Symptoms that Distinguish a Case by JULIA C. LOOS

 This articles discuss the importance of symptoms belongs to patient over the symptoms belong to disease and particular organs, in Homeopathic methodology to cure the patient. Article published in "THE MEDICAL ADVANCE.. AND ..Journal of Homeopathics, VOL. XLII., CHICAGO, FEBRUARY, 1904. No. 2."

Symptoms that Distinguish a Case: That Sketch the
Image of the Disease in a Patient
JULIA C. LOOS, M. D., H. M., HARRISBURG, PA.

The only basis for study of disease is the record of symptoms
of sick people. No better method has been devised than that of
Hahnemann for bringing symptoms into a comprehensive form
for study and making acquaintance with the image of any individual

miasm. As a preparation for dealing with diseases the first
essential is familiarity with their natural expression when their
course has no interference.

Every miasm (disease), whether acute or chronic, so acts upon
the economy that the orderly functions are disturbed; not properly
performed. In every disease, however, these disturbances occur
in a definite course, each maintains its own order of disturbance,
following the period of invasion, progressing through prodrome
and active period to a period of decline, in acute miasms, but in
never-ending progression throughout the life of the individual in
chronic miasm.

Each disease is characterized by special symptoms by which it
may be recognized, but in various beings these characteristics of
the disease appear in a variety of forms. No individual of the
human race is complete, hence no one is capable of exhibiting in
entirety either the virtues or the vices of its nature. Hence any
disease in an individual is shown only as a fragment of the whole
image, the full nature portrayed by a large number. This individual

fragment is yet a sufficient part of the whole to represent
its nature and is recognized as a form of this or that miasm by the
characteristic combination of symptoms characterizing the miasm.
Many symptoms are so common to different sorts of disturbances

of the vital force that they are characteristic of nothing.

Headache, skin eruptions, loss of appetite, rise of temperature,
vomiting, pain in the abdomen, disturbed bowel evacuations are
common symptoms of sickness; but a certain combination of some
of these common symptoms occurring in definite form characterize

the miasms.

A particular form of fever, with a definite kind of pain in a
certain part of the abdomen with diarrhea of a particular type,
a sluggish, stupid, malaise and peculiar kind of eruption form the
characteristics of typhoid fever.

So each miasm is imaged by a characteristic combination of
symptoms, any one of which is common to many miasms.
From a clear comprehension of the natural functions of all
parts and the control of functions in health, we judge the condition

of each part by the disorder symptoms. No one symptom is
diagnostic of a local condition nor of a disease. All things must
be considered together. The-expression of weak heart action may
include symptoms all over the body, each of which, with different
associations would signify a different derangement. A tumor of
moderate firmness in the epigastrium might be a feature of aortic
aneurism which it would be fatal to have ruptured, but the physician

should be prepared to see a later softening of the tumor with
discharge of pus when the history of the case shows that the tumor
develops after a severe blow at this point and examination shows
superficial tissues involved. To determine the condition giving
rise to functional disturbances sometimes requires careful discrimination, but should not be neglected, if full accurate knowledge is desired.

GENERAL SYMPTOMS

General symptoms of the patient are frequently deduced from
many particulars. We recognize a general catarrhal condition
from the discharges here and there, or a nervous depression from

sluggish response in several functions or a tendency to wandering
pains or alternation of similar symptoms in different parts or alternation of wholly different symptoms. Local changes lead to the
summing up —" general glandular enlargements " or " indurations "

or " deficient nutrition " or " congestions " or " zymotic state."

The broad conception of the symptoms must be considered
in estimating from the record the true state of the case.

CHARACTERISTICS OF THE PATIENT

The records of the sick people contain another class of symptoms,

viz., those that characterize the patient, an important class
in each case. Our standard of measurement is the normal healthy
man who naturally at night is prepared to sleep and when day returns, awakes and desires to enter into activity according to his
affections. At regular periods he grows hungry, eats, feels refreshed

and is ready for action again, grows tired from long, continued

exertion and by a short cessation is rested from fatigue.

He feels good, enjoys his activity, the society of friends, is unconscious of the action of internal organs, even of their existence.

He appreciates himself as a unit in mind and body, thinking, willing,

acting a harmonious individual.

But when he is sick, these things are changed. He becomes sensitive

to all sorts of circumstances that ordinarily, in normal state,
are unnoticed; sensitive to the very things which contribute to his
life: light, temperature changes, winds, motion, noise, touch, to
articles of food, etc. He has definite periods of time when he feels
bad, certain hours of the day or parts of the month or year. He
has definite aggravations associated with the natural functions of
the organs, digestion, defecation, respiration, etc. Those things
which normally refresh, now aggravate him. He is comfortable
only under certain limited conditions. He desires queer things.
His natural affections are perverted, he loathes friends, food, activity, his very life, and desires things ordinarily repulsive. He
scolds or becomes violent or taciturn. He dwells on trifles that vex
him, entertains morbid fancies, loses control of memory, of
thought, of feelings. In endless variety the individual himself is

disturbed in sickness irrespective of the way the bodily functions
are performed.

These then are the characterizing symptoms of the patient. To
understand the sick man all these things must be perceived. A
full record of symptoms must include these symptoms that mark
the patient as well as the common symptoms, and the symptoms
that characterize the miasm which afflicts him.

MORBID TISSUE SYMPTOMS.

One other class of symptoms is worthy of distinction. Mention
has been made of functions disordered by disease, i. e., by disorder
of the vital force. When disease action has continued under conditions favoring its progress, functions become so far disturbed
that tissue repair is interfered with and normal tissue formation
is replaced by degenerative tissue formation or increased production, developing so-called pathological growth. These things
(overgrowths and deficiencies then destruction), by their actual
presence in the particular locality where they occur, in their interference, give rise to symptoms of disturbed function. Symptoms of disease results must be distinguished from others of all kinds.
 
Pressure on a part of the brain, on the spinal cord, on the liver,
on the bowels, will be followed by a line of symptoms in accordance with the natural function of the part, not necessarily limited to the area receiving the pressure but extending where the disturbed function is in control. Scar tissue on a sensitive nerve,
growths on the valves of the heart, destruction of the tubules of
the kidney, each produces its mechanical symptoms according to
the function disturbed. These are symptoms of disease results.
Such discrimination of all the symptoms in a full record of disorder

is the rational method of perceiving the image of sickness
for practical use in treating individual cases. Thus we are enabled
to reach definite conclusions of what is going on within, following
the history step by step.

By our philosophy, now proved beyond doubt, the patient is to
be cured most promptly, mildly and permanently by the use of a
remedy most similar in its effects upon the economy to the effects
of the miasm in this particular case, as revealed by the symptoms.

SECTION 104 OF THE ORGANON

When the totality of the symptoms that specially mark and distinguish the case of disease or in other words, when the picture of the disease, whatever be its kind, is once accurately sketched, the most difficult part of the task is accomplished. The physician has then the picture of the disease, especially if it be a chronic one, always before him, etc. Every phrase in this first sentence is important in its meaning.

Read it again:

Among all the symptoms in the record of our patient, which are to be of use in the selection of the remedy? Those symptoms that accurately sketch the image of the disease, the totality of the symptoms that specially mark and distinguish the case.

From the foregoing discriminating study of symptoms it is clear
that not all the symptoms in the case belong to this class. All
symptoms that do not specially mark and distinguish the case
(i. e., the patient under consideration) are not to be included here.
Some of the symptoms in our record are those common to many
kinds of sickness. Some symptoms are common to the disease affecting the patient, they distinguish the disease. Some symptoms
may be evidences of the results of disease. But those that specially
mark the case are the symptoms of the patient himself. The characteristics of the patient under consideration, those peculiar aggravations and ameliorations that are not an essential element in the pathology of the disease but distinguish one case from another afflicted with the same miasm.

The characteristic symptoms of the miasm give an image of
miasm but the characteristics of the patient produce an image of
the man as he is disturbed by the miasm. The common symptoms
and symptoms of disease results may be ignored in sketching the
image of the disease in this particular case but those that characterize the disease and most of all those that characterize the particular patient affected constitute the totality of the symptoms that specially mark and distinguish the case of disease. When the
symptoms have been clearly distinguished in the record and the
image of the disease in this patient thus accurately sketched, then
the most difficult part of the task is accomplished.

Until this is done by the physician, he is not ready to take any
steps in administering remedies for the correction of the disorder.

No matter how long he must study the record, no matter how long
he must wait and watch and question and search, until the case is
thus sketched, he is not prepared to proceed with a prescription.
The curative remedy is the one capable of producing in the economy such an image of disorder as this disease has produced in this patient. How can it be determined what remedy will do that if
we do not perceive the image here portrayed. The characteristics
of this sick patient are to be the guide points to the curative
remedy, the remedy which is characterized by the same or the
most closely resembling symptoms. Evidently then we cannot
proceed until we determine the characteristic symptoms of the
patient in his sick state.

With this aim, to restore the patient to health, ever in view, having

determined what are the symptoms that characterize this patient

and in their combination keeping the image before us — we
seek the remedy which most closely resembles in its effects — or its image, this image of disorder. This should take the whole attention of the physician until it is accomplished. The intensity of
the patient's sufferings, the anxiety of friends, the social position
of the sick person, the possible financial returns to the physician,
the possible contagion of others,— each and all of these must give
way in the physician's mind to the paramount problem — determining the image of the disease in this patient and the remedy whose image is most similar. To concentrate the attention on this matter it is often necessary for the physician to go entirely out of
the environment of the patient and the patient's associates. More
frequently than not in a case of profound sickness it is necessary
to resort to repertories and records of provings to determine what
remedy is most similar.

When we realize the importance of determining in each case to
be treated what are the characteristic symptoms that sketched the
image of disease in the case, when we realize that when this is
done the most difficult part of the task is accomplished, we must
be impressed with the fact that no student who has not been
thoroughly grounded in this discrimination, no matter how many
years' preparation he has had, is not qualified to practice in the
name of Homeopathy.

What must we say, then of the colleges throughout the land

offering to train students in Homeopathy ? Do we find their graduates

well trained in this line? Do we find the professors in the
departments of Medicine, Clinical Medicine and Therapeutics drilling the students in the discrimination of symptoms to determine ineach case the characteristics that sketch the image of disease in
each patient ? Let the graduates of the colleges testify. Let them
show how much was their attention directed to this and how much
it was directed to bacteria annihilation and treatment of disease results. When these graduates in course of time realize that
" symptoms of disease," “symptoms of the patient," " general
symptoms," " common symptoms," — " disease-result symptoms "
are meaningless terms to them and yet are important in the homeopathic application of drugs to disease, how shall the college withstand the reproof of these who were taught in their halls ? How
shall they repudiate the anathemas?

“Woe unto you hypocrites, Pharisees, blind guides, for ye pay
tithes of mint and anise and cummin and have omitted the weightier

matters of the law. Even so ye also outwardly appear righteous

unto men, but within ye are full of hypocrisy and iniquity,
wherefore ye be witnesses unto yourselves, that ye are the children
of them which killed the prophets, while ye build tombs of the
prophets and garnish the sepulchers of the righteous."

CURE IS FROM WITHIN OUT.

Mr. I. C. L., 27 years of age, medium height, blonde, with blue
eyes and light brown hair, cheeks sunken, reported first on
December 1. He preceded the report of his own case by stating
that there was a family history of stomach troubles and he himself

had had indigestion for three years or so. Recently has been
emaciating. Weight reduced from one hundred thirty-five or one
hundred thirty pounds to one hundred fifteen. As a child he was
thin until seven years of age but grew stout after that and only
of late years has lost flesh.

Weak, draggy, languid; legs weak, used to be in forenoon but
now continues all day.

Sleep generally good until 4 or 5 A. M. Never can sleep late,
and feels unrefreshed in morning.

Feverish in evening after 5 P. M.; face hot, hands and feet
cold; < by excitement.

Indigestion: hungry always, not > by eating. Has had a diet
of eggs, until he has a distaste for them. By direction has used
malted-milk tablets and Wyeth's malt nerve tonic, and still growing

thin, craves sweets, vegetables, meat (latter, disagrees?) ; used
to crave sour things. Wants hot food. Averse to fat.
Thirstless, except about every two weeks has a spell of un-
quenchable thirst.

Mouth offensive odor: slimy, greasy tasting coating. Tongue
dirty, dry, red tip.

Eructations sour; heartburn.

Eyes yellow.

Constipation, may have no stool for two days at a time.

Colds settle in head from drafts. Had a severe cold four or
five weeks ago.

Skin: Eczema six or seven years ago, " itch," on arms (outer
side) and thighs, vesicles forming yellow lumps that can be rubbed
off. Itching, bleeding or scratching, < warm in bed, > warm
bathing (lard and sulphur). Now dry skin, peels up when shaves;
almost cracks. Color yellow, red blotches on forehead. Pricking,
itching, recently after bathing. (Cuticura soap.)

Perspiration little more of late, since he is weak.

Hair falling after eruption.

Chills slight, first, in summer of 1901, last summer doctored a
month or more (Quinine) ; tertian, 9-10 P. M.

Fever next day, all forenoon. During heat, diarrhea.
Sweat after fever began, continued after the fever.

Thirst absent. Intermediate day, weakness.

This continued until after he left the neighborhood.

Tonsilitis in 1899 at college; > in open air; > in warm room
70° to 72° comfortable, 65° is chilly.

Feet cold in morning, though well wrapped. Can't fall asleep
unless they are warm; one leg or one arm, sometimes middle of
back, cold, on waking; perspiration feet offensive < when cold.

Disposition variable; > company, < alone.

Dreads cold morning bath, past six weeks.

A few days later he reports cold in larynx. Hoarseness, cough

with rattling but difficult expectoration of yellow mucus, soreness
and tightness in chest, pain in back, lumbar region, coldness from
feet to knees and sore lameness all over.

The very clear and interesting sequence of things in this history
was emphasized to the young man. He admitted that he had
about concluded that driving off the eruption was really at the
beginning of his indigestion and was ready to accept the statement
that the skin trouble would return as well as some sign of chills.

Sulphur 55M.

The prescription was made after careful study
which brought Sulphur, Pulsatilla and Lycopodium most prom-
inently related to the case.

One week later he reported the cold improved immediately.
Diarrhea began shortly after last visit and for two days occurred
at 5 A. M. but not later in the day. Since that, bowels were regular.

He reported also that he was vaccinated at fifteen years of
age and had a running sore for six months. The proud flesh was
burned three times a week and bathing was prohibited. Healing
began after free bathing in warm water. A year later for a month
there existed a running sore on left side of lower lip. This left
a red scar which grows bright when he gets heated.

At the first visit his diet of eggs was discontinued and he was
told to eat reasonably of ordinary substantial food. This he did
from the first. In three weeks weight increased three and a half
pounds.

Chills came on the 19th, and each evening until the 29th, after
supper. At first they were followed by little fever and some thirst.
Later heat and perspiration followed.

Diarrhea again on 3Oth and for three days, beginning at 5 A. M.
Griping pain before and chilliness during stool; no straining,
stools yellow, brown, watery, with flatus.

Eruption on face before diarrhea; sore pustules; a few on back,
sensitive to pressure.

Rheumatism in shin muscles and ankles came at same time, later
persisted in right ankle only.

January 26. Sulphur 55m.

During next two months the eruption continued on face, neck
and shoulders in successive crops of pustules with redness and
itching. Eyes continued yellow, then vision became blurred and

lids agglutinated in mornings with yellow discharge. By the 20th
of March the following record was obtained:

Sleepless for two weeks; wakens often, falls asleep late and
wakens within fifteen minutes of 3 A. M. On waking feels active,
wide awake.

Loss of weight nine pounds in two weeks.
Bowels irregular, at times flatus from rectum.

Languid < evening 4:30 or 5 P. M. until 8 P. M., then feels
bright.

Feverish spells in evening.

Perspiration copious all over. Feet soles sore as if boiled; offensive.

Warm, feels excessively warm in moderately warm weather.
Appetite good. Thirsty for large drinks.

Headache dull, feels large. Eyes heavy. On shaking feels as
if something goes from one side to other < left side.

Eyes blood shot, pricking like splinters, on rising, morning, and
in evening after riding in the wind; > bathing cold water ;

lachrymation from light, from touch.

Cough for a week, from tickling in trachea, spasmodic, dry >
by lying; sense of contraction in upper trachea.

Mouth: ulcers on inner side of lip. When seven to eight years
old had several for which yellowish-white powder was used. Old
ones used to burn. These are sensitive to acid.

Depression of spirits comes suddenly in evening. Thoughts
wander when he tries to work mentally.

March 20th. Argentum nit. 4Om.

This was followed by a week of skin activity. The eruption
was much < on face and “every little scratch became a running
sore." Then it was “better than it ever was."

By the middle of April he reported that a gain of two pounds
in weight that week brought him to 121 pounds.

A return of symptoms, especially mental symptoms was the
occasion of a repitition of Arg. nit. on April 24.

After an absence of two months he reported himself better than
be had been for years; and we can readily believe it.

Here is a good verification of the doctrine set forth by Hahnemann,

in which the course of disease action in progress and under

curative measures is well displayed. The young man applied for
treatment to relieve him of indigestion but that was only one chapter

in the history and the treatment that cured that brought out to
the surface all the disorder from his early childhood and when
order was restored, he, the man, was better in every way, and the
physician was minus a patient. But the physician's duty in this
case was accomplished with satisfaction.

SYMPTOMS THAT CHARACTERIZE A CASE OF ERUPTION

Maud K., aged 16 years, came to the office about the middle of
July, complaining of an eruption which had troubled her for about
two weeks. She could give no history of its origin but said several
girls working in the same place, a candy factory, had been affected
similarly.

The eruption consisted of groups of small vesicles with dull red
areola, slightly hardened at base. Itching, at night in bed, <
when gets warm. After scratching, burns and breaks open continuing

to ooze yellow water. Areola spreads after first appearance.
Eruption began on abdomen, later developed on outer side of
right thigh, on back, back of neck and in axillae.

Leg stiff (on walking) about the eruption; soreness on walking.
Face on left side frequently has pimples under the skin. Is
swollen beneath the eyes on waking in the morning some days.

In attempting to pick out the most peculiar, unusual, striking
things about this eruption, the first selection was the place of its
first appearance.

Abdomen eruption: given in " Kent's Repertory " with the list:
Agar., Anac., Apis., Ars., Bar. m., Bry., Calc., Kali. bi., Kali. c.,
Merc. Nat. c., Nat. m., Phos., Rhus, Sul.

The following distinguishing features were then noted with
the remedies found in each of the preceding lists:

Eruption vesicles: Anac., Ars., Bry., Calc., Kali. bi., Kali. c.,
Merc., Merc, c., Nat. c., Nat. m., Phos., Rhus., Sul.;

 Itching, Anac, Bry., Calc., Nat. c., Rhus, Sul.;

Red areola, Anac, Nat. c., Sul.;
Discharging, Anac., Nat. c., Sul.;

Vesicles in groups, Sul;

Inflamed, Anac;

Itching becoming warm in bed, Anac., Sul.

Because the eruption with its peculiarities presented so unfamiliar

an image and that remedy seemed a little out of the ordinary
for eruptions, Anacardium was first consulted in " Hering's Guid-
ings Symptoms." How beautiful seemed the words of the text:

“SKIN— Bright scarlet eruptions of the whole body, especially of the thighs in contact with the nut and of the abdomen.
Destruction of the epidermis, leaving an inflamed surface covered with small miliary pustules, with unbearable itching and discharging a yellow liquid forming crusts. Chest, neck, axillae, upper arms, abdomen, scrotum and thighs were not only covered with raised crusts, discharging a thick yellowish liquid, but these had partly changed into wart-like excrescences, with thickened epidermis, the whole intermediate skin being of an erythematous redness and
the itching fearful. Itching worse in evening and when he went to bed.”

Here was a better description of the thing than I had made even
on seeing it. So, although the case presented a wholly unfamiliar
image at the beginning, here in the materia medica album I found
its photograph and had no doubt of the effects of Anacardium in
this case.

It was administered with the warning that the eruption might
come out more for a few days but would then grow better and
nothing was to be put on but olive oil and water.

Much later I learned that the eruption came out in large, close,
red spots on thighs and legs but occasioned little pain after a day
or two and the whole skin was cleared in about one week. The
other girls had a much longer siege, even to three months. Then
indeed was breathed again a prayer of thankfulness for means of
discriminating symptoms and the possession of a logical repertory.

A short time ago a friend of the allopathic persuasion, or, call
it what you will, remarked that he had rheumatism, and added
that " Salicylate is good enough for patients but I don't want any
of it; " and we wondered if he knew that homeopathic physicians
were not afraid to take what they prescribed; and if he had any
idea of the number of them who took Perfection Liquid Food —
which they find so good for their patients — " when a little run
down."