- '-' **r "%»^ **2 "2> *■'<£ ^ >>t*^-«^.-w > > :> ^>>-=-___ > V> > £jO*>£* > • > .: > > j> ^at>* > •» > ^ > »3E> ^> > > I o ^ > > »>,» » :> > ^ >> ^ .» >'-> >o »> >-< ^ >» > > ^>^ - t>yj> _> > >;> >;>o .> »> ■ „^> > > r> ^>; ;^ 3 ^> > i > r^> .»> > » as> > * *>iS& > >» _ ^ > -> -> •» » . j^ >>: ' ^> ^ "> ». ^ ^i > y> -> >> 3 > > > i)J > >^> > 5). 5 % - > >> > Surgeon General's Office | SUBJECTIVE OBJECTIVE SYMPTOMS. PRELIMINARY LECTURE DELIVERED AT THE Hahnemann Medical College, OF PHILADELPHIA; BY C. . Dear Sir: The undersigned, having been appointed for the purpose, at a meeting of the Students of the Hahnemann Medical College, of Philadel- phia, on the 26th inst., would respectfully re- quest for publication, a copy of your Lecture, on Subjective and Objective Symptoms, delivered before them on the 29th ult.; in order that the ideas and suggestions therein contained may be. the more widely diffused and carefully studied. Very Ilespectfully, A. C. REMBAUGH, Pa. ^j W. R. REUD, Pa. A. C. COWPERTHWAIT, 111. j> GOJIJUQ.Q.EE. V. F. ALEXANDER, Md. I T. S. DUNNING, Del. J Philadelphia, October 30, /868. Gentlemen: Agreeably to the request expressed in your kind note of the 29th inst., I herewith place at your disposal the desired manuscript. Tours, Very Respectfully, C. G. RATJE. Qo J£essrs. A. G. REMBAUGH, W. R. REUD, A. C. COWPERTHWAIT, V. F. ALEXANDER, T. 'S. DUNNING. LECTURE. Gentlemen: I shall speak to-day on the subject of Sub- jective and Objective Symptoms. I find there is still considerable confusion of ideas, concerning not only the nature of these symptoms, but also their relative importance and use. For instance, the old school of medicine never knew the value of subjective symptoms, nor did she ever learn to make any use of them. Directing all her force of attention upon the elucida- tion of objective signs, as means of diagnosis, she has been all the while treating subjective symptoms with a kind of contempt and—opium. For, when a patient complains of this or another pain, what does it matter to the physiological Doctor ! it is a mere subjective feeling, imagination, it may be—the doctor can not see it, neither does he feel it; it is not worth anything, at least '•'•for making out a Diagnosis." Only, if it should by its stubborn severity and by the patient's impatience overcome his contempt, then, of course, he would treat it with—opium. On the other side, there are Physicians—Homoeopathic Physi- cians—who neglect the investigation of objective signs, "because," they say, " they are not worth anything, at least for the selec- tion of the remedy ;" and thus it happens, that they find in their practice a great number of "inflammations" in all possible organs, because a great number of their patients happen to suffer with some acute pain here or there, and that, of course, must be inflammation; and they cure such inflammations and other terrible afflictions, such as tuberculosis, cancer or the like, with astonishing ease and remarkable success. Now, gentlemen, such bosh will not pass in this age; such wild stories are no longer believed; and we see by this, that the one party are as faulty as the other. The real Physician will have to pay as much attention to the one series of symptoms as 4 to the other; and in order that we may gain a clear insight into this matter, let us first examine more closely subjective symptoms. What are they ? None of us have any recollection of our first years of exis- tence. Only gradually does the child become cognizant of the things around it. When it is born, the only evidence of its higher nature which it discovers, are the faculties of seeing, hearing, touch- ing, smelling, tasting, and feeling. These faculties, termed Senses, we may call primal faculties; because they are not only the first manifestations of the interior being, the human soul, but also the basis whereupon all subsequent developments of the mind grow. This I will delineate as briefly as possible, and as fully as is necessary for our present purpose. The new-born child opens its eyes, and the light from the different objects around, pours into them; sounds fill its ears; its little hands come in contact with different external things; it tastes and smells; in short, it commences to use all its senses. By and by, we observe that in this way the child gains a know- ledge or consciousness of certain things which it knew not before; and if we observe closely, this consciousness of things grows clearer in the ratio in which the things act upon its senses; that is to say, the oftener the same external elements, as they go forth from a certain object, combine with correspond- ing primal faculties of the child, the clearer and stronger grows the consciousness of that object. Hence, first of all, the child learns to know its mother, because from her it receives its first and most varied impressions—provided she nurses it. Thus we find that notwithstanding the multitude of external elements, and their incongruous nature, which occupy the child's senses, never- theless, it does not become confused by them; because these im- pressions unite strictly according to their similarity, and form in this way, if I may say so, bundles of similar impressions, or units, consisting of more or less numerous combinations of similar external elements and corresponding primal faculties. For, this is the inner law; our senses constantly receive external impres- 5 sions and keep them ; and all the following impressions constantly unite with them as far as they are similar to them. By this law, inner order is at once established, for, no matter how indiscriminately external impressions may pour upon our senses, as in fact they do, they do not mix and mingle ad libitum, but unite strictly according to their similarity, and in this way constitute homogeneous compounds, which are lucid and clear in proportion to the multitude of their combinations. Thus, we may say that the origin of man's consciousness de- pends upon these two causes : 1. The existence in man of primal faculties to receive external elements, and to retain them, and— 2. The law of attraction of like to like ;—by which the single combination between a certain external element and a primal faculty is multiplied by repetition to an aggregate of any strength and clearness of consciousness. This is one form of consciousness, directly opposite to that state of man, wherein he has no consciousness at all; as in the case of a new-born child whose primal faculties have never yet received any external elements or impressions. To this first form we may add a second:—consciousness in its transitory state. Whilst we are pondering over this subject, we are totally un- conscious of what may have interested our minds yesterday; and an hour from now, your attention will be attracted in alto- gether a different direction. Thus our consciousness changes constantly from one object to another; now slowly and deeply, now more hastily and lightly; sometimes like a contrary child, not bringing forth what we would like to remember, and again playing with all sorts of old and long forgotten things, which we do not care about. You see at once that this is altogether a different view of the subject. It is no longer the question, how does consciousness originate in the soul; but, how does that constant change between consciousness or unconsciousness come to pass ? or how do ideas, which we already possess, be- come conscious ones ; and if once in that state, how do they get out of it again ? 6 To this the Psychologists of the old school—for you must know, that there is also in Psychology, as in medicine, an old and a new school—answer by simply using a metaphor:—"our ideas wake up and go to sleep." This answer, however, incites the question: By what do they get awakened and why do they go to sleep ? But to these questions you find no satis- factory answer in the old Psychology; just as there was before Hahnemann, no answer to the question: why does China cure some intermittent fevers, and not others ? The old school in her explanation has net reached to the elements of these pro- cesses. The new school has looked for these elements and the founder of it, Dr. Edward Benecke, who was Professor at the University of Berlin, has analyzed these questions in the clear- est and most admirable manner. You will not expect me to go into full details here. For our purpose it is sufficient to know: that consciousness originates through a multiplication of similar impressions upon our senses; or, as we have otherwise expressed it, by a repeated union of similar external elements with corre- sponding primal faculties. What at first is a mere vague sensation, grows by degrees, through repetition, to a full, conscious idea; thus each following similar element, as it unites with those similar elements previ- ously combined, must necessarily find them, hit them, give them a new impulse; in short, set them into new motion; that is, make them conscious again. Each moment of our life bears testimony to these facts. I look at an object, and at once all former similar impressions of that object, or similar objects, spring into my consciousness; I recognize it at once ; but if it is a thing which I never saw be- fore, it surely does not appear like an old acquaintance to me. This is one way in which consciousness is excited, but it is not the only way. For example, I want to remember a name, a fact, any thing, that does not now act by its elements upon my senses; for, if it did, I would not need to remember. What am I to do ? 7 So much is certain : if it cannot be reached by external ele- ments because they are wanting, I must try to get at it by something internal. What could that be ? Remember that consciousness grows out of a union of exter- nal elements with corresponding primal faculties. Now, if ex- ternal elements hit and set into new motion their similar aggre- gates, why should not also primal faculties, as the first consti- tuent basis of consciousness, have the same capability? Just in the same way as these faculties combine with external ele- ments, so do they also combine with already formed units, and excite them into new motion or consciousness; and then we have a voluntary excitation into consciousness. There are two wavs then, in which unconscious aggregates are set into motion: 1. By means of external elements ; as, according to the law of attraction of like to like, they hit upon the already formed similar aggregates, producing an involuntary excitation into consciousness. 2. By means of primal faculties or internal elements ; as they seek and, by a voluntary act, excite those aggregates, which we wish to remember. Now arises the question: How do aggregates, once excited into consciousness, become unconscious again ? I suppose the axiom—no effect without a cause—ob- tains in this as in every other case. Where there is motion, there must be a moving element, and if this element is taken away, motion ceases. If now, as we have seen, consciousness in its transitory state is nothing but motion of previously formed aggregates, caused either by external or internal elements, it is clear that this mo- tion must cease, as soon as these moving elements cease to flow to them; the excitement ceases, and the aggregate, recently excited, now becomes motionless; id est, unconscious. Thus the flood of our thought, coming and going, moves on, even in dreams, in accordance with unchangeable laws. I come now to speak of a third form of consciousness, the consciousness which we have of our mental developments, or self- perception. 8 Before we can obtain a clear idea of this form, however, we must have a clear understanding of what we mean by external perception. I perceive this book; what does it mean ? It means first: I see a something, which is square, of a certain length, breadth, and thickness, and which consists of single printed leaves. It may mean, I hear, it;—if somebody rustles its leaves. It may mean, I feel it;—if it comes in contact with my hands, and, through the sense of touch, I receive impressions of a thing of a certain length, breadth, and thickness, and which consists of single leaves and a cover. It may even mean, I smell it; if the peculiar odor of its paper, or the bookbinder's paste reaches my nose. In all these cases, certain external elements, which come from the book, combine with corresponding primal faculties, which belong to myself; and in each case, the last perhaps ex- cepted, this combination will cause in me the distinct idlea of a book. Now suppose we try this experiment before the senses of a new-born child. Will it cause in it the idea of a book ? Surely not! But if we try it with a child two or three years old, the idea will be received. Why ? what is the difference ? Do not the same external elements act upon the same corresponding primal faculties ? Certainly, they do ! But in the new-born child, they act for the first time ; whilst in the older child, they may have already acted many hundred times. If now, as we have seen, all similar impressions combine with each other in one aggregate; and if, as we likewise have seen, in this multiplication of similar impressions consist the strength and clearness of consciousness of such aggregates, it follows: that in the case of a child two or three years old the present impression of the book finds already so many hundred combined similar impressions, which by their developed consciousness make this new impression at once a conscious act; the child recognizes this thing at once as a book ; whilst in the case of a new-born child, no such combination exists, and the present im- 0 pression causes merely a sensation, without any noticeable sign of consciousness. This is the difference; and we learn, that in order to perceive a thing, it is not only necessary that external elements should act upon our senses, but that previously attained, similar aggre- gates should also come from ivithin to the new impression, and shed their light of consciousness upon it. For this very reason we do not preceive what may happen around us, if our attention be attracted by other objects; if, in short, the previously at- tained aggregates do not meet from within, or do not combine with the present impression, and it explains the remarkable fact, that some lunatics do not notice even a pistol fired close to their ears. To perceive a thing, then means:—The present external impres- sion must be met by, and combine with previously acquired aggre- gates of similar impressions from within ; in which case the new, single impression participates in all the light of consciousness that is contained in this aggregate. This is the nature of ex- ternal perception. We may now, also, easily understand the nature of internal, or self-perception. Loner before a child becomes aware of the fact that it thinks, wishes or feels, it has performed all these mental acts repeatedly. It has gained in the course of time, a number of Ideas, has per- formed a number of conclusions, has wished and rejected, felt joy and sorrow a number of times. All these different Ideas which the child has gradually gained, however they may differ amongst themselves, have nevertheless certain similarities which are common to all; and these similari- ties of all the Ideas again unite, according to the law of attrac- tion of like to like, and form a new unit, which we call the notion of an idea; containing the simile in a combination, manifold according as single ideas have by their simile, repeatedly entered into its construction. So, out of all the different acts of the will, the simile, which is common to each particular act, as an act of the will, unites again and forms a new unit which we call the notion of an act 10 of the will, containing the simile in a combination, manifold according as single acts of the will have entered their simile to its construction. So it is with all the different feelings, in short, with any and all mental actions and processes. As far as they are similar, this simile unites and forms new units or notions of mental developments. Now, let us suppose that we are performing one of these men- tal-acts, and further, that to it the notion which originated out of the simile of all such formerly performed similar acts, becomes excited into simultaneous consciousness. What effect will that have ? Undoubtedly this : the notion of such acts will add its concentrated light of consciousness to this present single act, and we shall perceive at once, that what we are now performing mentally, is either an act of thinking, wishing or feeling, as the case may be. Thus, in order to have an internal perception, the the following conditions must be present: 1. We must have already performed a number of mental acts. 2. The simile of all similar mental acts must have united in one aggregate of consciousness or in a notion of such acts ; and lastly, this notion must become excited into consciousness simultaneously with the single act which we want to perceive. Hence, you see that external and internal perception are mental processes of nearly the same nature. In either case there must exist previously acquired aggregates, from which the single present impression or process receives its light of consciousness- The difference between these processes, however, is this: the former receives impressions from external objects, whilst the latter finds its objects within the mind itself. It is thought, as a general thing, that external perceptions far exceed in clearness and exactness all internal perceptions; and this may, indeed, be true, if we confine it to the case of children, and that vast majority of men, who as for as mental growth and perfection are concerned, remain children all their lives. This belief is even the deepest foundation-stone of the materialistic school, when it endeavors to show that all mental action is but the result of certain bodily functions. They compare, for example, the 11 act of thinking to the act of burning phosphorous in the brain, m which light the brain is made to appear like a self-burning phos- phorous-box of Yankee style,—and this same belief also, lies at the bottom of the hasty declaration of a certain Dr. Kurtz, " that our materia medica ought to be stripped of all subjective symptoms! " But, the question is, is this opinion founded upon the inner nature of perception, either external or internal? Or, must external perceptions always and necessarily, according to their nature, excel in clearness all internal perceptions ? Consider for example, the external perception which we may obtain of gold. We perceive it yellow, of metallic lustre, hard, malleable, of different forms, coined and worked, and chemically as soluble or not soluble, as having affinity to certain things and none to others. With all this do we perceive the nature of gold ? To be sure, as far as it goes; but I need only remind you of the totally new views we have obtained by Hahnemann's provings of this metal, to show you how inadequate was the notion obtained. And does this exhaust our knowledge, actual or possible, of gold ? It seems not, for besides what may be dis- covered about it in future, our external perception gives us no clue as to why gold is yellow, why it is malleable, why it has an affinity for some things and none for others. This is the case with all external perceptions. We perceive external things only so far as they are capable of affecting our senses. The finer our senses the more and better do we per- ceive, and since the discovery of telescopes, microscopes and spectroscopes our views have been considerably enlarged, both towards the infinite magnitude as well as towards the infinite smallness of things. But notwithstanding all these auxiliaries, we do not perceive anything but the qualities which objects exhibit to our senses. To other, and still finer senses, they would appear very differently, in short, our external perceptions are altogether limited by the nature of our senses. What lies beyond the re- gion of the senses, we can never reach by them. Into the inner 12 nature of a thing they never penetrate, because this thing for- ever remains another being, another essence, never wholly assimilable by our senses. The case is altogether different with our internal perception. For, if you remember what we have learned of its nature, viz : —that it is the conscious co-existence between a single mental act which we now perform, and the aggregate which consists of the simile of all such previously performed similar acts, shedding all its concentrated light of consciousness upon the former; then you may at once see, that in this process nothing is intervening, neither senses nor outward objects; that it is a perceiving of itself and by itself—a self-perception, showing the thing as it is, and not simply as it appears. Can such a process yield less clearness, or less exactness, than external perception ? Surely not, if the perceiving aggregate is a unit of equally strong com- position. Hence, from the nature of perception, it follows that internal perception is capable, not simply of the same clearness and lucidity as external perception, but that it even excels the latter by yielding a knowledge of Identity between what perceives and what is perceived; whilst the latter gives only a knowledge of effects and appearances. Why then is it generally considered that external perception gives greater clearness and exactness than internal perception ? Simply because external perceptions are performed not only much earlier in life, but also much more frequently, both by children and by a majority of adults. Hereby they attain stronger ag- gregates ; and consequently, greater clearness of external per- ception. If we look for the first time through a microscope, what do we perceive ? Very little indeed to the purpose. It requires practice; that is, a formation of such aggregates by repetition, as are capable of adding light to the new impression. And so is it with self-perception; it must be learned by practice. Hence the supposed greater clearness of external perception has no foundation in its nature ; but is, if it exist at all, the 13 consequence solely of greater practice, a condition which heightens the quality of the one as much as the other. We come now to the question: how far does self-perception extend ? Answer : as far as consciousness extends. Consciousness originates, as we have seen, out of a combina- tion of primal faculties with corresponding external elements, in accordance with certain laws of the mind. If we consider the different primal faculties or senses, we find that the products, which we gain by sight and hea7'ing, possess a far greater clear- ness of consciousness than the aggregates which we obtain by means of the other senses. In fact, all science is based upon knowledge possessed by the exercise of these two senses. Next comes the sense of touch. It, too, is capable of great perfectibility, as we may observe in those unfortunates, the blind, or those both blind and deaf. The senses of smell, taste, and general feeling, are of a much lower order. Their products never attain that point of clearness, which is necessary for scientific constructions. No one, for instance, has yet succeeded—not even the great Linneus—in classifying flowers according to their smell and taste; because these senses do not yield products sufficiently clear and distinct for such purpose. Still lower in degree, as regards their capability of develop- ing consciousness, we find those primal faculties, by which we get cognizance of the organs and functions of respiration and circulation, which faculties seem to follow, best in order the sense of smell; and such faculties, as rule digestion, seemingly conjoined to the sense of taste, and also those by which we no- tice the actions of muscles, etc., joining the common sense of feeling. Although we take but little notice of these faculties, as long as they act normally, still they may become—by excitement of those organs—so prominent in our consciousness, as to over- shadow and hinder higher mental developments ; as any one who has suffered with Asthma, Colic, or Rheumatism, can readily testify. 14 Thus we may consider our whole being as a union of different systems of intimately connected primal faculties ; which, al- though marked by a gradual decline as to their capability of developing consciousness, are nevertheless all capable of doing so in some degree; and thus our whole organism is accessible to self-perception. Hence we clearly possess two different and distinct ways of observation : one by means of external, and the other by means of internal perception; and these two ways constitute the two different series of symptoms, which are known under the name of objective and subjective symptoms. It was Hahnemann who first pursued, by the closest observa- tion, both series of symptoms; the latter of which had been totally neglected by physicians up to his time ; and are still neglected by all sects of medical schools up to this very day— except by the true Hahnemannian. Why ? Because they could not and cannot make any use of them as diagnostic means, and they did not and still do not understand how to apply them as Hahnemann did for healing purposes. Unlucky and hurtful as their treatment had frequently proved itself, the inquiring minds amongst them despairingly gave up all medicines and concen- trated their energies into that one purpose, of unravelling the question: What is the matter ? hoping in this way to find the remedies which would cure. We all have reasons to be grateful to those men, who by united efforts, unremitting industry and great talent, have brought the science of Pathology to a perfection which it never had before, even if they did fail to discover the true mode of cure. What is the matter ? and What will cure ? are two entirely separate and unrelated questions, which stand in no causal con- nection to each other whatever. The question, tvhat is the mat- ter ? requires for its solution a cognition of abnormal states and conditions in the organism, which lie open to external perception, and so far as we can get hold of them by means of mediate or immediate inspection, auscultation, percussion, palpation and chemical processes, just so far are we enabled to make a sure 15 diagnosis,—or to know with certainty, what is the matter. But in cases in which these abnormal conditions of the organism are hidden, and out of the reach of external perception, there we stand before a shut-up box, the contents of which, we may guess at, but do not know, until we open the box,—post-mortem. There- fore, most brain diseases yield an uncertain diagnosis, and in some of them no diagnosis is possible until after death. In answering the question: what is the matter ? therefore, Ave stand entirely upon the ground of external preception, or objective symptoms. What ivill cure ? is another question. Abnormal conditions, morbid products, are not primitive changes, but results of a whole chain of morbid actions and processes in the living organism. A change in these processes must of necessity cause a change in their morbid products; either altering, checking or extinguish- ing them,—or preventing their growth altogether. But we know, a removal of these products, even if that can be effected, does not alter the morbid actions which produced them. Re- member, the converse of the proposition—Remove the cause, and the effect ceases,—is not true. If we wish to cure, therefore, we have to look deeper;—not to the morbid products, but to those morbid actions which cause them. Here then, we stand upon entirely different ground; be- fore a temple, to enter the sanctuary of which, neither micro- scopical nor chemical analysis furnishes us a key. These actions and processes of the living organism lie out of the reach of all objective, ocular, aural or manual investigations ; in the hidden laboratory of life, and are accessible only to internal or self- perception. Their utterances are subjective symptoms;—those primitive signs of abnormal actions, which eventuate in struc- tural changes and alterations which then become objective, that is, perceiveable by the senses. But as such, they lie far off from the primitive affection, of which we become cognizant only by self-perception. Internal perception then, is the only means, by which we can get at the root,—the starting point of so-called diseases ; and this is the reason why Hahnemann considered the 16 subjective symptoms-much more important in selecting the cura- tive remedy, than all other symptoms, and speculations about the essence of disease. And it also explains, why symptoms, which'are of the most importance for diagnostic purposes, are of little or no value to the homoeopathic physician, for the pur- pose of selecting the curative remedy. What is the matter ? is to be answered by the Diagnostician through close examination of all objective symptoms. What will cure ?—requires a minute investigation into the subjective symptoms : and herein consists the fundamental dif- ference between true Homoeopathy and all other systems of thera- peutics. But, there are objective symptoms, which quite characteristi- cally point out the curative remedy;—these are mostly the result of practical experience. And there are, on the other hand, subjective symptoms, which are of the highest importance for the purpose of diagnosis, and these are generally de- ductions from post-mortem examinations. It shall be my en- deavor to point them out to you in their respective places and thus establish a connecting link between Diagnosis and Thera- peutics. "But further deponent saycth not." Homoeopathic Therapeutics is the Materia Medica. Stez ■» C CX «££ < C <"'■*. <- c. c Cc r C < C CCC C( c« ; c< c ccc cc c< C C_ Cc C Cc .cc C c t Cc < V*c " c CC Cc . ^c C * C cc c c C 4 ccC c c C cc ^ «:« C c C ■ tr Sr^rt <~ C C C C c cc < V«CC C c - c cc jr« c C CC Cc c c CC Cc ' C cc c? ^^V*cCc ^ Vc fCfcC C c c .c C C l c c C C C C c cc < C CCCc. *r C CCCC