In a world that is rapidly undergoing radical changes, where values in every sphere of life, in every department of science, are upset and inadequate,it might be fit to consider again the problem of the comparative value of symptoms in homoeopathy. The object of this paper is to stir up a constructive discussion and to get the opinions of the most competent and experienced workers in our profession. Success or failure in homoeopathic prescribing depends mainly on the physicians knowledge and skill in ranking the symptom picture; and the correct picture of depends of the proper case taking and the careful examination of the patient, i.e., the gathering of all data susceptible to give the right understanding of every symptoms.
It this the so-called “totality of the symptoms”- the only absolute and definite basis for the homoeopathic prescription? No, it is not. What S. Hahnemann meant by the totality of the symptoms is the complete symptom picture of the NATURAL disease. Therefore, as a first step, the symptoms due to extrinsic factors-whether mechanical, chemical or physical-due to faulty habits, improper diet, etc., should be carefully excluded from the picture because the removing of he exciting or maintaining cause eradicates them ipso facto, and because they do not belong to the disease per se. This should be strongly emphasized; too often such symptoms are overlooked and not properly taken care of, although they do exist in practically every patient.
In other words, without a thorough investigation of the case, a record of its history,etiology, physio-pathology, without he knowledge of what is curable in the patient and what is curative in the similar remedy, the physician can do no scientific work, he cannot properly classify and rank the symptoms according to their significance and relative value.
He cannot possibly become a successful prescriber.
Now suppose we have a case: we have collected the full picture of the natural disease. HOw are we to proceed? It is obvious that it is practically impossible to find a remedy that will cover integrally every symptoms of the picture. Only comparatively few symptoms have to be picked out from the picture as particularly typical of the patient and therefore of the remedy. That is what is meant by ranking the symptoms.Now what method of valuation or ranking the symptoms. Now what method of valuation or ranking is to be followed?.
Hahnemann does not go into details on this particular question. THe essential points are stated in Paragraph 153 of the Organon:.
In this search for a homoeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to be disease to be cured, the more striking,singular,uncommon and peculiar (characteristic) signs and symptoms of the case of disease 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.
It has been J.T.Kents invaluable contribution to homoeopathy to precise and developed the question of the value of the symptoms, based on the philosophy of individualization and of the vital force, which he called simple substance. His conception and ideas have been commented and worked out mainly by English and American authors, notably R. Gibson-Miller, M. Tyler, J. Weir, etc., and more recently by the master of the postgraduate courses of the American Foundation for Homoeopathy.
Let me quote form E.B. Lyles article of Repertory Analysis (see Homoeopathic Recorder, Vol. 46, No. 1, p.43), the following resume of the Kentian method of symptoms valuation:.
For a brief reminder, the symptoms are ranked in the following order: the mental being highest in value as most indicative of the patient, followed by physical general as indicative of the tendencies of the body as a whole.
I. MENTAL SYMPTOMS.
(a) The will symptoms.
(b) The understanding: delusion, hallucinations, delirium, mental confusion, etc.;
(c) The intellect : memory, concentration, mistakes in writing and speaking.
II.PHYSICAL GENERALS
(a) Sexual conditions, menses, etc.
(b) Discharges.
(c) Food desires and aversion.
(d) Aggravations and amelioration of the whole body by time, seasons, temperature, air, weather, climate, etc.
(e) Sleep.
(f) General type: restlessness, weakness, prostration, chill, fever, etc.
(g) objective symptoms applying to the whole body.
III. PARTICULARS.
(a) Strange, rare and peculiar.
(b) Modalities of particulars…
Well, so far so good.. But is this the only method? Is it universally accepted? Is it applicable in every case of a busy daily practices? In a paper entitled Main Symptoms and Histological Specificity, presented at the International Homoeopathic Congress of Berlin (1937), Dr. Alexander Margittai of Budapest defends an opposite thesis, that is in fact the one almost universally accepted and followed on the European continent. He attacks, namely, Professor George Royals method of ranking the symptoms, which is very similar to the Kentian method , to wit:.
1. Mental Symptoms.
2. Modalities.
3. Sensations.
4. Pathological symptoms.
5. Functional disturbances.
Against this classification he reports a number of cures obtained by the prescription of remedies based on tissular specificity, where mental symptoms and modalities strongly contraindicated the successfully prescribed remedy.
He states that the “old American method” is purely empirical and that the new orientation is that of Theodore Bakodys tissular specificity. He proposed the following scale:.
1.Specificity of organs.
2.Specificity of tissues.
3.Specificity of function.
4.Modalities.
5. Psychic syndromes.
The German method, as we can see, considers the objective symptoms as paramount, whereas the Kentian method gives more importance to the subjective symptoms. The German has always opposed Kents ideas and ignored his philosophy; that is the reason why they criticized so bitterly and rejected the German edition of the Repertory a few years ago. Lately they show a growing interest in Paracelsus, whom they consider a national genius (although he was a Swiss); no doubt the spagyrist philosophy will bring them to a better understanding of Kents conceptions.
Now, it is interesting and significant to see that Dr. George Royal, ten years after the publication of the above mentioned method in his Textbook of Materia Medica (1920) rallies the German school. Indeed, in his Handy Book of Reference (1930), page 82, he summarized the question thus:.
Select that remedy from the class of drugs which the provers have demonstrated possesses the following:
1.The Strongest “elective affinity” for the affected tissues or organ;
2.Which has the power of the producing any of the four conditions found in the affected tissue or organ (whether inflamed, irritated, or changed functionally or structurally);
3. Which has the ranking subjective symptoms and modalities of the individual patient.
Although I am personally convinced by experience that Kents method is the best, I have nevertheless to admit that, aside from all theoretical controversy, it is not applicable to every case, and that the German scale seems to be apply to such cases where the subjective symptoms are absent or not available, and this is rather frequent in practice. Also in other instance where the seemingly well indicated remedy is inefficient.
As an illustration,let me report briefly the following case: I was called to see a 68 years old woman who was in great and constant pain from an extensive herpes zoster of the left hemi-thorax. For two days and nights she had been unceasingly walking the floor to the point of exhaustion. To sit or to lie down was an impossibility even for the time of my examination: She had to keep moving. This condition started with a cold, she said, about a week ago. She still had a dry cough and some sneezing with a scanty nasal discharge. Then a constant pain, burning and stitching in character, accompanied by itching, along the lower ribs on the left side.
She kept rubbing and applying heat to get a little relief. The condition grew worse, she got more and more restless, sleepless, with pain in the head and abdomen, nausea and vomiting-mostly in the morning-and an aversion for food and liquids. The tongue was dirty, cracked and dry with a red tip. THere was a deep red belt, about six inches wide from the spine, at the level of the fourth to the ninth dorsal vertebrae, following the left ribs to the middle line in the front, covered with crops of pinhead pinkish vesicles filled with cloudy fluid. The heart, normal in size, was quite irregular with numerous extra systoles and a soft pre-systolic murmur at the apex. B. P. 170/90. The urine, deep colored and cloudy, showed a specific gravity of 1.028, pH 6.0 and marked traces albumin and acetone. The rest of the examination was otherwise negative.
Allan D. Sutherland was born in Northfield, Vermont in 1897, delivered by the local homeopathic physician. The son of a Canadian Episcopalian minister, his father had arrived there to lead the local parish five years earlier and met his mother, who was the daughter of the president of the University of Norwich. Four years after Allan’s birth, ministerial work lead the family first to North Carolina and then to Connecticut a few years afterward.
Starting in 1920, Sutherland began his premedical studies and a year later, he began his medical education at Hahnemann Medical School in Philadelphia.
Sutherland graduated in 1925 and went on to intern at both Children’s Homeopathic Hospital and St. Luke’s Homeopathic Hospital. He then was appointed the chief resident at Children’s. With the conclusion of his residency and 2 years of clinical experience under his belt, Sutherland opened his own practice in Philadelphia while retaining a position at Children’s in the Obstetrics and Gynecology Department.
In 1928, Sutherland decided to set up practice in Brattleboro.