ANALYSIS OF THE CASE by H.A. Roberts
Dr. Robert’s comments on case analysis. Advise on what is necessary to take to complete the totality….
*** IN analysis of the case, the value of symptoms must be taken into consideration on several points. First, the personality, the individuality of the patient, must stand out pre-eminently in the picture. This can be illustrated by likening the whole symptomatology to a complete picture of the whole individual;, a whole personality. This embraces not only his physical characteristics, but the expiration of his mental and emotional characteristics as well.
While the generals rank the highest in evolution the case, and without generals we cannot expect to find the *simillimum, the mental and emotional characteristics have a high value, since these are the true reflections of his personality, the man himself. Because the subjective symptoms are the registration of his physical or other difficulties as expressed upon his own personality, these are also of great value. The objective symptoms are less differentiative, yet their value lies in the fact that they cannot be distorted by the design of the patient; the little realizes that he is manifesting these objective symptoms and therefore they picture accurately certain phases of the case.
Objective symptoms, those that are seen by the careful observer, have more importance in child life than in adult life, because through them we see the expression of the child’s disposition and desires. Therefore, many of the seemingly objective symptoms may be translated into a subjective form. It is for us to interpret the symptoms according to our understanding of its proper value. While they may be presented to yes in child life almost entirely as objective symptoms, yet they may have their counterpart subjectively in the province.
Now in taking a case was must take into consideration the nature of the disease and its peculiar types. We must know disease accurately before we can give effective relief. Occasional cures take place without such knowledge, but it is almost by accident. that is, we must know it peculiar manifestations in each individual case, taking into consideration its complete symptom totality. the complete knowledge of the case is associated with another important item. We must know and possess the means by which we are able to relieve. Without this latter knowledge any knowledge of symptoms is of no avail.
There has been a great knowledge of disease attained from investigators from the earliest times methods have been improved whereby diagnostic symptoms have been correlated, and all praise is due to these investigators along this line. The only difficulty is that diseases have come to be treated by names of the diseases instead of by individual symptoms; the disease has been treated rather than the patient. It is only upon the totality of the symptoms that we can base our prescription, and so we require many individual symptoms as showing the characteristics and personality of the patient; so these diagnostic symptoms are of very little use to the homoeopathic prescriber in selecting the remedy. In fact, the *simillimum is practical never found among the diagnostic symptoms. In considering the diagnostic symptoms in the selection of the remedy, its only practical value is the excluding those remedies from consideration which do not correspond to the genius of the disease, but act chiefly on other parts of the organism.
If we allow ourselves to become influenced by the diagnosis in making our remedy selection, we are very apt to become confused and fail to help our patient. We may be faced with a diagnosis of some grave condition such as some form of deep abscess, a grave pneumonia condition, an internal haemorrhage, or any one of a host of conditions. Selection of the remedy on the basis of the diagnosis may, and probably will, fail completely. However, the symptoms of the patient are an infallible guide, and the more serious the condition, the clearer cut are the inductions for the remedy. If we allow ourselves to be guided by these symptoms, we shall probably save the patient, *even though the remedy selected on the basis of the symptom totality may never have been used under like diagnostic conditions before.
The symptoms of location frequently furnish quite characteristic symptoms, and they deserve particular attention, since every remedy acts more, and more decidedly, on certain parts of the organism. These differences enter into the consideration for certain local manifestations, like tuberculosis, but it also enters into those types of disease that localize in certain parts, like gout in the great toe, and yet are of systemic origin. These symptoms all have their bearing and should be considered as to location; and they are particularly valuable to us as pertaining to localization in the right or left side or the body, or of certain organs of the body. They are particularly valuable in noticing the location, as in the base or apices or middle lobe of the lungs. They are particularly to be noticed as to direction on which side the trouble starts and in which direction the symptoms move and where they localize, as, for instance, throat troubles going from the left side to the right, or the right side to the left, or continuous alternation of sides.
All these finer shadings have much to do with Homoeopathy, and have every little to do with ordinary medicine. Even the nurses wonder when we ask regarding the localization of symptoms. However, these things do enter in and make considerable difference in our ability to select the correct homoeopathic remedy. The localization of symptoms and the direction of symptoms will often appear as marked symptoms before pathological change have manifested themselves, as for instance, in the beginning of the syndrome which we call tonsillitis, or in the beginning of a similar syndrome in pneumonic conditions where, if the remedy is given an early opportunity to exhibit its power, the pathological condition will not arise. In such states the localization and direction for symptoms become of considerable moment to the Homoeopathic physician.
The chief aim of the Homoeopathic physician consists in ascertaining the remedy that most completely and fully covers each individual case. In other words, the totality of the symptoms. We hear so much of the totality of the symptoms that sometimes it behaves us to stop and think what this means. The Homoeopathic physician may be likened to an artist painting a portrait. He fills in all those features pertaining to the likeness which he is paining, and those features which may be found on all faces, eyes ears. nose, mouth, lips. In this way all individuals are similar, but each individual has peculiarities of his own, and in order to make the picture complete the artist must present the individualities in the portrait, but not accentuate over and above the other features the normal position, shape, and size, as it appears in the individual himself. In taking a likeness, how strange the finished picture would be were we to draw or paint only the peculiar things Just a nose or just an eye, and nothing by which we could distinguish the one whom the picture was intended to represent. On the other hand, if we painted the classic features only there would be no distinguishing characteristics in the finished product.
It is in this relationship that we must gain a knowledge of the concomitant symptoms of we would prescribe homoeopathically. In drawing the picture we must present the rare, the striking, the peculiar symptoms which present themselves, not out of keeping but associated with the other symptoms which form a background upon which the peculiar, rare, and characteristic symptoms must be presented as determining the individuality, the personality, of the man for whom we are prescribing. It is not the common symptoms, common to all disease syndromes, that are of value, but the rare, the peculiar, the unusual, that stand out by themselves. It must necessarily follow that these concomitant symptoms have a wide variety and are widely distribute throughout the organism.
It is almost impossible to name all the peculiarities in all the case that we might find, but their are certain ones that stand out. First of all, those symptoms that are common and found in almost all diseases may be left out of our count unless they manifest themselves in a striking manner. The same may be true of those ailments and symptoms that usually appear in the disease under consideration, unless they should be distinguished by some rare peculiarity, and in this way offer something particularly characteristic, like thirstless fever, or chill with desire to uncover. On the other hand, all the attendant symptoms should be carefully noted:
(*a) Those symptoms which rarely appear in connection with the leading disease, and therefore are found rare, among the provings
(*b) Those which belong to another sphere of disease than the principal ailment.
(*c) Those which have more or less characteristic signs of the medicine even though they have not before been noticed in the present relationship or diagnostic group.
Then again, besides these concomitant symptoms that have already been mentioned, there should be one in which the genius of the remedy should be plainly and definitely portrayed, so that it would be immediately noticeable. This symptom would immediately attain such importance that it would outweigh the chief ailment, and thus be chosen as the *simillimum. Such a *simillimum corresponds to Hahnemann’s dictum which calls for a striking, strange, peculiar, and unusual sign, which may then be considered almost alone in choosing the remedy, because it gives pre- eminently the character of the whole design.
A peculiar and unusual deduction from these concomitant symptoms is that they often illumine remedies that have never been thought of before in this relationship to the individual case and therefore broaden our vision and concept of the ***LAW OF SIMILARS.
In considering what Hahnemann calls the “strange, rare, and peculiar (characteristic) symptom” and their value in directing us to the remedy, let us remember the exposition that A. Conan Doyle so often puts into the mouth of his famous character, Sherlock Holmes. This worthy, in summing up some famous case in which he has acted the scientific detective, uses these words: “That which is out of the common is usually a guide rather than a hindrance.” And again”:”That which seemingly confuses the case is the very thing that furnishes the clue to its solution.”
In considering the value of symptoms in solving any chronic case we cannot do better than to take these aphorisms for our guide, and to remember that those symptoms which confuse the ordinary physician, or which he regards as useless or a having no relationship to the case, are the very symptoms that furnish the clues for the remedy.
In considering the value of symptoms there are certain symptoms that are apparently caused by conditions, and that almost precede the symptomatology, and seem to gives a basis for the patient’s condition. These may be exposure to cold: exposure to wet; all those conditions of which people say that thus and so was the cause of their illness and the cause of their symptoms. These play a large part in pathological prescribing. In pathological prescribing. these causes of disease loom, large; in homeopathic prescribing they do not loom as large, save as showing the tendencies of the patient.
This embraces causes that are directly traceable to diet as well as climatic conditions. Embraced in this category also are susceptibility to disease conditions and idiosyncrasies. The symptoms that are produced by trade conditions come in this category and the poisoning that many take place from too much drugging, or from working in metals. The symptoms produced from working in metals. The symptoms produced from such conditions may be valuable in showing the Pathological trend of the metal or gas or drug causing the condition, but they do not show the finer differentiations nor have they the same value that they do from the exhibition of the potencies.’
Sometimes these early symptoms will place the physician in a position to see clearly the basic miasmatic condition from which the patient is himself suffering. This should bear a larger place in the evaluation of symptoms.
This, too, brings up the question of infectious diseases and the symptomatology attending the so-called contagious diseases. It is the duty of the physician to take very close observation of the first cases he has in an epidemic of infectious diseases for the symptomatology of each epidemic is distinct of the epidemic, while the next epidemic may have an entirely different symptomatology. Immunity can be assured to patients if we will closely observe the symptomatology and select the epidemic remedy in the early stages of epidemic by administering the epidemic remedy as a prophylactic. In this way the symptomatology of epidemic diseases is exceedingly valuable to the homoeopathic physician
In analysing the case, very valuable symptoms are those pertaining to the aggravations and ameliorations, because the aggravations and ameliorations are the natural modifiers of diseased states and are the definite reaction of the man himself. We must take into consideration that every symptoms of note has these modifying conditions of aggravation and amelioration, as to time, the time of day, the time of season, the time of the moon; the aggravation or amelioration from thermic conditions; from motion or rest, of the part affected or of the condition as a whole; from lying down or sitting or standing, and the positions taken during such conditions, waking or sleeping, and the aggravation and amelioration from such positions and circumstances; the various positions in motion that aggravate or ameliorate; the desires or aversions to eating and drinking, especially in feverish conditions; aggravations from certain foods and drink. These are all modifications that are of the utmost importance in evaluating the symptoms.
While we cannot hope to cure a patient without strong general symptom, yet conditions of aggravation or amelioration may in themselves become generals, if they appertain in the same say to several parts of the body; they then become conditions of the man as a whole, or general symptoms, even though they seemingly express themselves in local parts. For instance, if a headache is worse by motion; if the pain in the knee is worse by walking or stepping; if there is pain in the shoulder from raising the arm; then the worse from motion becomes a general as of the whole man, although it seemingly appears ion dissociated parts.
The contradictory symptoms have an importance, because they may rule out many of the remedies that otherwise might be considered in connection with an individual case. That is, symptoms that are decidedly opposed to the provings, like the thirstlessness of the of the fever of *Ignatia or Apis or *Pulsatilla when fever is present and when other symptoms agree. Contradictory symptoms may have a strong bearing in choosing the remedy from the standpoint of being themselves a symptom, just as a paucity of symptoms may be a symptom in itself, as has been brought out in the provings of the so-called “do nothing” remedies, which are often called for in profound states. For this reason, if you cannot find a remedy because of alternating or contradictory symptom, or for very lack of symptoms, take these conditions as indications for symptoms of the very first rank.
To emphasize again the necessity for consideration of the aggravation and ameliorations of the periods of distress: it is well to bear in mind the period of onset in periodic manifestations of symptoms, the increase, the same, the decrease, and the end of disease manifestations in the evaluation of symptoms. For instance, condition such as *Cedron, *Spigelia, *Sanguinaria, a *Natrum mur-these remedies have a decided periodicity, and it is very important to consider also those symptoms that occur in the recession or in the intervals between the periods of aggravation.
These are but a few of the conditions confronting the homoeopathic physician if he would cure his patients and he should learn early to evaluate symptoms, because symptoms are the sole expression of the internal disturbance, and it is only by the proper understanding of the case expressions in disease, and an equal knowledge of the condition as expressed in the provings, that we can apply our guiding law, *similia similibus curentur, intelligently and for the benefit of our patients. What symptoms rank the highest in an analysis of the case?
How do we rate: Generals? Mental and emotional symptoms? Subjective symptoms Objective symptoms? Concomitant symptoms?
Where do we place much emphasis on objective symptoms and why?
Cite an instance where an objective symptom may be translated as a subjective symptom.
How much consideration should we place on the diagnosis of the case?
Give an outline of the totality of a case.
When may common symptoms attain a peculiar value?
What do we mean by “epidemic remedy” and how can we determined the epidemic remedy?
When may a particular symptom become a general?