THE GRADING OF SYMPTOMS:
- James Tyler Kent
Among the Generals, the symptoms of the first grade are, if well marked,the MENTAL SYMPTOMS. These the highest rank; and a strongly marked mental symptom will always rule out any number of poorly-marked symptoms of lesser grade. (For these may never have appeared in the drug-pathogenesis-perhaps for lack of a sufficiently drastic loving; and yet, time and again, the drug will clear them up). The Mental symptoms, always provide that they are very definite and well marked, are the most important symptoms of the case.
But for the mental symptoms particularly, it is well to go constantly through the Repertory (Mind-section),and to master all that it presents; and to make cross references; sand top be sure that upon get the correct rubric; and often combine two rubrics that practically amount to the same thing, and yet do not give quite the same life of drugs. As, for instance, aversion to company and better alone may not be quite the same thing; and yet it is often difficult to sort them. Again,worse in the dark,and fear of darkness are difficult to fix correctly in many cases; while the elements fear of robbers fear of shots-of apparitions,etc., may come in; so here you have at least four rubrics which you may come in : so here you have at least four rubrics which you may have to combine on pain of missing something. Many of the rubrics much be considered in company, and all with intelligence and so elasticity,or there is great dander of eliminating the very drug you are in search of. And -the better you know your Repertory, the more rapid your work will be, and the better your results. Never grudge turning its pages! Second in grade, after the mental symptoms, and his reactions to mental environment, come, if well marked, such general symptoms of the patient as his reactions, as a whole, to bodily environment:- to times and seasons, to heat and cold, to damp and dry, to storm and tempest, to position, pressure,motion, jar, touch, etc. But they have got to be in capitals or in italics in the patient as well as in the Repertory, to take this rank; or be safely used, some of them, as eliminating symptoms. ("Some of them," because there are perhaps only half-a-dozen symptoms which it is at all safe to use in this way: and then only, of course, if strongly marked) and, once again, be sure that you have your very rubric; and if necessary combine two rubrics that work out practically as synonyms, and yet do not present quite the same list of drugs. A doctor was driven to despair over a case of melancholia by using better for open air instead of desire for open air. The symptoms was so intensely marked that it was used without hesitation as an eliminating symptoms, ruling out Sulphur (which has desire for open air in capitals, but hardly appears in the rubric better for air), but which had every other big symptoms of the case in capitals and which promptly cured. You have got to know your Repertory from cover to cover if you are to have the best results; and you have got to use it with brains and imagination.
The third-grade General symptoms are the CRAVINGS AND AVERSIONS.But to be elevated to such rank, they must not be mere likes ad dislikes, but longings and loathings: in big types in the Repertory, and in the patient in correspondent types. anyhow!
In corresponding types everywhere and all through: and this is most important. As, for instance, if your patient is only a little restless. Ars, and Rhus, superlatively restless remedies, will, of course, by rather contra-indicated. Big types in the Repertory will never help you,. unless the symptoms are big type in the patient too. In first taking the case, it is will to very the type as you set down the symptoms; to out those poorly marked in breakers, and to underline the intensely marked symptoms; for of permanent way,are less vital to the company than the brain quality of its General manager, or the force, that will help you to match them correctly.
Then next in importance comes, in women, the MENSTRUAL STATE, i.e., general aggravation of symptoms before, during and after the menses. Of lower rank comes the question of menses early, late, and excessive-and this last of course only where there is nothing such a polypus, fibroid, menopause, to account for it.
And now, at last, you come to the PARTICULARS-the symptoms that bulk so largely for the patient, and for which he is as a matter of fact, actually consulting you. You will have taken them down first, with the utmost care and detail, listening to his story, and interrupting as little as possible; but you will consider them last;l for these symptoms are really of minor importance from your point of view (certainly in chronic cases) because they re general to the patient as a living whole, but only particular to some part of him In a general railway system, for instance, a strike at raise the price of fuel for a new weeks , and accident on the line that means compensation to the injured, and replacement of rolling stock, and repair of a few yards of permanent way, are less vital to the /company than the brain quality of it's General Manager, or the force, competence and activity of he Chairman and Board of Directors. Make the executive of the Company efficient, and it will deal in the best way with details. In like manner, put your patient, as a whole, in order, and he will straighten out the disorder of his parts. You have got to get at him; and you can only get him though his general and mental symptoms. Start for the Particulars, and see were they land you ! In the body politic, where the executive is not sound, you deal with lax discipline here with peculation there, with incompetence, and disorder, and slackness, and inefficiency. There is rottenness and the core; and you will find that as fast as you clear up one mess; the system breaks low at a new part. Go for the Management;put that right; and let it act. So with your work:- start treating an eczema, per se, and "cure" it, to find yourself confronted with-say asthma; prescribe for that , and the wretched patient comes black presently with a brand new disease Rheumatism: tinker with that- and the heart gives out. Go for the executive-for the patient himself-the patient who was all ailing capable of eczema-asthma-rheumatism: go for the patient as a live entity, revealed by his general and mental symptoms in chief;deal with him according to the Law of Similars and he will do the rest. Always provided that the thing has not gone too far, that the tissue changes are not too gross, he will even undo the rest, step by step backwards, to the reproduction of the initial lesion on the skin. The whole is greater than is part. Never juggle with "Particulars"at the expense of the life of the whole.
But, in their right position of secondary importance, you must go into the particulars all the same, and with great care (if only top confirm your choice of the drug); and it will amaze you to find how they fall into line,when the choice is correct. More than that, when the drug has been chosen on general grounds the patient will return and tell you,not only" I am better., and tit the trouble for which he consulted you is better, but he will volunteer, "My knees are better too, all the swelling has gone", and referring to your notes you discover that you had never heard of his knees before ! and he will go on and tell you that his back (of which you hear now for the first time) is much less painful: and the constipation, which he had not previously mentioned, is a thing of the pasts. (This was a Nitric acid case !)
Among the PARTICULARS, for first-grade symptoms will always be anything peculiar or unusual, or unexpected,o unaccountable,. You now want to know not only how your patient, as a whole, reacts to environment, but how his head, his stomach,his lungs, his muscles and joints stand heat and cold, damp weather and dry react to stuffy atmosphere or draughts, desire or resent movement and jar. You will find one headache being hanged against the wall; while another has to be nursed with such extreme came that the sufferer dare not move finger ,and would swear, if the movement of his lips were not agony, when will demand a bolt upright position; while for a fourth the only thing is to kneel up,while it is pressed low in to the pillow, or against the floor.
Now, to get the terms clearly....A GENERAL SYMPTOM, OR A GENERAL, IS ONE THAT REFERS TO THE PATIENT HIMSELF AS A WHOLE, AND OF WHICH HE CAN SAY "I" instead of "My" "I feel the cold frightfully:" "I dare not move hand or foot in a thunderstorm; and I simply couldn't be long." "This heat is knocking me all to pieces-I just can't stand it !" -these are Generals. In these the patient expenses himself. ?Remember, he is the sum of many life's, building up many tissues, and s of diverse function. Through the Generals:-the Life which very their individual life and vigor,m these the sum of the live and move and have their being;" and with whom,m whatever their individual life and vigor, they parish. Truly the whole is greater than its part. Surely it is scientific to deal with the whole first, as a Whole?
But where your patient says "My" instead of "I" there you have a Particular. "My headache is awful in the house: the only thing for it is to got out a walk about If often drives me out of bed at 2 or d a.m., to walk the Common for hours." (These are not exaggerated statements: we are giving you, all through, actual words of actual patients;and the magic drug for the last was Plus) different,
But the Generals and the Particulars nay not only be quite different, but they may be flat contradictory in the same patient: so you see how imperative it is to get then clearly and to know what value to give to teach. Arsenicum is worse from cold: Ars. stands in the lost of "predominantly cold remedies" in capitals. And yet the headache of Arsenicum is better from cold. ARs., has been described as only comfortable when 'rolled in blankets up to his chin, with his head out of the window" Lycopodium is a warm remedy the main, and often cannot stand heat; yet his stomach symptoms,which are a great feature of the drug, are ameliorated by hot food ad drinks. Of these the patient says not "I," but "My," therefore they are particulars. He may say," I cannot stand heat," (a General of the highest importance, and one of the most safe and useful of eliminating symptoms if strongly marked!) "I cannot stand heat, but my indigestion" (a particular of the greatest importance to the patient, and on which he lays greatest stress) "is better for hot food and drinks. Cold things always disagree with me," (meaning his stomach). Again, Phosphorous stands in capitals as a very cold person.
If you are to be a good prescriber, but the way, your drugs have got to be people for you, with whims, fancies and terrors, with tempers and idiosyncrasies and characteristics: you have got to see them staking about the world, speaking and moving and halting with the bodies-minds-souls of men. You have got to travel with them in tram or train, and they will betray themselves buttoned up and shining together or loose and jolly and open; fidgety, restless, fearful; dull and inert; quarrelling for an open window, growing at the draught with windows closed.
You have got to dine with them, and they will reveal themselves in their relation to food and drink, ad in the mental revelations such convivial moments of relaxation call forth. You may spot hem standing of preference, or sinking always into the nearest seat; stoop shouldered and drooping or erect ad full of "go" depressed and purlieus. restless and anxious, as their deeply; lined faces testify'; smooth and smug; dirty complexioned and careless of appearance chalky faced and flabby of superlative tissue; compact and hard as nails; fault-finding-affectionate and mild-responsive to every wave of sentiment and emotion-dull and indifferent. Look for them everywhere, and learn them, ad they will betray themselves at every turn; and you will often save yourselves hours of solid work, by spotting them as they enter your consulting room.
So, to hard back...Phosphorus is a very cold person,but his stomach is better for old drinks. when that is sick he craves for cold water which is vomited, however, so soon as it gems warm in the stomach. This is a particular, true, but a priceless one, because it is peculiar to phosphorus. And here we have a new term-a "PECULIAR" symptoms,strongly diagnostic of one drug. these peculiar symptoms are especially useful in acute diseases where you are more likely to meet them, and where they often provide a brilliant short cut to the drug, saving time and toil. And see how these peculiar unaccountable, contradictory symptoms help you how unexpected they are, and how diagnostic! Here you have the superlatively chilly Phosphorous and yet his pains are often of the most intensely-burning description: and though, as a whole, he cannot tolerate cold, yet his sick stomach craves for icy drinks, which it cannot even retain when they get warm! Take your Generals and Particulars mixed up and aware and just any how., and you might land in giving such a patient Lycopodium; for both are worse for heat, ad worse for cold only the Generals and Particulars are exactly reversed! for Lycopodium is in the remain, intolerant of heat, which his stomach craves; while Phosphorous detests the cold which his such stomach demands with vehemence. ?See how all-important it is target your Generals and Particulars right! This is where we fail, and blame Homeopathy.
Then, besides Kent's Generals and Particulars, you have COMMON SYMPTOMS. A symptoms nay be common to all cases of a certain disease,m and therefore of nt. great use in picking out the individual remedy for a particular case of that disease or it may be common to a very great number of drugs, and therefore indicate one of a large group of remedies only, and so of very little use in repertorising. Take thirsty, a general symptom of the patient, though in the Repertory relegated to the section :Stomach": "I am terribly thirst." If there is nothing to account for the thirst, it may be an important symptom; though common to a great number of drugs! But if the patient is running a high temperature , or suffering from diabetes, of it his work keeps him in the heat of bakehouse or an engine-rom, of of the weather is suddenly and unusually host, the symptom becomes becomes a Common symptom, and almost valueless., Don't waste life in writing down that awful list of remedies' Thirsty,.:" absence of thirst under conditions where you would except it, on the contrary, becomes a very important symptom; as absence of thirst with a very high temperature Kent has a rubric for that. Remember-THE MORE UNCOMMON A SYMPTOM IS, THE MORE VALUABLE: THE LESS YOU CAN ACCOUNT FOR A SYMPTOM AND THE MORE INTENSELY PERSONAL IT IS, THE MORE IMPORTANT.
In inflammation, for instance, worse from pressure is what one would expect, and of little value-so many drugs and most inflammations have it ! But better from pressure, under these circumstances, is priceless; and leads you to small group of drugs, such a Bryonia. Frequent maturation with a fibroid impacted in the pelvis is not a symptom that will help you in working out your case; it is a Common symptom and amply accounted for ... and this leads one to insist on the absolute necessity for correct diagnosis before you even open your Repertory. Remember, the priceless symptoms for success are the strange,m the rare, the unaccountable ones; those that flatly contradict preconceived ideas, and head off straight for a limited number of drugs.
Among the Generals, the symptoms of the first grade are, if well marked,the MENTAL SYMPTOMS. These the highest rank; and a strongly marked mental symptom will always rule out any number of poorly-marked symptoms of lesser grade. (For these may never have appeared in the drug-pathogenesis-perhaps for lack of a sufficiently drastic loving; and yet, time and again, the drug will clear them up). The Mental symptoms, always provide that they are very definite and well marked, are the most important symptoms of the case.
But for the mental symptoms particularly, it is well to go constantly through the Repertory (Mind-section),and to master all that it presents; and to make cross references; sand top be sure that upon get the correct rubric; and often combine two rubrics that practically amount to the same thing, and yet do not give quite the same life of drugs. As, for instance, aversion to company and better alone may not be quite the same thing; and yet it is often difficult to sort them. Again,worse in the dark,and fear of darkness are difficult to fix correctly in many cases; while the elements fear of robbers fear of shots-of apparitions,etc., may come in; so here you have at least four rubrics which you may come in : so here you have at least four rubrics which you may have to combine on pain of missing something. Many of the rubrics much be considered in company, and all with intelligence and so elasticity,or there is great dander of eliminating the very drug you are in search of. And -the better you know your Repertory, the more rapid your work will be, and the better your results. Never grudge turning its pages! Second in grade, after the mental symptoms, and his reactions to mental environment, come, if well marked, such general symptoms of the patient as his reactions, as a whole, to bodily environment:- to times and seasons, to heat and cold, to damp and dry, to storm and tempest, to position, pressure,motion, jar, touch, etc. But they have got to be in capitals or in italics in the patient as well as in the Repertory, to take this rank; or be safely used, some of them, as eliminating symptoms. ("Some of them," because there are perhaps only half-a-dozen symptoms which it is at all safe to use in this way: and then only, of course, if strongly marked) and, once again, be sure that you have your very rubric; and if necessary combine two rubrics that work out practically as synonyms, and yet do not present quite the same list of drugs. A doctor was driven to despair over a case of melancholia by using better for open air instead of desire for open air. The symptoms was so intensely marked that it was used without hesitation as an eliminating symptoms, ruling out Sulphur (which has desire for open air in capitals, but hardly appears in the rubric better for air), but which had every other big symptoms of the case in capitals and which promptly cured. You have got to know your Repertory from cover to cover if you are to have the best results; and you have got to use it with brains and imagination.
The third-grade General symptoms are the CRAVINGS AND AVERSIONS.But to be elevated to such rank, they must not be mere likes ad dislikes, but longings and loathings: in big types in the Repertory, and in the patient in correspondent types. anyhow!
In corresponding types everywhere and all through: and this is most important. As, for instance, if your patient is only a little restless. Ars, and Rhus, superlatively restless remedies, will, of course, by rather contra-indicated. Big types in the Repertory will never help you,. unless the symptoms are big type in the patient too. In first taking the case, it is will to very the type as you set down the symptoms; to out those poorly marked in breakers, and to underline the intensely marked symptoms; for of permanent way,are less vital to the company than the brain quality of its General manager, or the force, that will help you to match them correctly.
Then next in importance comes, in women, the MENSTRUAL STATE, i.e., general aggravation of symptoms before, during and after the menses. Of lower rank comes the question of menses early, late, and excessive-and this last of course only where there is nothing such a polypus, fibroid, menopause, to account for it.
And now, at last, you come to the PARTICULARS-the symptoms that bulk so largely for the patient, and for which he is as a matter of fact, actually consulting you. You will have taken them down first, with the utmost care and detail, listening to his story, and interrupting as little as possible; but you will consider them last;l for these symptoms are really of minor importance from your point of view (certainly in chronic cases) because they re general to the patient as a living whole, but only particular to some part of him In a general railway system, for instance, a strike at raise the price of fuel for a new weeks , and accident on the line that means compensation to the injured, and replacement of rolling stock, and repair of a few yards of permanent way, are less vital to the /company than the brain quality of it's General Manager, or the force, competence and activity of he Chairman and Board of Directors. Make the executive of the Company efficient, and it will deal in the best way with details. In like manner, put your patient, as a whole, in order, and he will straighten out the disorder of his parts. You have got to get at him; and you can only get him though his general and mental symptoms. Start for the Particulars, and see were they land you ! In the body politic, where the executive is not sound, you deal with lax discipline here with peculation there, with incompetence, and disorder, and slackness, and inefficiency. There is rottenness and the core; and you will find that as fast as you clear up one mess; the system breaks low at a new part. Go for the Management;put that right; and let it act. So with your work:- start treating an eczema, per se, and "cure" it, to find yourself confronted with-say asthma; prescribe for that , and the wretched patient comes black presently with a brand new disease Rheumatism: tinker with that- and the heart gives out. Go for the executive-for the patient himself-the patient who was all ailing capable of eczema-asthma-rheumatism: go for the patient as a live entity, revealed by his general and mental symptoms in chief;deal with him according to the Law of Similars and he will do the rest. Always provided that the thing has not gone too far, that the tissue changes are not too gross, he will even undo the rest, step by step backwards, to the reproduction of the initial lesion on the skin. The whole is greater than is part. Never juggle with "Particulars"at the expense of the life of the whole.
But, in their right position of secondary importance, you must go into the particulars all the same, and with great care (if only top confirm your choice of the drug); and it will amaze you to find how they fall into line,when the choice is correct. More than that, when the drug has been chosen on general grounds the patient will return and tell you,not only" I am better., and tit the trouble for which he consulted you is better, but he will volunteer, "My knees are better too, all the swelling has gone", and referring to your notes you discover that you had never heard of his knees before ! and he will go on and tell you that his back (of which you hear now for the first time) is much less painful: and the constipation, which he had not previously mentioned, is a thing of the pasts. (This was a Nitric acid case !)
Among the PARTICULARS, for first-grade symptoms will always be anything peculiar or unusual, or unexpected,o unaccountable,. You now want to know not only how your patient, as a whole, reacts to environment, but how his head, his stomach,his lungs, his muscles and joints stand heat and cold, damp weather and dry react to stuffy atmosphere or draughts, desire or resent movement and jar. You will find one headache being hanged against the wall; while another has to be nursed with such extreme came that the sufferer dare not move finger ,and would swear, if the movement of his lips were not agony, when will demand a bolt upright position; while for a fourth the only thing is to kneel up,while it is pressed low in to the pillow, or against the floor.
Now, to get the terms clearly....A GENERAL SYMPTOM, OR A GENERAL, IS ONE THAT REFERS TO THE PATIENT HIMSELF AS A WHOLE, AND OF WHICH HE CAN SAY "I" instead of "My" "I feel the cold frightfully:" "I dare not move hand or foot in a thunderstorm; and I simply couldn't be long." "This heat is knocking me all to pieces-I just can't stand it !" -these are Generals. In these the patient expenses himself. ?Remember, he is the sum of many life's, building up many tissues, and s of diverse function. Through the Generals:-the Life which very their individual life and vigor,m these the sum of the live and move and have their being;" and with whom,m whatever their individual life and vigor, they parish. Truly the whole is greater than its part. Surely it is scientific to deal with the whole first, as a Whole?
But where your patient says "My" instead of "I" there you have a Particular. "My headache is awful in the house: the only thing for it is to got out a walk about If often drives me out of bed at 2 or d a.m., to walk the Common for hours." (These are not exaggerated statements: we are giving you, all through, actual words of actual patients;and the magic drug for the last was Plus) different,
But the Generals and the Particulars nay not only be quite different, but they may be flat contradictory in the same patient: so you see how imperative it is to get then clearly and to know what value to give to teach. Arsenicum is worse from cold: Ars. stands in the lost of "predominantly cold remedies" in capitals. And yet the headache of Arsenicum is better from cold. ARs., has been described as only comfortable when 'rolled in blankets up to his chin, with his head out of the window" Lycopodium is a warm remedy the main, and often cannot stand heat; yet his stomach symptoms,which are a great feature of the drug, are ameliorated by hot food ad drinks. Of these the patient says not "I," but "My," therefore they are particulars. He may say," I cannot stand heat," (a General of the highest importance, and one of the most safe and useful of eliminating symptoms if strongly marked!) "I cannot stand heat, but my indigestion" (a particular of the greatest importance to the patient, and on which he lays greatest stress) "is better for hot food and drinks. Cold things always disagree with me," (meaning his stomach). Again, Phosphorous stands in capitals as a very cold person.
If you are to be a good prescriber, but the way, your drugs have got to be people for you, with whims, fancies and terrors, with tempers and idiosyncrasies and characteristics: you have got to see them staking about the world, speaking and moving and halting with the bodies-minds-souls of men. You have got to travel with them in tram or train, and they will betray themselves buttoned up and shining together or loose and jolly and open; fidgety, restless, fearful; dull and inert; quarrelling for an open window, growing at the draught with windows closed.
You have got to dine with them, and they will reveal themselves in their relation to food and drink, ad in the mental revelations such convivial moments of relaxation call forth. You may spot hem standing of preference, or sinking always into the nearest seat; stoop shouldered and drooping or erect ad full of "go" depressed and purlieus. restless and anxious, as their deeply; lined faces testify'; smooth and smug; dirty complexioned and careless of appearance chalky faced and flabby of superlative tissue; compact and hard as nails; fault-finding-affectionate and mild-responsive to every wave of sentiment and emotion-dull and indifferent. Look for them everywhere, and learn them, ad they will betray themselves at every turn; and you will often save yourselves hours of solid work, by spotting them as they enter your consulting room.
So, to hard back...Phosphorus is a very cold person,but his stomach is better for old drinks. when that is sick he craves for cold water which is vomited, however, so soon as it gems warm in the stomach. This is a particular, true, but a priceless one, because it is peculiar to phosphorus. And here we have a new term-a "PECULIAR" symptoms,strongly diagnostic of one drug. these peculiar symptoms are especially useful in acute diseases where you are more likely to meet them, and where they often provide a brilliant short cut to the drug, saving time and toil. And see how these peculiar unaccountable, contradictory symptoms help you how unexpected they are, and how diagnostic! Here you have the superlatively chilly Phosphorous and yet his pains are often of the most intensely-burning description: and though, as a whole, he cannot tolerate cold, yet his sick stomach craves for icy drinks, which it cannot even retain when they get warm! Take your Generals and Particulars mixed up and aware and just any how., and you might land in giving such a patient Lycopodium; for both are worse for heat, ad worse for cold only the Generals and Particulars are exactly reversed! for Lycopodium is in the remain, intolerant of heat, which his stomach craves; while Phosphorous detests the cold which his such stomach demands with vehemence. ?See how all-important it is target your Generals and Particulars right! This is where we fail, and blame Homeopathy.
Then, besides Kent's Generals and Particulars, you have COMMON SYMPTOMS. A symptoms nay be common to all cases of a certain disease,m and therefore of nt. great use in picking out the individual remedy for a particular case of that disease or it may be common to a very great number of drugs, and therefore indicate one of a large group of remedies only, and so of very little use in repertorising. Take thirsty, a general symptom of the patient, though in the Repertory relegated to the section :Stomach": "I am terribly thirst." If there is nothing to account for the thirst, it may be an important symptom; though common to a great number of drugs! But if the patient is running a high temperature , or suffering from diabetes, of it his work keeps him in the heat of bakehouse or an engine-rom, of of the weather is suddenly and unusually host, the symptom becomes becomes a Common symptom, and almost valueless., Don't waste life in writing down that awful list of remedies' Thirsty,.:" absence of thirst under conditions where you would except it, on the contrary, becomes a very important symptom; as absence of thirst with a very high temperature Kent has a rubric for that. Remember-THE MORE UNCOMMON A SYMPTOM IS, THE MORE VALUABLE: THE LESS YOU CAN ACCOUNT FOR A SYMPTOM AND THE MORE INTENSELY PERSONAL IT IS, THE MORE IMPORTANT.
In inflammation, for instance, worse from pressure is what one would expect, and of little value-so many drugs and most inflammations have it ! But better from pressure, under these circumstances, is priceless; and leads you to small group of drugs, such a Bryonia. Frequent maturation with a fibroid impacted in the pelvis is not a symptom that will help you in working out your case; it is a Common symptom and amply accounted for ... and this leads one to insist on the absolute necessity for correct diagnosis before you even open your Repertory. Remember, the priceless symptoms for success are the strange,m the rare, the unaccountable ones; those that flatly contradict preconceived ideas, and head off straight for a limited number of drugs.
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