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 1st.-Locality.
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.
