescription is a proper subject or scrutiny and forethought. The probabilities of aggravation and amelioration; the reasons for the same; the periods of probable occurrence; the interpretation of paroxysmal and other changes; the incidental drug-provings which may crop out, intended or not; their recognition, anticipation, and guidance, sometimes their open prediction-these are a part of our daily duty, and should be made the subject of definite study and teaching.
In all, the symptoms of the given case must play a great part and require close study. The chair of clinical medicine has this field for its own.
6. Therapeutic Symptomatology.-This is the climax of our work, and it includes all the rest. Whatever their help, however, necessity binds us, for the present and after all, to the mechanism of Hahnemann’s method as laid down in the Organon. In pursuing it we may yet invoke the aid of Boenninghausen, with his fourfold classification of symptoms-“location, sensation, condition, and association” (or concomitants); also of Hering, with his essay on Hahnemann’s Three Rules. All of this relates closely with the Selection of the Remedy.
“Taking the case,” by the rules of Hahnemann, is the first and most important step in therapeutic symptomatology; the use of the Repertory and of the Materia Medica duly follows. To be able to do these rapidly and successfully is a necessary attainment, and no Homoeopathy physician is prepared for his work who has not become fairly expert therein; hence, no college has fulfilled its contract with its students which fails to thus qualify them by special and careful instruction.
In this connection I recall a remark of Dr. J,T, Temple, of St. Louis, thirty-five years ago, and which has proved invaluable to me, viz.: “I find my best selections of remedies are made under the rubric, “Generalities.”.
I agree largely with him, but would extend this term so as to include all that follows it i an arranged proving, viz., skin, sleep, fever, conditions; also, and above all, mental states, together with related attitudes and actions. All these, grouped under the one heading, express strikingly the whole constitutional status.
Minute Localizations.-Paradoxical as it may seem, we may sometimes, on the other hand, get our best indications in the minutest localizations; but that these readily harmonize with the other, is plain enough.
Dr. Jacob Jeanes, of Philadelphia, was an expert in this line of study, e.g., in his discovery of the specific relation of Stramonium to the hip-joint, especially of the left side.
Dr. A. Fellger also contributed to it; as in his indications for Aurum, mercury, and Kali bichromicum in syphilis, relating them, respectively, to the palate, the fauces, and the pharynx; and many others might be named. The best guide in this particular study is Allen’s edition of Boenninghausen’s Therapeutic Pocket- Book or repertory, in which “locality” is pretty thoroughly wrought out, and the “sides” of the body, etc., presented under each heading. Further minuteness, however, can be secured by subsequent reference to the Materia Medica, and by clinical observation.
Again, Dr. Lippe recognized a point of the greatest practical significance in reference to relief from medicinal palliatives as well as from palliatives of other kinds; for instance, from coffee, from alcohol, from vinegar. Dr. Hering, in his Materia, Medica, under many remedies, observes the same principle, in the rubric “Other Drugs,” as to both amelioration and aggravation, etc., of these upon the proving-symptoms and the therapeutic effects. Hering and Lippe alike would regard such indications merely as additional reasons for the choice of or objection to the remedy under study, i,e., when the patient is worse or better, as the case may be, from such palliatives or from such “other drugs” when taken surreptitiously by the patient or of his own self-treatment.
On the other hand, some of our school have taken an opposite view of this subject, especially if such palliatives form a part of the “folk-lore” of the common people. Dr. Hering himself venerated this sort of folk-lore. Hahnemann has rescued many a medical tradition as to the powers of drugs. Taste, in his Materia Medica, has scrupulously done the same, believing that there is more than palliation therein, even cure, provided potentization and individualization be invoked. Following this lead, Macfarlan, of Philadelphia, in view of the traditional and empirical use of common tar (Pix liquida) for the cure of skin diseases, potentized it for internal use; and now Pix liquida itself almost specific in eczema and alopecia.
“Symptoms which are arrange, characteristic, and peculiar”- paraphrased by Prof. C.G. Raue as “queer symptoms”-are of the highest therapeutic rank, both in natural diseases and in the Materia Medica according to Hahnemann, and require special study. They may be wholly irrelevant in pathology as now understood, being often merely personal, but they are in subtle relation with the constitutional substratum; thus essential.
If some of these indices (“characteristics,” “keynotes,” etc.) be conspicuous in a given case, the drudgery of studying the whole totality of symptoms in detail can yet lead to the true similimum. In the very early days, when our Materia medica embraced but few drugs, and all the provings were short it was no great task to study the whole, at any time, or even to keep it mostly in memory; but this can no longer be said.
The writer once sought a remedy for a case of intermittent fever; chill beginning on the right side. Taking Jahr’s Symptomen-Codex, he examined the “Fever” rubric of every drug, and found under Rhus tax., “the left side of the body felt hot, and the right side cold,” etc. Examining for the other symptoms- pains, etc., this drug was found to have all of them; and Rhus tax. was then known to be the remedy.
In this work the ubiquitous four categories of Boenninghausen constitute the classes into which the symptoms naturally fall. In “taking the case” it is desirable to express in writing, for every marked feature of the same, all, or rather the first three of these categories. This will greatly facilitate their use in the subsequent choice of the similar remedy.
These categories, familiarly called “Boenninghausen’s For Points,” cannot be too frequently stated. In taking the case and in selecting the remedy, they are a never-failing guarantee of exact thought and practice.
Category 2d.-Sensation (kind of symptom).
Category 3d.-Condition (of worse and better).
Category 4th.-Concomitants (or associations).
Allen’s Boenninghausen’s Therapeutic Pocket-Book is the handbook for the easy pursuit of this method. In every perfect study, however, the final step must be a consultation of the Materia Medica (or “provings”) under each seemingly similar remedy, comparing each with the others through Hahnemann’s schema, and thus determining the identity of the most similar, which is the object in view.
This method of comparison of similar drugs is the clinical; it is distinct from the non-clinical methods; and is illustrated in the process of selection of the similimum in any subtle, difficult case of chronic disease. (See Hahnemann’s Three Rules, by C. Hering.).
This consists in taking two or more drugs, as found by means of the index or repertory to be closely related to the symptoms of the case (as well as to each other, of course), for trial. Opening the Materia Medica at each of these, read, rubric by rubric, noting the agreement of each with the case as previously written down.
Discarding the least similar, the chief simile is again compared with the others, and the best chosen.
The “numerical method” of finding the similimum is a variety of the foregoing. Its most salient expression is found in Dr. W.J. Guernsey’s Boenninghausen. In this the rubrics of the Therapeutic Pocket-Book are printed upon separate long slips of stiff paper, with the rank of each drug thereunder, 1,2,3,4, in numerals. Selection the slips containing the various symptoms, they are placed, side by side, upon a table; then each drug, beginning with those of highest rank, is counted by adding all its printed numerals together. The one having the highest number is held to be the similimum, irrespective of the claims of keynotes, etc.
Individualization in practice, so insisted by Hahnemann and his true disciples, can surely be realized through the convergence of all these studies, based upon a faithful preliminary college drill; and thus the future of Homoeopathic therapy may prove an advance upon even the wonderful success of the pioneers!.
The plan of Boenninghausen separates the symptoms from each either, as actually observed, and the localities and kinds of symptoms, pains, etc., from their conditions of aggravation and amelioration, etc. Now at first sight this seems to abolish all prospect of just combination. In practice, however, the drug- genius is found to corroborate and justify by satisfying therapeutic effects.
Several specialties in symptomatology demand a further continuation of this discussion, all related to general clinical practice, and catalogued at the beginning of this second part.
The first, the Dietetic, is recognized in these days as its true value by many physicians; yet by too many, in no scientific spirit. The perusal of Paxy on Food, and similar works, will be the proper means of studying this branch of our present inquiry.
Every one should be prepared, on short notice, to furnish information to patients, which is often indispensable, and occasionally all sufficient, to cure, from the dietetic standpoint.
Pathological symptomatology having furnished the facts and indications, of diabetes, for instance, it is more important and effective to regulate the diet, excluding starches and sugars, than it is to give medicine, however well chosen.
In diarrhoea, and the like, it is frequently essential to stop the use of all course-grained cereals, as granular oatmeal, all sorts of vegetables or fruits; or at least, to strain out of a desirable vegetable soup, all unreduced lumps, which are indigestible and aggravating.
On the contrary, in constipation, these substances are most salutary, and are to be prescribed. Also, the profuse use of water, especially at night and morning. Bulky meals, not too rich or heavy, and often late at night may be serviceable. Eating fruit at bedtime, and just before breakfast, with the assistance of water drinking, is aperient in effect.
Anti-fat diet, and building-up diet, etc., all are the outcome of discriminating study of this kind of symptomatology; and all should be carefully taught in the medical colleges, and at length. This is now much better done then of old; but there is room for improvement.
7. Curative Symptomatology is that which expresses the amendment of function and of tissue-formation during the treatment of disease. Applying to drug-treatment the light afforded by the foregoing discussion, what signs have we, as Homoeopaths, to guide our judgment of its good effects?.
The first, of course, is diminished tissue and organ-lesion, as to extent and intensity. Secondly, improved psychical state. Thirdly, increased physical strength. Fourthly, correction of functional errors. These, we have, in common with all physicians. The opposites are, a priori, unfavorable.
Again, in paroxysmal disease, as neuralgia, intermittent fever, etc., we have an improved state of secretions, shown by the tongue, the skin, the bowels, which is a sine qua non, in cure, here. Further, the amelioration of the attacks, the shortening of the same, the post-ponement of recurrences, the lengthening of the intermissions, the removal or improvement of complicating ailments, the improvement of the intermissions, as to special symptoms and general well-being.
On the other hand, aggravation of the paroxysm may indicate only the Homoeopathic action of the drug, and require the entire cessation of all medicine except a placebo and a watchful waiting for the ensuing vital reaction to cure.
In constitutional ailments, a gain in flesh, diminished complaints and other familiar signs are at hand to show curative conditions. Normal temperature may be added, in all sorts of cases. .
These are, besides, in Homoeopathic practice, certain subtle indications which experience has proved to be reliable. Thus, susceptibility to environment and to other circumstances, often annoying, disappears. Dr. Lippe used to say of the Natrum carb. patient” He, must carry an umbrella when the sun shines hot; you give him this medicine, and he no longer carries or needs his umbrella”.
Again, in any disease, especially the acute, if the patient falls asleep soon after taking a dose of Homoeopathic medicine, it is pretty good evidence of its curative fitness, and a promise of good to follow.
Once more: if, in all local symptoms, the person is no better, or even worse, yet in the general sphere feels “more like himself,” or, as Dr. H.N. Guernsey phrased it, “not locally better, but ‘all-over better;’ “he is better, and patient waiting under a placebo, will later realize universal improvement. Even in diphtheria, with assurance of proper selection of remedy, and a single does given, high, in consultation; finding, on a second visit, some hours later, that all was in status quo, this great prescriber remarked: “The patient is certainly no worse; therefore, the bad tendencies are arrested, at least, and that means, he is better; continue the placebo;” and the third visit justified this decision.
The same authority told a scared doctor, who had, in a case of broncho-pneumonia in a child, repeated Bryonia, 200, until brain symptoms supervened, “Well, doctor, you’re nothing more to do; give Sac. lac. and wait, and you’ll cure the case; but don’t spoil it by giving any more active medicine.” A few hours demonstrated that he was right. It is easy to :”spoil a case;” let us beware therefore,. of undue officiousness in critical cases.
Thus, pathogenetic symptoms, “read between the lines,” may be most pleasing to the expert; always provided the drug be indeed the similimum.
Further” when the “inmost” of the person, the nobler organs, and the psychic nature, grow better, and when the symptoms of the malady seem to move from within outward, or from above downward, the patient is better. And yet again, if the latest symptoms (especially in chronic diseases) improve first, followed by the others, in the inverse order of their appearance, a true and permanent cure has commenced, and must be let alone.
8. Toxical symptomatology is fairly well taught now in all medical colleges, and we need only to refer, besides, to the standard works on poisons, under this head.
9. Pathogenetic Symptomatology has already been hinted at, above. But in requires distinct elaboration. Diagnostic and prognostic, in part, it may be best studied, in these relations. In drug provings, and in therapeutic medication, it is likely to exercise the medical mind to its full capacity, But that capacity is too often but puerile, even full capacity is too often but puerile, even among well-educated physicians; and hence, the better the teaching and drill, in the college should be.
Lack of faith in drug power, especially in attenuated doses, emasculates the student’s mind at this critical juncture-for such it is. Such a one should first clear his horizon substances, as Silica, Lycopodium, and many more, and of that familiar condiment of our tables, common salt, or Natrum muriaticum, and the Austrian re-proving of the latter, sweep away al of the reasonable doubts of candid Homoeopaths; as witness Dr. Watzke, the superintendent of the last named.
He says, “I am, alas! (I say, alas! for I would much views)-I am compelled to declare myself for the higher dilutions. The physiological experiments made with Natrum muriaticum, as well as the great majority of the clinical results obtained therewith, speak decisively and distinctly for these preparations.” [See Hughes’ Pharmacodynamic, 1876, page 562.].
Pathogenesis goes hand in hand with curative drug-action, Hahnemann’s original reason for attenuation was the diminution of the former, and was impressed that this did not, by any means, abolish, but only refined it.
Yet, more; he claimed that no dose yet known is so mall, that it is inferior in strength to the natural to be cured. Still further, he held that the cure depends upon that fact, and that it produces, always, a disease of like nature, and superior strength, which supplants the original disease, and thereby, alone, can the Homoeopathic cure, so far as we know, for effected. (Organon, 24 to 34; 279 to 283). In 29, he says, “an artificial morbid affection is substituted, as it were, for the weaker similar natural disease.” He also indicates that a drug-disease, being brief and self-limited, provided the doses be not toxic, it is soon afterwards terminated by the vital force, and its own self-limitation.
One of our daily difficulties in Homoeopathic practice is to reduce the morbific drug-action to comfortable limits. Any additional method of limiting and controlling this would be welcomed. One, that promises something, is to give the doses, so far may be, immediately after meals; but this is limited in its applicability. Other timing of doses may help.
Now, in general, what signs can be considered as evidence of drug-pathogenesis, either in a proving, or during its therapeutic administration. Our standard of comparison has been already set up, viz; Physiological Symptomatology; and to that we must refer. Mens sana in corpore sano-the consent of all healthy organs and functions-produces a synaesthesia-a total sense of well-being; and any deviation therefrom means: “I am sick;” and whenever in drug, or other morbid influence has preceded such deviation, it surely has same part, small or great, in its causation.
No one agent, however, can claim the whole of such causation. No physiological error would be possible, of course, without a personal, individual susceptibility, and this individual response. Again, no such effects was ever independent of the existing environment. In a drug-proving, then, “pure drug- symptoms” are an absolute impossibility; and every symptom is the outcome of the three-fold activity, viz; of the individuality; of the environment, after all, however). Now, the symptoms appearing at the apex of these three forces from the so-called drug- pathogenesis; and the three must always be reckoned with.