The Homoeopathic Physician
May, 1883
The Importance Of A Single Symptom
Ad. Lippe, M.D., Philadelphia
Edited By: Dr. Vandana Patni
The importance of a single
symptom becomes apparent when we detect in a patient a single characteristic
symptom corresponding with a single characteristic symptom observed in the
proving of a drug. To illustrate this position I will, first, quote a case from
my case-book in which an objective symptom indicated the truly specific remedy.
This case was one of very
malignant “ship fever.” The patient had been sick nine days when I found him in
the morning, lying on his back, perfectly unconscious; eyes wide open, glaring,
and fixed on the ceiling, pupils dilated; cheeks red and hot; mouth wide open,
lower jaw hanging down; tongue and lips dry, black, and cracked; picking of bed
coverings; pulse 200. The pathological condition was most certainly approaching
paralysis of the brain.
The unconsciousness in this
case reminded me at first of Bell. Bell. 2 P.M. , I found him with his eyes and mouth firmly closed in
a natural sleep and in a very heavy perspiration. He finally recovered fully,
and enjoyed perfectly good health for many years.
In this case the single
characteristic was a guide in the selection of the curative remedy, but not in
the diagnosis of the disease. If this single symptom had been a guide in the
diagnosis of the disease, it would not have been a guide in the
selection of the curative remedy.
To illustrate further the
position assumed that one single symptom is very important, let us refer to the
frequently recurring symptom, “Sinking at the epigastrium.” This symptom
standing alone and by itself is of no importance whatever, neither
characterizing a remedy or any abnormal condition of the system. Whether caused
by a disturbed condition of pneumo-gastric nerve, or of the uterus, or by
nervous depression, the symptom by itself, or the supposed cause, will never
assist us in finding the curative remedy.
As far as our observations
have been able to enlighten us, this symptom has been successfully removed by
the following medicines: Alumen, Ambra, Baryta, Digitalis, Ignatia, Kali Carb,
Lobelia, Lycopodium, Petroleum, Oleander, Sepia, and Veratrum.
The important single symptom
in this connection under Alumen is that the sinking sensation is aggravated
after eating, while under Baryta it is relieved by eating. This symptom is on
record in Hahnemann’s Chronic Diseases: “Sensation of weakness in the
stomach, which disappears after eating.” The important single symptom under
Ambra we find thus in Hahnemann’s Materia Medica Pura: “She must lie down on
account of giddiness and a sensation of weakness in the stomach.”
Under Alumen and Baryta we
find one conditional symptom, the aggravation and amelioration after eating.
Under Ambra we find one concomitant and one conditional symptom, the
combination of the sinking feeling with the condition of being obliged to lie
down.
Digitalis has the
characteristic symptom so often confirmed in practice and given by Hahnemann in
his Materia Medica Pura: “A weakness of the stomach, as if the stomach
were sinking away and as if life would vanish.” Later it was observed that this
sensation of weakness generally occurred “after eating.”
Under Ignatia, we find in
Hahnemann’s Materia Medica Pura: “A peculiar sensation of weakness in the
upper abdomen and in the pit of stomach;” and “drawing and pinching in the
lower abdomen, descending into the rectum like pressing, with qualmishness and
sinking in the pit of the stomach and paleness of the face (after forty-eight
hours, two days before menstruation).” And again: “Debility, as from weakness
(sinking), around the pit of the stomach; he feels qualmish and must
lie down.”
Under Kali carb., we find in
Hahnemann’s Chronic Diseases: “Pressure in the stomach with rumbling,
sensation of emptiness and eructations.”
Under Laurocerasus, we find
pain in the stomach, like fainting; feeling of weakness in the stomach.
Under Petroleum we find in
Hahnemann’s Chronic Diseases: “Sensation of emptiness in stomach, as
from fasting.”
Under Lobelia, we find:
“Feeling of weakness of the stomach or in the pit of the stomach, extending
through the whole chest.”
Under Oleander, we find in
Hahnemann’s Materia Medica Pura: “Sensation of great emptiness in the
pit of the stomach, with a fullness in the abdomen,” and it had been observed
that this sensation of emptiness in pit of stomach has been relieved by
drinking brandy, often accompanied by nausea.
Under Sepia, we find in
Hahnemann’s Chronic Diseases: “Emptiness in the stomach (sensation of)
with nausea as soon as she thinks of any food that might be offered to her.”
Under Veratrum, we find in
Hahnemann’s Materia Medica Pura: “Sensation of weakness of the stomach,
with an internal sensation of coldness in the region of the stomach and a light
pressure.”
The importance of a single
symptom in connection with this much perplexing sensation of “sinking at the
epigastrium,” weakness at the pit of the stomach, is very obvious. We find that
Alumen and Digitalis have an aggravation of this sensation after eating; that
Baryta has an amelioration after eating; that under Oleander brandy relieves;
that under Kali carb. is accompanied by eructations; that under Ignatia this
sensation has appeared two days before menstruation, accompanied by pale face
and qualmishness, which caused the patient to lie down; that under Sepia the
sensation was increased by thinking of food. The sensation is strongest in the
pit of the stomach under Digitalis, Ignatia, and Lobelia; under Digitalis the
sensation is so intense that he feels as if life would vanish.
Many cases will met in
practice in which these symptoms are present with the sensation of sinking at
the epigastrium; yet, at times, other remedies will have to be looked for to
find symptoms corresponding with the peculiar characteristic symptoms of the
patient.
A single symptom is
all-important if it is the characteristic of the medicine, corresponding with
the characteristic symptom of the case to be treated. Inasmuch as we no longer
treat diseases, or supposed diseases conditions giving rise to them, but as we
treat patients, it is no longer our duty to find the single symptom as a
guide in diagnosis. It is our task, however, to find the single characteristic
symptom both of the patient and of the remedy.
If we first get a clear idea
of what constitutes the characteristics of medicines, we involuntarily adapt
ourselves to the easy finding of the characteristic symptoms of the patient.
The characteristic symptoms of a medicine go through all its pathogenesis like
a red streak. We find, for instance, that all the symptoms, Aconite is capable
of producing in the human system, and therefore is able to cure, are
accompanied by “Anxiety,” and differ in the restlessness which is caused by
“anxiety” under Aconite from the restlessness which is caused by “anguish”
under Arsenic. Aconite has no characteristic pains. The burning and stinging in
internal organs, tearing in external parts, and tingling in (fingers,
oesophagus, and back) external parts, Aconite has in common with many other
drugs; if, for instance, a patient complains of tearing in external parts, as
in acute rheumatism, yet lies perfectly quiet, afraid to move, and if compelled
to move suffers much pain, no experienced physician could think of
administering Aconite, simply because the accompanying fever indicates
inflammatory disease, but he would give Bryonia, if the other symptoms also
indicate it. On the contrary, if the patient is very anxious and restless. Not
afraid to move, but tossing about, which he declares he cannot help, although
it increases his pains, no one would give Bryonia, but Aconite, if otherwise
indicated.
The “Anxiety” of Aconite may
be termed a general characteristic, like the “anguish” of Arsenic or the
constant aggravation of all the symptoms after sleeping under Lachesis, or the
amelioration in open cold air under Pulsatilla; the amelioration the cold air
alone being equally characteristic of Iodine, or the aggravation at 3 A. M.
under Kali carb.
Besides these general
characteristics which go through the whole remedy, we observe special
characteristics as under Kali bichr. that all the mucous discharges are
stringy, or under Phosphorus that the cough is aggravated in the cold air.
The single symptom, which
becomes all-important in a case, may comprise the kind of pains experienced, as
under Apis “the burning, stinging pains;” or it may comprise the locality, as
wrist and ankle under Ruta; or the direction the pain or disease follows, as
from right to left, below upward, from the inside outward, or vice versa; or
the condition (of amelioration or aggravation),as in the amelioration from heat
of Arsenic, the amelioration from cold of Iodine; or from concomitant symptoms,
as the great, unquenchable thirst, the great desire to drink large quantities
under Natr. mur. or again, the thirstlessness of Pulsatilla.
The single symptom becomes
all-important in some well-known diseases, as, for instance, in whooping cough.
**** Yet the true physician has first to choose the proper remedy, and then to
administer it properly if he hopes to be successful in this, as well as all
other diseases. The character and peculiarities of the cough alone do not
indicate a remedy. it is indispensably necessary to inquire further, and first
ascertain at what time of the day the cough is aggravated. What else aggravates
the cough? What are the concomitant symptoms? What is the character of the
expectoration?
And in this manner it will
become apparent that as to time the Drosera aggravation is after midnight ; that the cough returning every day at the same hour
may indicate either Lycopodium or Sabadilla.
Under the conditional
aggravations it will become apparent that if pressure on the larynx aggravates
the cough, Cina will be indicated; or that if walking fast brings on or
aggravates the attack, Sepia will cure; or that if hasty eating or drinking
causes an attack, Silicea will cure; or, with regard to the expectoration, that
if the great quantity of mucus which threatens to suffocate the patient is
difficult to expectorate, and if raised at all is tough and stringy and hard to
detach, etc., Coccus cacti is the remedy.
All these single symptoms
become important and will enable the practitioner to select the curative
remedy; the name of the disease never will, as no medicine has ever produced or
can produce whooping cough, but only a cough similar to whooping cough. The
cough produced by mephitis for instance, has been very similar to whooping
cough, but was not whooping cough and can only cure in those cases where the
concomitant symptoms correspond with mephitis – Am. Hom. Review, 1863.
= = = = = * * * * *
* * * = = = = =
This paper was written twenty
years ago, and after that long lapse of time its author is more than ever
convinced of the great importance of the single symptom. The single peculiar
symptom, expressive, as it were, of the characteristic individuality of the
sick and not necessarily belonging to the form of disease of which he suffers,
if also characteristic of a proved drug – becomes very frequently a guiding
symptom, will very often lead us to compare the symptoms of the sick with the
symptoms of the drug presenting that guiding symptom, a remedy which probably
escaped our notice without it, and if the similarity between the symptoms of
the sick and the provings of the drug become apparent, then and then
only has this single guiding symptom been profitably utilized. Later on it
was claimed that this single symptom, when present both on the sick and in the
provings, would absolutely demand recognition and was erroneously termed a
key-note, and this erroneous interpretation of the importance of the single symptom
opened the way for great and fatal abuses. And now for an illustration: We
find, for instance, in that excellent work on Diphtheria by Dr. Gregg, a case
of diphtheria cured by Lachnanthes. The indications for the use of Lachnanthes
were – the stiff neck the patient had. A cure followed. The deduction from this
observation of a cure would be that a stiff neck in diphtheria is a key-note
for Lachnanthes in that disease. This is, of course, poor logic, and later
experience illustrates it. In a case of diphtheria we lately published this
very painful stiff neck was a very prominent symptom, and the clinical
experiment has shown that another case of diphtheria where this stiff neck was
present had been promptly cured by Lachnanthes, that in the stiff neck
following not unfrequently diphtheria and scarlet fever Lachnanthes had very
often cured it. In the case alluded to, all and every symptom of the patient
suffering from diphtheria, also the stiff neck, were covered by Kali bichr.,
and the stiff neck was cured with the other very grave symptoms of diphtheria.
Kali bichr. has probably never been given for wryneck before, and now if in a
case of diphtheria this stiff neck occurs, we will have to take into
consideration the similarity of the other symptoms of the patient, having this
guiding symptom to make us compare Kali bichr. and Lachnanthes. Again, we find
under Lachesis, as a very characteristic symptom, throat and cough symptoms
worse after awaking. The clinical experiment demonstrates that Kali bichr. and
Aralia have the same symptom, and we will now, knowing that this great
aggravation after sleeping is not a key-note for Lachesis, not be easily
disappointed when we carefully compare also other remedies causing and curing
this single important symptom. The lesson we are taught is, that a single
important symptom alone should not be termed a key-note, but a guiding
symptom.
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