"The Sick" - Kent's Philosophy (Lectures on Homoeopathic Philosophy, Lecture 1)

Who is "The Sick"?

"It is a man that is sick and to be restored to health, not his body, not the tissues."

The Man and His House - A Key Metaphor

• The man = the living, dynamic individual animated by the vital force
• The house = the physical body, tissues, bones

"The physician must discriminate between the man and his house, and between the repair of man and the repair of his house."

The Vital Force - Centre of Sickness

• The soul or will of man - the innermost essence
• A conscious, intelligent energy that governs all vital operations
• Connected to the will, understanding, and memory (the three levels of inner man)

"Our vital force, as a spirit-like dynamis, cannot be attacked and infected by injurious influences on the healthy organism caused by the external inimical forces that disturb the harmonious play of life otherwise than in a spirit-like (dynamic) way." (Organon §16, as taught by Kent)

Why Germs Are Not the Cause

"The microbe is not the cause of disease. We should not be carried away by these idle allopathic dreams and vain imaginations but should correct the Élan vital."

Levels of Sickness (Hierarchy within the Sick Man)

1. Will (spiritual level) - the innermost; derangement here is the deepest sickness
2. Understanding (mental level) - the intellect, perception, memory
3. Body (physical level) - the outermost; physical symptoms are the last to appear and first to respond

What is NOT "Being Sick" in Kent's View

• Bad habits (coffee, vinegar, alcohol) - a matter of personal responsibility and hygiene
• Environmental causes (damp houses, sewer gas) - a public health / sanitation matter
• Mechanical injuries - the province of surgeons
• Structural deformities - surgical problems

Practical Implication: The Totality of Symptoms

• The totality of symptoms (all visible, perceptible expressions of the inner derangement) is the only guide to the remedy
• General symptoms of the patient (how the whole person is affected) carry more weight than particular or local symptoms
• The characteristic mental and emotional generals must be present for true individualization
• The similimum (the remedy most similar to the totality) acts dynamically to restore harmony to the vital force

"Totality of symptoms is all that is visible and represents the disease in the natural world to the eye, the touch and the external understanding of man."

Summary

Examination of the Patient - Kent's Homoeopathic Philosophy

Purpose of Examination

"It is our purpose to cure the case, and it is necessary for this purpose to bring the patient's symptoms in the very best possible way before the mind. Disease must be brought out in symptoms, with the end of its becoming a likeness of some remedy of the Materia Medica."

Sources of Symptoms

1. The patient himself - the primary source; his direct experience of what he feels
2. The attendants / relatives - those who observe the patient's behavior, especially mental changes that the patient may not recognize or report
3. The physician's own observation - what the physician sees, hears, and perceives directly

Fundamental Rules of Examination

1. Preserve the Simplicity of Symptoms

• The patient must be allowed to describe symptoms in his own language and his own way, without interruption - interrupting derails his train of thought
• The physician must always record symptoms in the language of the patient, using synonyms only when they cannot be misunderstood (e.g., "monthlies" for "menses")
• The physician must never put words into the patient's mouth or bias his expressions
• The physician should say as little as possible, but keep the patient talking and close to the line

"Leave the patient in freedom always. Do not put any words into his mouth."

2. Conduct of the Interview

• Allow the patient to tell their full story in the first interview without correction or guidance
• If the patient goes off track, bring him back quietly without disturbing him
• Never hurry the patient - develop a fixed, calm habit of examination
• In private practice, the physician generally gets better information than in a clinic setting

3. Instruct the Patient to Record Symptoms

• If the patient forgets symptoms when in the presence of the doctor (which is common), instruct them to write down symptoms as they occur at home
• If the patient refuses to do this, Kent says the physician should insist on it or refuse to prescribe - a remarkable stance showing how seriously he takes complete symptom collection

Classification of Symptoms (The Heart of Examination)

The Three Types of Symptoms

"If you examine any part alone, you are only examining the particulars. If you examine the liver symptoms alone, you are examining particulars... But after you have gathered the particulars of every region of the body, and you see there are certain symptoms running through the particulars, those symptoms that run through the particulars have become generals."

• Things that apply to the whole man = generals
• Things that apply to one part = particulars
• Things that are common to all disease = common symptoms (useless for prescribing)

Hierarchy of Symptom Importance

1. WILL (affections, loves, hates, fears) ← Highest
2. UNDERSTANDING (intellect, memory, perception)
3. PHYSICAL GENERALS (temperature, thirst, sleep, appetite, sweat)
4. PARTICULARS with marked modalities
5. Common pathological symptoms ← Lowest value

Common vs. Peculiar Symptoms

• Common symptoms - symptoms found in nearly all patients with a given disease; shared by many remedies; useless for individualization (e.g., fever with infection, pain with inflammation)
• Peculiar / uncommon symptoms - symptoms strange, rare, or characteristic to this individual patient; found in only a few remedies; these are the guiding symptoms

"Some symptoms have reference to pathology and diagnosis, while others have reference only to the Materia Medica, and symptoms must be constantly weighed in the mind in order to establish their grade whether common or peculiar. If all are found to be common symptoms, the Materia Medica is left out."

The Complete Symptom

1. Location - where in the body
2. Sensation - what it feels like (burning, stitching, pressing, etc.)
3. Modalities - what makes it better or worse (time, temperature, position, motion, weather, etc.)
4. Concomitants - symptoms occurring alongside the main complaint

Mental and Emotional Examination

• Fears (death, disease, darkness, crowds, being alone, insects, etc.)
• Disposition and temperament (irritable, mild, obstinate, weeping, cheerful)
• Relationships and affections (loves, hates, jealousy, grief)
• Memory (forgetfulness, poor concentration, confused thinking)
• Dreams - these are an important window to the inner man
• Impulses and passions - including those the patient may be ashamed to admit

Obstacles and Difficulties in Examination

Separating Acute from Chronic

"A chronic patient may be suffering from an acute disease and the physician on being called may think that it is necessary to take the totality of the symptoms; but if he should do that in an acute disease, mixing both chronic and acute symptoms together, he will become confused and will not find the right remedy. The two things must be separated."

Arrangement of Symptoms in the Record

• Begin a fresh line for every new circumstance mentioned
• Record the date of each symptom and its onset
• Arrange symptoms so they are easy to read at subsequent examinations and easy to search when hunting for confirmatory symptoms
• Record in the patient's own words

The Overall Framework: From Center to Circumference

SPIRIT / WILL
      ↓
UNDERSTANDING / INTELLECT
      ↓
PHYSICAL GENERALS (whole body)
      ↓
PARTICULARS (local symptoms, pathology)

Summary Table