Classification of Symptoms:
I think we are now prepared to say that a classification of symptoms will be of help. We will divide them into the following classes: Dynamic, Physiological, Pathological, Toxicological. While attempting to define and show the advantage of such a classification let us keep in mind the statement that a symptom is only a manifestation of disease; that it bears the same relation to disease that the withered leaves, charred branches and splintered trunk of a tree bear to a bolt of lightning. We realize that any or all of the above classes may intermingle with any other, but we hope to show that they differ in importance and should be assigned to different rank in making up the totality. Let me use a few authenticated cases to illustrate my meaning.
An individual, apparently normal in every particular, about her usual duties, is abruptly and brutally informed of the sudden death of her mother and husband. A cry, a fall, a change; the spiritual man has severed his connection from the intellectual and physical. Again, the triune man is standing in a field during an electrical storm. Without even a cry he falls dead. The same separation has taken place. Up to the instant of the shock no change had taken place in the intellect, and in neither case did a careful minute examination, post-mortem, reveal any change in tissue or organ of these two bodies.
One other, the triune man, a train dispatcher, with dark hair, mentally clear and reliable, for some unaccountable reason failed to switch a train. A whistle! A collision with the usual results! In this case, the spiritual man remains with the other two, but that black hair is changed to white in 48 hours and that clear, reliable mind is clouded and unreliable. Every time that man hears a whistle he becomes a raving maniac. Here are your two extremes of dynamic cause of symptoms. You are all familiar, with what may take place between these two extremes. What is this “dynamic, spirit-like force” which produces such results? If any of you can state fully, definitely, clearly, do so. I cannot. But that this class is the most important I do know and that one symptom of it may outweigh a score of those of the second, in the totality, I also know.
Let us take the function of the sweat glands for an illustration of the second class. We all know the difference between a profuse warm, critical sweat which marks the termination of some cold or fever and that profuse cold, clammy sweat, which, in shock, in the crisis of pneumonia or in acute dilatation of the heart, warns us that every available resource must be used to save our patient’s life. By knowing the value of these different manifestations of a perverted function we may form some idea of the rank in the totality.
As a result of this form of variation we have ulcers, tumors, atrophy, hypertrophy, changes of the blood, of the secretions, of the excretions, etc. It is by a knowledge of these conditions that we make our diagnosis of disease or, to put it in the words of the Organon, determine each individual case.