Symptomatology by Stuart Close
The Homoeopathic Materia Medica.- The Materia Medica of Hahnemann is an enduring monument to the genius of its author, original in its conception and design and unique in its form and contents. Its foundation is on the bedrock of natural law. It is constructed of the cut stones of accurately observed facts, laid up in the cement of irrefrangible logic. Over its portals are graven the words, *Similia Similibus Curantur; Simplex, Simile, Minimum.
Hahnemann, on apprehending a new general principle in therapeutics, was confronted with the problem of creating an entirely new materia medica by means of which the principle might be applied in practice. If diseases were to be treated according to the principle of symptom-similarity it was necessary to know what symptoms drugs would produce in healthy persons, since these would be the only symptoms which could possibly resemble the symptoms of sick persons.
There was no materia medica in existence which contained the facts or phenomena of the action of drugs upon the healthy. The existent materia medicas contained only the incidental observations, theories and opinions of drug action of men who gave drugs to the sick or treated cases of poisoning upon purely empirical and speculative assumptions; and these were given, not singly, but in such combination and mixtures as to render impossible any intelligent conception of what the action of a single drug might be.
Undismayed by the magnitude of the task, Hahnemann set about creating a materia medica which should embody the facts of drug action upon the healthy. He instituted “provings” of drugs upon himself, members of his family, friends, students and fellow practitioners, keeping all under the most rigid scrutiny and control, and carefully recording every fact and the conditions under which it was elicited. This work was continued for many years, parts of it being published from time to time, until the mass of material had reached enormous proportions.
Adopting the plan of arranging the drug symptoms thus derived according to the anatomical parts and regions of the body in which they occurred, as the most rational and simple method of classification for the purpose of comparison with disease symptoms, Hahnemann constructed and published, first, the Materia Medica Pura, and later, The Chronic Diseases, the greater part of which is composed of provings of drugs. Covering nearly three thousand royal octavo pages, they constitute one of the most stupendous works of original experimentation and research ever attempted and carried out by one man. To this original work of Hahnemann many and large additions have been made by later workers.
The vast collection of symptoms of which the materia medica of Homoeopathy is composed is incomprehensible without an understanding of the principles upon which it is based. In a good working homoeopathic library there are about two hundred volumes, by many authors, upon the subject of materia medica, including special collections and classifications, repertories, charts and indexes of symptoms. Confronted by such a mass of material it is no wonder that the student is at first confused and discouraged. But when the basic principle has been explained to him and he has learned the meaning of symptoms, their method of classification and interpretation, and when he has seen the means if ready reference provided, his bewilderment gives way to admiration.
The task of mastering the materia medica, vast and even impossible as it seems, is comparatively simple. The compass that points the way through the seeming wilderness of symptoms is the principle of *Similia – the remedial law of homoeopathy.
When the drug symptoms recorded in the homoeopathic materia medica are seen to be exact counterparts of the symptoms of disease, and it is explained that medicines cure disease by virtue of this similarity of symptoms, the reason for the existence of the materia medica in its characteristic form is evident. *The arrangement of symptoms according to an anatomical scheme is for the purpose of comparison – symptoms of drugs with the symptoms of disease. Given the basic principle and its corollaries, the rest is merely a matter of mastering the logical classification and interpretation of symptoms and the use of the manuals, indexes and repertories provided.
Symptomatology.– The first requisite to a correct understanding of the subject of symptomatology is to know the full meaning of the world “symptoms” and all that it involves.
Knowledge of the true nature and constitution of a symptom is necessary in proving or testing medicines; in the examination of a patient; in the study of the materia medica and in the selection and management of the indicated remedy. It is a standard by which to judge the reliability of a proving, a clinical case, an examination record, or the professions of a new coming *confrere.
Ignorance of the nature and constitution of symptoms on the part of provers, directors of provings and physicians has resulted in the production of certain provings and books on materia medica which are practically worthless, and the publication of reports of cases which have served no better purpose than to float their authors’ names on the sea of printer’s ink. Such productions, consisting largely of commonplace generalities, indefinite pathological names and pseudo-scientific instrumental and laboratory findings, reveal the ignorance of their authors of all that goes into the making of reliable cures and provings conducted under classic homoeopathic principles. The result is useless to the prescriber because it does not contain the elements upon which a homoeopathic prescription can be based.
It is not intended to belittle or ridicule laboratory and instrumental findings. Such observations are useful and necessary for certain scientific, particularly diagnostic and pathological purposes; but they are only a part, and a very small part of homoeopathic provings, or of clinical symptom-records designed for the use of the prescriber. They cannot take the place of the more important things which have been left out. What those things are will appear as the definition of symptoms proceeds.
Symptoms Defined. – In general, a symptom is any evidence of disease, or change from a state of health. In materia medica no relevant fact is too insignificant to be overlooked. There is a place and use for every fact, for science has learned that “Nature never trifles.” 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 defines symptoms broadly as, “any manifestation of a deviation from a former state of health, perceptible by the patient, the individuals around him, or the physician.” We have here the basis of the common division of symptoms into two general classes- Subjective and Objective.
Hahnemann further defines symptoms as “evidences of the operation of the influences which disturb the harmonious play of the functions, the vital principle as a spiritual-dynamis.” (Substantial, entitative source of vital power and activity.)
Subjective Symptoms.- Subjective Symptoms are symptoms which are discoverable by the patient alone, such as pain and other morbid sensations of body or mind, presenting no external indications. With Hahnemann’s announcement of the doctrine of the Totality of the Symptoms as the basis of the homoeopathic prescription, it became possible for the first time in the history of medicine to utilize all the phenomena of disease. Prior to Hahnemann’s time two of the most frequently occurring and important groups of symptoms were practically ignored-the mental symptoms and the subjective symptoms. The “regular” practitioner of medicine even today is interested very little in subjective symptoms. They play but a very small part in governing the practical treatment of his case. To him they are merely inarticulate cries of suffering, serving only to suggest the direction in which investigations are to be made by physical and laboratory methods for discovering the supposed tangible cause of the disease, and the location and character of its lesions.
Under the new system of therapeutics devised by Hahnemann subjective symptoms naturally took their proper place in the study of the case. As expressions of the interior states of the organism, and particularly of the psychic and mental states, they take the highest rank. Nothing can supersede them. They constitute the only direct avenue of approach to that inner sphere which must otherwise remain closed to our investigation, except as it is indirectly revealed in certain automatic or involuntary objective symptoms from which more or less accurate deductions can sometimes be made. They enable the physician to view disease from the standpoint of the patient. How great an advantage they afford to the prescriber can be appreciated only when we are deprived of them, as in the case of infants and animals, and find how much more difficult is our task under such circumstances.
Before Hahnemann’s genius opened up the new way pain was merely pain. To discriminate between various kinds of pain; to analyze and classify pains, and not only pains, but all other subjective sensations and feelings, and to relate them as phenomena of disease to remedies, as Hahnemann did, had never been thought of before. It is ridiculed and scoffed at today by those who do not see that there is something radically wrong with a system of medicine that practically ignores the great bulk of the symptoms of almost every case and tantalizes the patient by learned explanations of their cause; by assurances that they are of no consequence; or, if his clamor becomes too loud, clubs him into silence with an opiate.
Objective Symptoms.-Hahnemann defines objective symptoms as. “the expression of disease in the sensations and functions of that side of the organism exposed to the senses of the physician and bystanders.” In this peculiar definition there is an allusion to his definition of disease as a dynamical disturbance of the vital force and of Medicine as, “a pure science of experience, which can and must rest on clear facts and sensible phenomena clearly cognizable by the senses.” There is also a reminder that there is more in an objective symptom than is perceptible to the eye alone. The subjective “sensations and functions” of the visibly affected organ or part are to be considered as well as the purely objective signs. Hahnemann here implies that functional and sensational disturbances precede organic changes; and this is consistent with his basic premise that all disease is primarily a dynamical disturbance of the life principle. He never loses sight of this fundamental conception of the nature of disease.
Totality of the Symptoms.- “Totality of this Symptoms” is an expression peculiar to homoeopathy which requires special attention. It is highly important to understand exactly what it means and involves, because the totality of the symptoms is the true and only basis for every homoeopathic prescription.
Hahnemann (Org., Par. 6) says:- “The ensemble or totality of these available signs or symptoms, represents in its full extent the disease itself; that is, they constitute the true and only form of which the mind is capable of conceiving.” The expression has a two-fold meaning. It represents the disease and it also represents the remedy, as language represents thought.
1. The Totality of the Symptoms means, first, the totality of each individual symptom.
A single symptom is more than a single fact; it is a fact, with its history, its origin, its location its progress or direction, and its conditions.
Every complete symptom has three essential elements:- Location, Sensation and Modality.
By *location is meant the part, organ, tissue or function of body or mind in which the symptom appears.
By *sensation is meant the impression, or consciousness of an impression upon the central system through the medium of the sensory or afferent nerves, or through one of the organs of senses; a feeling, or state of consciousness produced by an external stimulus, or by some change in the internal state of the body. A sensation may also be a purely mental or physical reaction, such as fright, fear, anger, grief or jealousy.
By *modality we refer to the circumstances and conditions that affect or modify a symptom, of which the conditions of aggravation and amelioration are the most important Dr. William Boericke well said:
“The modalities of a drug are the pathognomonic symptoms of the Materia Medica.”
By *”aggravation” is meant an increase or intensification of already existing symptoms by some appreciable circumstance or condition.
“Aggravation” is also used in homoeopathic parlance to describe those conditions in which, under the action of a deeply acting homoeopathic medicine (or from other causes), latent disease becomes active and expresses itself in the return of the old symptoms or the appearance of new symptoms. In such cases it represents the reaction of the organism to the stimulus of a well selected medicine, and is generally curative in its nature.
*”Amelioration” is technically used to express the modification of relief, or diminution of intensity in any of the symptoms, or in the state of the patient as a whole, by medication, or by the influence of any agency, circumstance or condition.
2. The Totality of the Symptoms means *all the symptoms of the case which are capable of being logically combined into a harmonious and consistent whole, having form, coherency and individuality. Technically, the totality is more (and may be less) than the mere numerical totality of the symptoms. It includes the *”concomitance” or form in which symptoms are grouped.
Hahnemann (Org., Par. 7) calls the totality, *”this image (or picture) reflecting outwardly the internal essence of the disease, i.e., of the suffering life force.”
The word used is significant and suggestive. A picture is a * work of art, which appeals to our esthetic sense as well as to our intellect. Its elements are from, color, light, shade, tone, harmony, and perspective. As a composition it *expresses an idea, it may be of sentiment or fact; but it does this by the harmonious combination of its elements into a whole – a totality. In a well balanced picture each element is given its full value and its right relation to all the other elements.
So it is in the symptom picture which is technically called the Totality. *The totality must express an idea. when studying a case from the diagnostic standpoint, for example, certain symptoms are selected as having a known pathological relation to each other, and upon these is based the diagnosis. The classification of symptoms thus made represents the *diagnostic idea. Just so the “totality of the symptoms,” considered as the basis of a homoeopathic prescription, represents the *therapeutic idea. These two groups may be and often are different. The elements which go to make up the *therapeutic totality must be as definitely and logically related and consistent as are the elements which go to make up the *diagnostic totality.
The “totality” is not, therefore, a mere haphazard, fortuitous jumble of symptoms thrown together without rhyme or reason, any more than a similar haphazard collection of pathogenetic symptoms in a proving constitutes Materia Medica.
The Totality means the *sum of the aggregate of the symptoms: Not merely the numerical aggregate – the entire number of the symptoms as particulars or single symptoms – but their sum total, their organic whole as an individuality. As a machine set up complete and in perfect working order is more than a numerical aggregate of its single dissociated parts, so the Totality is more than the mere aggregate of its constituent symptoms. it is the numerical aggregate *plus the idea of plan which unites them in a special manner to give them its characteristic form. As the parts of a machine cannot be thrown together in any haphazard manner, but each part must be fitted to each other part in a certain definite relation according to the preconceived plan or design – “assembled,” as the mechanics say-so the symptoms of a case must be “assembled” in such a manner that they constitute an identity, an individuality, which may be seen and recognized as we recognize the personality of a friend.
The same idea underlies the phrase, *”Genius of the Remedy.” Genius, in this sense, being the dominant influence, of the essential principle of the remedy which gives it its individuality.
The idea of the Totality as an abstract form, or figure, has been applied to the materia medica as a whole. The materia medicas as a whole is the sum total of the symptoms of all proved medicines – a grand, all inclusive figure which may be imagined or personified in the form of a human being or “super-man,” this conception being based upon the anatomical, physiological and psychological plan or framework of the materia medica.
The idea is applicable in exactly the same way in pathology. Disease in general, considered as a whole, is composed of the totality of all the symptoms which represent it to our senses. The pathological totality, also, can be personified or pictured by the imagination in the form of a human being.
Starting with this conception some of our ingenious writers have amused themselves and added to the gaiety of the profession by personifying medicines, microbes and maladies and casting them in all sorts of roles – a dramatic whimsy which has its value as an educational expedient for a certain type of mind.
The materia medica from this point of view becomes a portrait gallery of diseases, a sort of medical “Rogues Gallery” by means of which we may identify the thieves who steal away our health and comfort and bring them to justice. In homoeopathic practice to carry out the simile, we merely “set a thief to catch a thief.”
As a constructive principle, therefore, the idea of the Totality enters into the formation not only of the materia medica as a whole, but of every remedy and every symptom.
Each disease, each individual case of disease and each symptom of disease has its totality or individual form.
If the “day books” or records of a good proving are examined it will be seen that the symptoms of each prover are set down chronologically in the order of their occurrence; that each symptom is as complete as possible in its elements of locality, sensation and modality; that the symptoms are stated mostly in the vernacular, the plain simple language of the layman, who describes phenomena as they appear to him, simply, graphically, or by analogy or homely comparison. The record of these facts with the remarks and observations of the director of the proving constitutes a “proving,” in which exists the elements from which the Materia Medica is constructed.
*The Day Books of the provers are not the Materia Medica. Not until this mass of material has been analyzed, sifted, classified according to its anatomical, physiological and pathological relations and had its general and particular characteristics logically deduced, does it become materia medica for practical use. Many things in a proving must be interpreted in the light of anatomy, physiology, pathology, or psychology before they are available for therapeutic use, just as the statements of patient in regard to his sufferings must be interpreted in making a diagnosis or in making a prescription.
The true Totality, therefore, is a Work of Art, formed by the mind of the artist from the crude materials at his command, which are derived from a proving or from a clinical examination of the patient.
It is important that these points should be understood, because, otherwise, there is liability to err in several directions.
1. Error may arise in placing too much emphasis upon a single symptom, or perhaps actually prescribing on a single symptom as many thoughtless do.
2. Error may arise in attempting to fit a remedy to a mass of indefinite, unrelated or fragmentary symptoms by a mechanical comparison of symptom with symptom, by which the prescriber becomes a mere superficial “symptom coverer.”
3. Failing in both these ways the prescriber may fall to the level of the so-called “pathological prescribers,” who empirically base their treatment upon a theoretical pathological diagnosis and end in prescribing unnecessary and injurious sedatives, stimulants, combination tablets, and other crude mixtures of common practice.
The physician who known what a symptom is from the homoeopathic standpoint and how to elicit it; who knows what the totality of the symptoms means and how to construct it, and who has the intelligence, the patience and the honesty to study his case until he finds it will not be guilty of such practice.
Characteristics and Keynotes.- In paragraph 153 of the Organon, Hahnemann says that in comparing the collective symptoms of the natural disease with drug symptoms for the purpose of finding the specific curative remedy, “the more striking, singular, uncommon and peculiar (*characteristic) signs and symptoms of the case 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. The more general (common) and undefined symptoms; loss of appetite, headache, debility, etc., demand but little attention when of that vague and indefinite character, if they cannot be more accurately described, as symptoms of such a general nature are observed in almost every disease and drug.”
This seems a sufficiently clear description of what Hahnemann meant by “characteristic” symptoms; and yet the term has been the subject of much discussion and many have differed as to what constitutes a “characteristic.”
Confusion arose and still exists through the inability on the part of many to reconcile the teaching of this paragraph with the apparently conflicting doctrine of The Totality of the Symptoms as the only basis of a true homoeopathic prescription. These have taken refuge either in the mechanical “symptom covering” already referred to, as fulfilling their conception of the “totality;” or in what is knows as “keynote prescribing,” which, as they practice it, means prescribing on some single symptom which they (perhaps whimsically) regard as the “keynote” of the case.
The fundamental mistake here has been in the failure to distinguish between the *numerical totality and the related or logical totality, as already explained.
Both of these misapprehensions should be recognized and corrected.
The real “keynote system,” as taught and practiced by the late Dr. Henry N. Guernsey (but perverted by many) does not conflict with the doctrine of the totality of the symptoms, nor does it fall short of complying with Hahnemann’s injunction to pay most attention to the peculiar and characteristic symptoms of the case. It is, in fact, strictly Hahnemannian. The truth is that Dr. Guernsey simply invented a new name for the old Hahnemannian idea.
A synopsis of Dr. Guernsey’s keynote method will be of value in this connection.
The term “keynote” is merely suggestive as used in this connection. The reference being to the analogy between materia medica and music. This analogy is shown in the use of other musical terms in medicine, as when the patient speaks of being “out of tune,” or the physician speaks of the “tone” of the organism. Disease is correctly defined as a loss of *harmony in function and sensation.
The keynote in music is defined as “the fundamental note or tone of which the whole piece is accommodated.” In pathology the term “pathognomonic symptom” expresses what might be called the keynote of the disease, or that which differentiates it from other diseases of a similar character.
In comparing the symptoms of medicines we find that each medicine presents peculiar differences from all other medicine. These differences from all other medicine. These differences by which one remedy is distinguished from an other, are the “keynotes” of the remedy, according to Dr. Guernsey.
It does not mean that the keynote of the case alone is to be met by the keynote of the remedy alone and that the other features of the case or remedy are to be ignored. The keynote is simply the predominating symptom or feature which directs attention to the totality. Its function is merely suggestive. A prescription is not based upon a keynote, considered as one symptom, no matter how “peculiar” it may seem. Its utility lies in this: that when the prescriber has become familiar with these “keynotes” or “characteristics” of remedies he will be able more quickly to find the remedy in a given case because the field of selection has been narrowed. When he recognize such a keynote in the symptoms of a case it suggests or recalls to mind a medicine, or medicines, having a similar keynote. Reference to the repertory and materia medica will verify and complete the comparison. There is usually something peculiar in the case, some prominent feature or striking combination of symptoms that directs the attention to a certain drug, and this is what Dr. Guernsey called a keynote.
The misunderstanding and abuse of this method has caused it to fall somewhat into discredit. But considering Guernsey’s “keynotes” and Hahnemann’s “characteristics” as synonymous terms, which they are, and making legitimate use of Guernsey’s method, it has value.
*A characteristic or keynote symptom is a generalization drawn from the particular symptoms by logical deduction. Evidently the characteristic or peculiar symptoms of a case cannot be determined until a complete examination has elicited *all the symptoms of the case (the numerical totality) for purposes of comparison. This having been done there are various ways of selecting the characteristics.
Dr. Adolph Lippe illustrated his method in this way: ” In many cases,” he says, “the characteristic symptoms will consist in the result obtained by deducting all the symptoms generally pertaining to the disease with which the patient suffers, from those elicited by a through examination *of the case.” In other words *the characteristic symptoms are the symptoms peculiar to the individual patient, rather than the symptoms common to the disease.
He illustrated this by a case, as follows: “The patient was attacked by cholera. All the characteristic symptoms of cholera were present; but in this individual case there was (1) an unusual noise in the intestines, as if a fluid were being emptied out of a bottle. (2) The discharge came away *with a gush. Of what pathological value these symptoms were we know not. Still they formed part of the totality which we must cover. Deducting from the (numerical) totality of the symptoms those common to the disease, we were in possession of the characteristic symptoms of the patient.
“We found that those two symptoms are also characteristic of *Jatropha curcas, and that this remedy, at the same time, has caused symptoms corresponding with the general pathological condition.” Jatropha promptly cured the case.
The selection of a curative remedy in this case, therefore, was governed by two symptoms of no known pathological value, and of seemingly trifling character. Yet these two symptoms were what gave the case its individuality. and unerringly pointed out the curative remedy.
This case is a beautiful example of the kind of work for which Dr. Lippe was famous. It illustrates the necessity of being familiar with the natural history, symptomatology and diagnosis of disease. Dr. Lippe could not have decided that these two symptoms were peculiar and characteristic if he head been unfamiliar with the symptoms of cholera. Neither could he have selected these two symptoms as peculiar if he had not had the rest of the symptoms before him for comparison. The mistake of arbitrarily picking out some “freak” symptom, and giving a remedy which has a corresponding symptom, should be avoided. Dr. Guernsey did not teach prescribing on a single symptom.
In the preface to the first edition of his great work on obstetrics Dr. Guernsey presents the subject of “keynote prescribing” in another way. He says: “The plan of treatment may seem to some rather novel, and perhaps on its first view, objectionable, *inasmuch as it may seem like prescribing for single symptoms, whereas such is not the fact. It is only meant to state some strong characteristic symptom, which will often be found the governing symptom, and on referring to the Symptomen Codex or Materia Medica all the others will be there if this one
“There must be a head to everything; so in symptomatology; if the most interior or peculiar symptom, or keynote, is discernible, it will (usually) be found that all the other symptoms of the case will be also found under that remedy which produces this peculiar one, if the remedy be well proven. It will be necessary, in order to prescribe efficiently, to discover in every case that which characterizes one remedy above another in every combination of symptoms that exist. There is certainly that in every case of illness which pre-eminently characterizes that case, or causes it to differ from every other. So in the remedy to be selected, there is and must be a peculiar *combination of symptoms, a characteristic or keynote. Strike that and all the others are easily touched, attuned or sounded. There is only one keynote to any piece of music, however complicated, and that note governs all the others in the various parts, no matter how many variations, trills, accompaniments, etc.”
If it is understood that the “keynote” to a case may and often does exist in, or consist of, a “peculiar combination,” as Dr. Guernsey puts it, and that is it not merely some peculiar, single, possibly incomplete symptom which the tyro is always mistakenly looking for, the subject is cleared of part of its obscurity. Dr. Guernsey might have summed up the whole matter in one word – Generalization, which has been discussed at length in the chapters on the logic of homoeopathy.
Dr. Lippe, discussing characteristic symptoms, wrote as follows: “When medicines are submitted to provings upon the healthy they develop a variety of symptoms in a variety of provers. Each prover has his own peculiar, characteristic individuality affected by the medicine in a peculiar manner; other differently constituted individuals experience different, yet similar, peculiar symptoms from the same medicine. There is a similarity and a difference evident upon close comparison. In like manner diseases and all other external influences affect different individualities differently, yet similarly. The physiological school and its followers accept in disease only what is general (common) to all those affected by it; in medicinal provings in the same manner they accept only that which has been experienced alike by many. In both cases they simply (sic) generalize. The homoeopathic school reverses this order. Accepting all the symptoms experienced by the differently constituted provers, they consider as peculiarly characteristic the individual symptoms of the patient; those *not generally experienced by others suffering from a similar form of disease.”
This is individualizing with a vengeance! In aspersing the process of what he calls generalizing Dr. Lippe traduces the very instrument he is apparently unconsciously using, but misusing the word. One is the traditional pathological – diagnostic method based upon an arbitrary and artificial classification of only the common or gross phenomena of disease; the other is the homoeopathic natural or inductive method of modern science, based upon *all the phenomena of the case, but paying particular attention to the *uncommon and peculiar features, never forgetting that we always have an *individual patient to treat and cure.
Dr. P.P. Wells says: “Characteristic symptoms are *those which individualize both the disease and the drug. That which distinguishes the individual case of disease to be treated from other members of its class is to find its resemblance among those effects of the drug which distinguish it from other drugs. This is what we mean when we say that with these the law of the cure has chiefly to do. When we say “like cures like” this is the ‘like’ we mean.”
Characteristics may sometimes be symptoms observed only as a result of the closet scrutiny, like the apparently trifling clues in a mysterious murder case which the ordinary detective overlooks or ignores, but which a Sherlock Holmes pounces upon and utilizes with amazing logical acumen to clear up what is otherwise impossible of solution. Their value depends upon who is using them. An Agassiz or a Leidy, placed in possession of a fragment of bone, or the scale of a fish, found in the remains of some pre-glacial geologic period, will reconstruct for us not only the animal or fish from which it came, but unfold a whole chapter of natural history, picture the scene and repeople a forgotten period of earth’s history before our delighted eyes.
Dr. Charles G. Raue pointed out that scarcely one of the “keynotes” or characteristic symptoms belongs exclusively to a single remedy, and cautioned us not to diagnose a remedy on one symptom only, be it ever so characteristic. “While in some cases,” he says, “it may point exactly to the remedy, it cannot do so in every case, as it is not rational to suppose that the whole sphere of action of a remedy, which is often extensive and complex, should find its unerring expression and indication in one symptom. But such characteristics are of great aid in the selection of the remedy, as they define the circle of remedies out of which we must select.”
Dr. Hering, in his quaint fashion, years before the “keynote system” was ever heard of, said: “Every stool must have at least three legs, if it is to stand alone.” He advised selecting at least three characteristic symptoms as the basis of prescribing.
A milking stool will stand upon one leg-*if you sit on it and thus provide your own two legs as the other necessary props; but even then, as every farmer’s boy knows by bitter experience, a vicious kick, or a “corkscrew swat” from the old cow’s tail may upset the youthful milker and his pail of milk and bring him to grief.
So it is wise to always give the symptomatic milk-stool as broad a base and as many legs as possible. The youthful prescriber will get many a vicious kick from refractory cases. He may be knocked sprawling and lose his pail of milk a few times, but he will be able to avoid this when he has learned the peculiarities of his patient as well as I learned the peculiarities of my bovine kicker when I was a boy.
The Totality is an ideal not always to be realized. As a matter of fact, in practical experience, it is often impossible to complete every symptom, or even a large part of the symptoms. Patients have not observed, or cannot state all these points. They will give fragments; the location of a sensation which they cannot describe, or a sensation which they cannot locate; or they will give a sensation, properly located, but without being able, through ignorance, stupidity, failure to observe or forgetfulness, to state the conditions of time and circumstances under which it appeared. Sometimes no amount of questioning will succeed in bringing out the missing elements of some of the symptoms.
What is to be done under such circumstances? Make a guess at the remedy? Give two or three remedies, in alternation? Give a combination tablet? Or “dope” the patient with quinine or morphine? Rather than do any of these things, follow the advice of my old preceptor, Dr. P.P. Wells. Sometimes, when I approached him with a difficult case, he would assume a quizzical expression and ask, “Don’t you know what to do?” On being answered in the negative he would say, “If you don’t know what to do, do *nothing- until you do know;” emphasizing the injunction with a characteristic downward stroke of his right forefinger. Then he would go over the case and show what should be done and how to do
It was he who taught me Boenninghausen’s method of dealing with such cases. And I thought the more of it because he had known Boenninghausen and had received instruction and treatment from the Grand Old Man personally, while travelling in Europe.
Boenninghausen’s Therapeutic Pocketbook.- Boenninghausen’s famous Therapeutic Pocketbook was devised primarily to deal with just such cases. The materia medica contains a great number of incomplete symptoms. Until Boenninghausen’s time this constituted one of the greatest obstacles to successful homoeopathic prescribing. Boenninghausen first conceived the idea of completing these symptoms partly by analogy, and partly by clinical observation of curative effects. He discovered that many if not all of *the modalities of a case were *general in their relation, and were not necessarily confined to the particular symptoms with which they had first been observed. The “aggravation in a warm room” of Pulsatilla, for example, might first have been observed as applying to a headache. Boenninghausen assumed that this modality applied to *all the symptoms – *to the patient himself, in other words; and that this modality, once discovered in relation to any particular symptom of Pulsatilla, might be used to complete all other symptoms of Pulsatilla which, up to that time, had been incomplete in respect to their modalities. Experience proved this to be true.
Out of this grew the idea that all other combinations of symptoms might be thus made. By classifying the characteristic features of medicines in certain general relations to each other, in such a way that one part could be used to complete another, the prescriber might always be able to construct a related totality, even with apparently fragmentary symptoms.
Starting with the basic idea that every symptom is composed of the three elements of locality, sensation and modality, and that fragmentary symptoms may be completed by analogy or by supplementary clinical observation of the curative effects of similar remedies, Boenninghausen, in his Therapeutic Pocketbook, distributes the elements of all symptoms, pathogenetic and clinical, according to this analysis, into seven distinct parts or sections which, taken together, form a grand totality. (1) Moral and Intellectual Faculties; (2) Locality or Seat of the Symptoms; (3) Morbid Conditions and Sensations; (4) Sleep and Dreams; (5) Circulation and Fever; (6) Modalities, Etiology, etc.; (7) Concordances. Each of these sections is subdivided into rubrics containing the names of remedies arranged alphabetically under the symptoms to which they correspond.
Of this arrangement he says: “Although each part ought to be considered as a complete whole, it never yields, however, more than a part of a symptom, which receives its complement from one or many of the other parts. In odontalgia, for example, the seat of the pain is found in the second, the nature of the pain in the third, the exacerbation or diminution of pain, according to time, place, or circumstance in the sixth; and that which is necessary as an accessory to complete the description of the malady, and warrant the choice of medicines, must be sought in the different chapters.”
By this method, as Dr. Wm. Boericke observes: “a remedy is selected for a case that is found possesses in its symptomatology marked action (1) in a certain location, (2) to correspond with the sensation, and (3) to possess the modality; *without necessarily having in the proving the very symptom resulting from the combination. It is to be inferred that a full proving would have it, however. For instance, a patient with a tearing pain in the left hip, relieved by motion, greatly worse in the afternoon, would receive Lycopodium, not because Lycopodium has so far produced in the healthy such a symptom, but because from the study of its symptoms as recorded in the materia medica, we do find that it effects the left hip prominently (locality); that is pain in various parts of the body are “tearing” (sensation); and that its general symptoms are relieved by motion and aggravated in the afternoon (modality).”
The experience of nearly a century has verified the truth of Boenninghausen’s idea enabled us, in the use of his master-piece, The Therapeutic Pocketbook, to overcome to a great extent the imperfections and limitations of our materia medica.
In constructing a materia medica from the materials of the provings, all the symptoms of the different provers of the same drug are collected under the name of the drug. The second step is to distribute the symptoms thus collected under the names of the various parts, organs and functions of the body affected by the drug. This localizes the phenomena of each drug and gives the materia medica its anatomical and physiological structure.
When all the symptoms have been collected and arranged in this form under the name of the medicine, it represents a sick man, whose likeness may be met almost any day in the actual world. The drug symptoms are in fact disease symptoms, artificially induced. In other words they are symptoms of a drug disease. The significant thing is that drug diseases or poisonings accidentally or internationally produced, *are similar to natural diseases – so similar that it is sometimes difficult to distinguish them. A person poisoned to a certain degree by arsenic, or camphor, or veratrum album, for example, presents an appearance so similar to one suffering from cholera, that any one but an expert might be deceived. If this is so strikingly true of the gross and violent phenomena produced by poisonings, it is equally true of the milder, finer and less obvious symptoms which result from proving drugs in small or moderate doses.
Language of the Materia Medica.- The symptoms of the homoeopathic materia medica, experienced by the provers, are expressed in plain and common terms. The language of everyday life is used, not the technical language of the medical profession. For this reason, the homoeopathic materia medica is enduring. It is not subject to the influence of the transitory theories of general medicine, with its constantly changing terminology and bewildering array of newly invented names. So long as common language endures, the homoeopathic materia medica will be intelligible and useful to every person who can read and write.
It is enduring also because it is a record of the facts of actual, voluntary experience, in a sphere and under conditions open and common to all men. In other words, the “experiments” of homoeopathy are made by men, upon men, for men under the *natural conditions which belong to the everyday life of all men.They are not necessarily conducted in elaborately equipped technical laboratories, nor by using and abusing poor, dump animals, “whose only language is a cry,” who are often forced to give up their lives, under unspeakable torture, to bolster up the theory, or satisfy the curiosity of some cold-blooded man of science. While knowledge gained by vivisection may be valuable to the surgeon, it is unnecessary for the physician. The homoeopathic way of determining the effects of drugs by giving small doses of single, pure medicines to intelligent healthy human beings, who can observe and describe their feelings, is the only way to obtain reliable knowledge of medicines for use in healing the sick. It is safe to say that nothing of any real therapeutic value has ever been learned by experiment upon animals that could not have been learned better, more simply and more humanely by harmless experiments upon human beings; while the knowledge gained in such experiments on human beings is equally valuable for use in the treatment of sick animals.