APHORISM 100

kent says "Keep that in your mind, underscore it half a dozen times with red ink, paint it on the wall, put an index finger to it."

One of the most significant things is to keep out of the mind, in an examination of the case, some other case that has appeared to be similar. If this is not done the mind will be prejudiced in spite of your best efforts.

Every fresh case is a new case. Keep out of mind if you have cured something of similiar in nature before, for if you do you will be prejudiced.

The purpose of all this is that you will go away and examine the patient with an unprejudiced mind-

	that you will consider only the case before you,
	that you will have nothing in mind that will distract your attention,
	that you may not think of things that  anteceded it and find out from among them a remedy while examining the patient. If you are biased in your judgment and examine the patient towards a certain remedy, in many instances this will prove to be useless.
	Have no remedy in mind until you have everything that you can get on paper.
	Have it all written down carefully and then if upon examining it in relation to remedies, you are unable to distinguish between three or four, you can go back and re-examine the patient with reference to those three or four remedies. That is the only possible time you try to fit a remedy, or image of a remedy, while examining a patient. Get all the symptoms first and then commence your analysis in relation to remedies.
	The analysis of a sickness is for the purpose of gathering together that about it which is peculiar, for the peculiar thing relate to remedies. Sicknesses have in them that which is peculiar, strange and rare. and
	the things in sickness are the things to be compared with those in the remedy that are peculiar.

Now in order to see that which is wonderful and strange it is necessary for you to have much knowledge of disease and much knowledge of Materia Medica ; not so much  broad knowledge of morbid anatomy, but a knowledge of the symptoms or the language that disease expresses itself.

A great deal depends upon a physician's ability to comprehend what constitutes the miasm. If he is dull of sensing he will blend symptoms that do not belong together. Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance. Hahnemann was expert in this respect because he was a hard student of Materia Medica and because he proved his Materia Medica daily. He had examined the remedies carefully, he saw them, he felt them, he realized them. We should never  substitute hypothesis in the room of observation, never regard any case as already known. Now we see why it is that it does not make any difference with a physician whether he has seen such diseases before or not. The homoeopathic physician is familiarised with the signs and symptoms of the man, and a different disease is only a change in the combination of them, only a change in their mode, class and representation.

Special note

 This aphorism says when an epidemic breaks, the homoeopathic physician should consider that  epidemic as new one even though if it has appeared in the previous year or some time back, in the same  or different locality. Then collect as much  as totality of symptoms from as many people of different age, sex, temperament. Only after thorough examination of the epidemic, by carefully noting down symptoms of many cases in that epidemic, we can find that epidemic is easily distinguished from other epidemic which has ever occurred. Nomenclature of disease by its name is never recommended in Homoeopathy.

                                                   § 102

In the course of writing down the symptoms of several cases of this kind the sketch of the disease picture becomes ever more and more complete, not more spun out and verbose, but more significant (more characteristic), and including more of the peculiarities of this collective disease; on the one hand, the general symptoms (e.g., loss of appetite, sleeplessness, etc.) become precisely defined as to their peculiarities; and on the other, the more marked and special symptoms which are peculiar to but few diseases and of rarer occurrence, at least in the same combination, become prominent and constitute what is characteristic of this malady.¹ All those affected with the disease prevailing at a given time have certainly contracted it from one and the same source and hence are suffering from the same disease; but the whole extent of such an epidemic disease and the totality of its symptoms (the knowledge whereof, which is essential for enabling us to choose the most suitable homœopathic remedy for this array of symptoms, is obtained by a complete survey of the morbid picture) cannot be learned from one single patient, but is only to be perfectly deduced (abstracted) and ascertained from the sufferings of several patients of different constitutions.

¹ The physician who has already, in the first cases, been able to choose a remedy approximating to the homœopathic specific, will, from the subsequence cases, be enabled either to verify the suitableness of the medicine chosen, or to discover a more appropriate, the most appropriate homœopathic remedy.

Commentary: Taking as many symptoms from as many cases as possible it becomes possible to get more better picture of the epidemic. We can see that more characteristics and peculiarities as well as general symptoms (e.g., loss of appetite, sleeplessness, etc.)  of the epidemic becomes more and more clear after thorough study of each of the many cases of that epidemic. As more and peculiarity  form, we can find characteristic remedy for that epidemic. Even though the epidemic has come from same source (water, air, mosquitoes, animals, birds etc or source can even mean the pathological cause such as bacteria, viruses, parasites etc) whole detail of epidemic and the totality of its symptoms  cannot be learned from one single patient, but is only to be perfectly deduced (abstracted) and ascertained from the sufferings of several patients of different constitutions.

In many instances it was very easy for Hahnemann  to trace the venereal relationship of disease conditions, and he soon found it easy to distinguish the naming of this group. At first he classed these under one head, but later divided the venereal miasms into two classifications, syphilis and sycosis, gonorrhœa.                                                                            

However, the great majority of disease conditions remained unclassified. For ten years cases were studied, patients were closely questioned, and even history was called upon to divulge the course of disease through the centuries. Through endless difficulties Hahnemann traced these hitherto unclassified diseases, and gave to them the name of psora. 

Each and every case will not give complete idea of psora. One person give the the mind symptoms of psora more prominently, second person will give eye symptoms others may give more than one symptoms of psora etc etc . In order to get complete picture of psora many cases must be studied just like an investigation of an epidemic fever.

                                                       § 104

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,¹ 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 to guide him in his treatment; he can investigate it in all its parts and can pick out the characteristic symptoms, in order to oppose to these, that is to say, to the whole malady itself, a very similar artificial morbific force, in the shape of a homœopathically chosen medicinal substance, selected from the lists of symptoms of all the medicines whose pure effects have been ascertained. And when, during the treatment, he wishes to ascertain what has been the effect of the medicine, and what change has taken place in the patient’s state, at this fresh examination of the patient he only needs to strike out of the list of the symptoms noted down at the first visit those that have become ameliorated, to mark what still remain, and add any new symptoms that may have supervened.

¹ The old school physician gave himself very little trouble in this matter in his mode of treatment. He would not listen to any minute detail of all the circumstances of his case by the patient; indeed, he frequently cut him short in his relation of his sufferings, in order that he might not be delayed in the rapid writing of his prescription, composed of a variety of ingredients unknown to him in their true effects. No allopathic physician, as has been said, sought to learn all the circumstances of the patient’s case, and still less did he make a note in writing of them. On seeing the patient again several days afterwards he recollected nothing concerning the few details he had heard at the first visit (having in the meantime seen so many other patients laboring under different affections); he had allowed everything to go in at one ear and out at the other. At subsequent visits he only asked a few general questions, went through the ceremony of feeling the pulse at the wrist, looked at the tongue, and at the same moment wrote another prescription, on equally irrational principles, or ordered the first one to be continued (in considerable quantities several times a day), and, with a graceful bow, he hurried off to the fiftieth or sixtieth patient he had to visit, in this thoughtless way, in the course of that forenoon. The profession which of all others requires actually the most reflection, a conscientious, careful examination of the state of each individual patient and a special treatment founded thereon, was conducted in this manner by persons who called themselves physicians, rational practitioners. The result, as might naturally be expected, was almost invariably bad; and yet patients had to go to them for advise, partly because there were none better to be had, partly for fashion’s sake.

Commentary:

Once totality of symptoms which gives the complete picture of a man is taken the symptoms so collected has to go through 

	addition
	modification
	deletion
	classification

ADDITION: Should write down accurately all that the patient and his attendants have told him in the very expression used by them. Should keep himself silent, merely asking few discreet questions from time to time to clarify a point and allow them to say all they have to say and refrain from interrupting them unless they wander of to other matters.

MODIFICATION: Should revert to each symptoms after they have finished talking to make it complete by noting (a) locality (b) sensation (c) modalities (d) concomitant factors with regards to each symptoms. The patient is too lazy to write down the symptoms when they appear, and too work-shy  and forgetful to remember them in the presence of the physician. The symptoms do not come up in his mind when he is in the presence of the doctor, and he is too work-shy  to write these symptoms down when he feels them at home. To such patient more precise questions  must be  asked if he feels he has not yet gained all information he needs.

DELETION: Some patient has tendency to over exaggerate their symptoms. You will find that they will magnify their symptoms, really and truly trusting that the doctor will give them stronger medicine if they are very sick and will pay more attention to them ; and if they do not magnify violently, probably he will turn them off with a simple remedy. Such over exaggerated symptoms must be avoided all together.

CLASSIFICATION: The physician has now  the picture of the disease, especially if it be a chronic one, always before him to guide him in his treatment; he can investigate it in all its parts and classify symptoms into 

general

particulars                                               

 pathological or tissue changes                                                            

Strange, Rare, and Peculiar: is a homeopathic term referring to symptoms that are unique to the individual and used to describe human experience, which  is  unusual  and also listed in repertory with only small number of remedies. They refer to symptoms that sound odd or out of context but an important place in selecting a remedy.

example head ache at 

common symptoms: are those symptoms which are both common to human experience and have a very large number of remedies listed in repertory.

General symptoms: can be divided into mental generals and physical generals.

Mental general: are symptoms which describe the patient as a whole.           Include all mental and emotional symptoms. Such symptoms as described as phrases "I feel..."or "I am...anxious ","I am.... depressed "

physical generals: these refer to physical states which apply to patient as a whole. These include food and drinks, symptoms in relation to atmosphere eg "i feel cold all the time", "i cannot tolerate the heat of stove"

Particular or local symptoms                                                        These are the symptoms  of particular organs or parts of the body and which in the patient's view are the most urgent, requiring prompt aid and relief. They are, however, of minor importance in deciding on the relevant homoeopathic remedy except for purely acute complaints.

Pathological tissue changes;  These symptoms are based on findings only from laboratory investigations and/or scanning and/or x-ray and/or physical examination and/or any other sophisticated methods of finding out a disease. These have tremendous importance in allopathic diagnosis, they are unimportant in selecting a remedy. However it can helpful in prognosis of a disease. For example for treating a diabetic patient, we can know how far our homoeopathic remedy acts  .

Example : tumors in the abdomen (by scanning), eosinophilia (by laboratory investigation) etc, goitre by just physical examination.