The Value of Symptoms—Continued

It is very important that you should understand what is meant by general, common and particular symptoms and so I will repeat somewhat. The generals are sometimes made up of particulars. If you examine any part alone, you are only examining the particulars. If you examine the liver symptoms alone, you are examining particulars. If you are examining the eye symptoms, or the symptoms of any other region considered apart from the whole man, you are examining particular symptoms. But after you have gathered the particulars of every region of the body, and you see there are certain symptoms running through the particulars, those symptoms that run through the particulars have become generals, as well as particulars. Things that apply to all the organs may be predicated of the person himself. Things that modify all parts of the organism are those that relate to the general state. Anything that the individual predicates of himself is also general. There are things that an individual might say of himself that might relate to only one organ, but of course that becomes a particular; but most of the things that the man predicates of himself are general. Now, suppose you take the symptoms of sleep. You might at first think that they related to the brain, but the brain does not sleep any more than the whole man. “I was wakeful last night;” he is predicating something of himself and hence it is a general. Or, he says, “I dreamed;” well it is true that the whole man really dreamed. You might say that the mind merely dreamed, but the mind is the man, and, therefore, we see how important sleep and dreams become in the anamnesis of a case. Scarcely more important is what the woman says of her menstruation; menstruation so closely relates to the whole woman that it becomes most important. The special senses also are so closely related to the whole man that the smells that are grateful and the smells that are disagreeable become general. There are certain smells that relate more particularly to the nose itself, because the smell is in the nose and is due to some pathological condition of the nose, and thus becomes a mere particular. The smell of food is agreeable when the man is hungry, and that will relate to the whole man, but one who has a vicious catarrh of the nose, with much local disturbance, has many perversions of smell, which are particular, because they relate to the nose. A patient says: “I see” so and so, without seeing; that relates to the generals. It is to a great extent a seeing with the understanding. Now, when the eye itself becomes affected, the symptoms gathered are particulars because they relate to the anatomy of the eye. The more the symptoms relate to the anatomy of the parts, the more external they are; the more they relate to the tissues, the more likely they are to be particular. But the more they relate to internals that in-involve the whole man, the more they become general. You will see, therefore, that the things that relate to the man are to be singled out in the anamnesis and marked first. After gathering together all the symptoms of a patient you should single out for study first of all everything and anything that you can predicate of the man, everything of which you can say he feels so and so, she suffers so and so. Find out what remedies relate to these symptoms first. Sometimes when you have figured the anamnesis of the generals, you have settled by your anamnesis upon three remedies, or possibly upon one. In ninety-nine cases of a hundred you can leave out the particulars, for the particulars are usually contained within the generals. If there be but one remedy that has the numerous generals, and covers those generals absolutely and clearly and strongly, that will be the remedy that will cure the case. There may be a lot of little particulars that may appear to contra-indicate, but they cannot; for nothing in particulars can contra-indicate generals. One strong general can overrule all the particulars you can gather up. “Aggravation from heat” will throw out Arsenicum from consideration in any case.

It may be advisable to dwell again for a little upon the common symptoms. Sometimes we find in women the common symptom, prolapsus. It is a common thing for them to say, “Dr., I have such a dragging down in my bowels. I feel as if my insides were coming out.” That is a common feature, and it is a common symptom. There is nothing about that alone that will enable you to find a remedy, but for these common symptoms we have a class of remedies. When you see a rubric containing a dozen, fifteen or twenty remedies, you may often know it is a common symptom. We would say that all women who have prolapsus have to a great extent a dragging down feeling, as if the uterus would come out. If we were to take this symptom and follow it up, we would see that it works in various directions; we would see that it runs into generals, and into particulars. How shall we decide when to give Sepia, when Lil tig., when Murex., when Bell., when Puls., when Nux, and when Natrum mur.? To enable you to pick out of that group of remedies the one that will cure you must study both the generals and the particulars of the patient and the generals always first. If it be a Nux vomica patient who has the prolapsus of the uterus, what will she say of herself that will make you see Nux in it? She would be chilly, full of coryza, with stuffing up of the nose in a warm room; she would be very irritable, snappish, want to kill somebody, want to throw her child into the fire, want to kill her husband. She would probably have constipation and every pain that she had with it would make her want to go to stool; urging to stool, but only a little is passed and she wants to go frequently. You at once see that she has the generals of Nux, and whatever particulars she has are in harmony with those generals, and so you go from generals to particulars. The whole problem, like any other scientific problem, must be gone into and followed from generals to particulars. Suppose that Sepia is indicated for that woman. You have in it as well this common symptom. Now, what is there in this patient that no other patient has? The dragging down is just the same, but with it an awful all-gone sinking feeling in the stomach, and she gets relief only when sitting with the legs crossed. She has a constant feeling of a lump in the rectum that makes her want to go to stool; but she goes for days without any urging at all; she is sallow and sickly, talks of bilious symptoms and has a yellow saddle over the nose. She tells you that she has an aversion to her children, and feels very sad that she does not love her husband as she ought to. She is unable to exercise the love she has to her children. Now you have that which she says of herself in general, and that which she tells of the stomach and rectum in particular, and yet peculiar. You can see now that the dragging down sensation is not general nor particular, but is common. Many of the symptoms that are of regions are both common and particular, particular because they are of regions and common because they describe a state. Scarlet fever gives us an illustration of this. We would group all the striking symptoms indicative of scarlet fever, the rash, the appearance of the mucous membranes, the sore throat, the fever, the history, and the period of prodrome. The remedies for scarlet fever must have these symptoms in common with scarlet fever. The appearance of scarlet fever is among the common things of Belladonna. Ailanthus has in its common things the appearance of scarlet fever; Apis has the appearance of scarlet fever; Rhus has the appearance of rough scarlet fever. Sulphur and Phosphorous have a rash similar to scarlet fever. So if we were to make a rubric for the repertory we would put the names of all these remedies in the common group and call it scarlet fever. But when are you going to give one remedy and when another? We can sometimes figure out from local manifestations things in general. For instance, you can take an Arum triph patient; that which appears to be most striking is that he picks his nose and lips until they bleed. If you examine that state well you will ascertain that these parts and the fingers and toes tingle; about the extremities where the circulation is feeble and where the nerves are abundant, in the nerves of the fingers and toes, there is an unusual tingling like the creeping of ants, and he keeps picking at these parts. It is a state marking almost the whole economy. If you watch a little more closely, you will see that a liquid oozes out of the parts he has picked, a bloody, watery oozing, and that it denudes the skin around the parts. It becomes a part of the general state. Then in scarlet fever, with the rash only partly out, we want to take the language of nature alone. I spoke of Phosphorus. Phos. has a typical scarlet fever rash. Suppose you have a case that is putrid, the rash has become very dusky and the skin has become mottled and purplish, and there are places about the body that have a tendency to suppurate. You find there are swellings about the neck, swellings upon the hands and fingers, that are, inclined to suppurate; or there is an oozing round about them and pus is welling forth, and the case is so putrid and offensive that as soon as you enter the room you detect the horrible stench. If you examine into the case, you will see that the child cannot get water enough and cannot get it cold enough. The countenance is sunken, and the eyes are puffed and swollen and red. Blotches are appearing of a septic character intermingled with the scarlet fever blotches. There you have a Phos. case, and Phos. will stop the trouble immediately. Now, what have you gathered together? You have gathered together an evidence of the general state. You see running all through that case putridity and a zymotic state. You may have many cases of malignant scarlet fever, and you will find that you can manage them with your remedies as you would an unruly horse with reins.

Now as to the grades. The value of symptoms is divided into three grades. General symptoms are divided into three grades, first, second and third, and common symptoms and particular symptoms are divided into the same three grades. You will see in Bœnninghausen a fourth grade, but as a matter of fact these remedies do not form a grade; they are only probationary remedies, requiring demonstration by re-proving and clinical confirmation.

The general symptoms of the first grade are such as all or the majority of provers state of themselves as a class of provers. For instance, take that symptom of Apis, “suffocation in a warm room;” all the provers of Apis. or nearly all, were affected to a great extent in that way. All the powers of Pulsatilla were worse in a warm room. There can be no doubt about such symptoms for all the provers felt that state so strongly. Kali hyd., Pulsatilla, Iodine and Apis are among those that have that symptom in the first grade, worse in a warm room, suffocation in a warm room. Now when those symptoms which have existed as generals among the provers come into the experience of the practitioner, and are confirmed by curing those states extensively, wherever administered, for years, then these remedies are fully entitled to this grade. When only one prover has recorded a certain symptom, it is doubtful whether that is a symptom from the action of the remedy, but when several provers have recorded the same symptom it becomes confirmed, When that symptom has been removed or cured by the remedy in the hands of a physician, it can then be said to have been verified. So that symptoms are recorded, confirmed by reprovings, and verified upon the sick. When several provers have observed that Puls. is worse in a warm room, and this is confirmed by other provers, and then verified by cure upon the sick, it immediately places Pulsatilla in the first grade of that general state. Suppose that it were something that was in relation to the bladder; Puls. has a symptom of frequent urination; now, that is immediately classified as a particular symptom because it relates to a region. Now, if all of these provers had irritable bladder when they took Puls. that would be a confirmation of it, and if it cures for years experience verifies it and it is then placed as belonging to Pulsatilla under the particulars, and marked in the highest grade. So with the symptom of bearing down, which also comes under Pulsatilla; that would be classed as a common symptom, but of the first grade.

Suppose now that there are more symptoms that have only been brought out by a few of the provers; they do not run through the whole family of provers, but they have been confirmed and occasionally verified; then you see they are not entitled to so much consideration and as a matter of degree they belong to the second grade, because not so strong as the first grade, which produces these symptoms upon everybody or nearly everybody. Of course, what is true of the generals will be true of common and particular. Then as to the third grade. Now and then a prover brings out a symptom and it has not yet been confirmed by re-proving, but it stands out pretty strong, and seems to be worthy of a third place, or it has been verified by having cured sick folks, or on the other hand it is admitted as a clinical symptom. Sometimes close and careful observers have noticed that certain symptoms, not in the proving, have generally yielded to a certain remedy, and others have confirmed this clinical experience; these symptoms are admitted to go into the third grade. A great many of Bœnninghausen’s fourth grade symptoms really belong to the third grade, because Bœnninghausen was very cautious with the symptoms that had never been verified. His fourth grade remedies include such as he had gathered from his clinical experience, and he was doubtful about the propriety of placing them in the third grade, and also those symptoms that occurred in the provers but had not proper confirmation or were not verified. He laid them, as it were, upon a shelf for approbation, to be hereafter proved or accepted.