The Key-Note System. BY HENRY N. GUERNSEY, M.D., PHILADELPHIA.
[We have taken the liberty of reprinting the following admirable paper from the pen of our friend Dr. Guernsey, because, in the first place, we think that the « key-note », as a system of simplifying the selection of the remedy, stands unequalled; and in its Hahnemannian excellence, it is simply unrivalled. Secondly, we reproduce it, because, in Great Britain at least, we seem to be utterly ignorant of its worth and true merit, and because we are constantly being asked regarding it, if we « see anything in it? » Our reply is, « but for characteristics or key-notes in practice, we could never succeed as we do, they are simply invaluable; and if Homoeopathy is ever to stamp-out Allopathy and reign supreme, it can only be by every one of us mastering the pathogenetic and clinical characteristic symptoms of our medicines, which, in other respects, is the ‘key-note system’ of Professor Guernsey, » who shall now speak for himself. We shall only add, that we hope soon to be able to publish a new Characteristic Materia Medica as an Appendix to The Organon. In this great work we have been promised the able and kind assistance of our valued friend Dr. Simmons, of Cheltenham, who informs us, by letter, that he has suffered from « characteristics on the brain for the last ten years. »—EDITOR]
In view of the fact that numerous inquiries have been made of me regarding the principle of Homoeopathic practice attempted to be expressed in the term « key-note system », and as much attention has been attracted to the subject recently, in journals and otherwise, I have deemed it eminently proper to place before the members of our Society, a correct exposition, as far as I am able to make it, of the scope and utility of the method expressed by that term, as a part of practical Homoeopathy.
The term « key-note » is not to be regarded as in itself definitive, nor did I, in first using it, wish or intend it to be taken as a piece of scientific nomenclature. It occurred to me as being in a very great degree expressive of a fact in medicine, and as such alone is it to be accepted.
The term « key-note » is therefore suggestive, and merely provisional; to be continued in use only until its scientific successor is duly chosen and qualified by general acceptance. But while it is true that the term is nothing more than an illustration, an analogue and a hint, its immense significance is not thereby diminished. It is still the expression of a fact, a truth, central and fundamental; the knowledge of which, in Homoeopathic theory and practice, is necessary to the full and complete comprehension and the most extended use of the law of the similars.
The key-note, in music, is defined to be « the fundamental note or tone to which the whole piece is accommodated; » and the key-note of music finds, by analogy—through which things most remote and unlike superficially are connected in the closest relationship—its likeness everywhere. The key-note of Religion is God’s existence. By it every one of the innumerable theologic tones, however apparently discordant, are harmonized. Gravitation is the key-note of the order that governs the myriad spheres that plough their way through space. Progress is the key-note to which the wonderful political, social and industrial movements of the day are attuned. The key-note of the Church—is faith; of the true household—love. Thus has been given suggestively, and perhaps with sufficient clearness, the meaning, force and true application of the term as I have used it in medicine, and with the feeling that suggestion is often more lucid than direct expression, I hesitate to give a more exact definition. When a man tells us he is « out of tune », or when a medical author speaks of depressed or improved « tone », or want of « tone » of the system, we scarcely require an explanation of the meaning of the terms thus used, and more is conveyed to the minds, perhaps, than could be made clear by a laborious attempt to express in other words the same thing. It is thus with the term « key-note. »
It is intended to be expressive of a truth that could not be expressed in any shorter or more compact sentence; and as conveying or rather suggesting to the mind the whole truth itself. A casual observer, viewing the fair field of our Materia Medics, would say that the flowers are all alike; so similar and so common as to be utterly valueless; and, indeed, without the principle involved in the term I have used, this would appear to be the truth. In Materia Medica and in Pathology we have before us, vast heaps of apparently inharmonious, confused and unrelated facts, and these continually accumulating, with the prospect that the higher faculties—upon the unencumbered and vigorous action of which depends all real achievement—would eventually become hopelessly bewildered, were it not that the guiding principle, the one fundamental characterizing power, the key-note, in fact, is struck, and every tone and feature and expression is attuned to it and by it, modulated and harmonized.
The « key-note system » is not only applicable to the array of symptoms constituting the pathogenesis of our Materia Medica, but as well to the array of symptoms and conditions constituting disease. In pathology, the term pathognomonic symptom is intended to express, in very many instances, what might be termed the key-note of a given disease, and yet while this is true so far as it goes, it does not go far enough to cover the whole ground; to embrace the whole category of diseases; or to mark the distinctive features that characterize one case of the same disease from another. Now the Homoeopathic physician does not profess to treat disease, per se, but rather patients; and thus from the very nature of things, even the erudite generalizing of the Allopathic School cannot be received by us. Although the chief features of a disease are present and similar in all persons attacked by the malady, and even those symptoms which perhaps have furnished it with its name, yet we must all confess that we are able to detect some sign or symptom, some all-pervading condition, some characterizing circumstance that gives that case its individuality, and causes it to differ, if ever so slightly, from all other cases.
Thus we may be said to have first—the expressions that evidence disease; then the special markings that distinguish classes and orders; the conditions or symptoms by which each class or order is subdivided and each subdivision furnished with a specific name; and finally, the characteristic features which serve to distinguish each case of the same disease from all other cases; as in the human family we find first the broad and ever-present features of the race; then the distinctive marks of nationality; then the peculiarities of family; and lastly, the lineaments, deeply or faintly traced, which characterize the individual. This, now, is what we would call the key-note system, as carried into the study of disease. It is comparative pathology in its most extended sense. You are, perhaps, ready to tell me that this is nothing new. I am well aware of it. HAHNEMANN laid it down as distinctly as it was possible to give utterance to truth, and while it is not true simply because HAHNEMANN gave utterance to it, it is true because the experience of thousands of Homoeopathists have confirmed it as the true system of diagnosis; the truly practical method of distinguishing between one case and another, or, in other words, of individualizing.
Alas, that it should be so often lost sight of in the fascinating whirlpool of generalization. Let us now turn to the store-house from whence is to be drawn the agencies that are to prove curative for these multifarious forms of disease, and see how the « key-note system » is to be applied there, and with what effect. From the « provings » of aconite; from its numerous toxicological effects; and from the revelations of its scope furnished us by its use in diseases a vast tissue of symptoms might be accumulated, that it is not exaggeration to say would fill a large volume; and to these we might add the results of new provings, on different individuals, ad infinitum. How very many of these symptoms are very similar to, or apparently identical with, those produced through the provings of other drugs? Truly the flowers appear all alike. Yet there is something within that pathogenesis, indicative of aconite alone; embodying in expression its one characteristic, unfailing, predominant effect, which makes it to differ from all other drugs, and which pervades all its other effects with more or less predominance. This symptom or condition, these symptoms or conditions form the key-note or key-notes of aconite as a medicine, and furnishes the key to its indication in disease.
Thus, in instituting comparisons between medicines, by taking all the symptoms and comparing them carefully, we will find that each one presents, besides the fundamental similarity to all the others, peculiar differences from all the others; and these invariable points of peculiar difference are the « key-notes » in a comparison of such remedies. Here, then, we have the characteristic peculiarity in the disease that individualizes that case, and we are enabled to call up from the store-house of the Materia Medica and place in apposition with it that medicine which possesses in its pathogenesis a corresponding similar characteristic, peculiarity or « key-note », and which will prove to be the curative agent for that case of disease. It is charged against the key-note system that it is in conflict with the doctrine that teaches the necessity of meeting the totality of the symptoms, or, in other words, the doctrine of true homoeopathy. This is by no means true.
It is claimed,—not that the key-note in the case is to be alone met by the key-note of the remedy; nor that the whole case is to be met by the key-note alone,—but simply that the predominant symptom or condition of the case that individualizes it and constitutes its key-note, suggests to the mind a medicine having a corresponding predominant symptom, condition or key-note, and that if there has been no error committed either in viewing the key-note of the disease, or of subsequently selecting just that remedy having the corresponding feature, there will then be found in the pages of a symptomen codex, under the heading of that particular remedy, the remaining features, symptoms and conditions of the patient, or, in other words, the « totality. » Thus the « key-note », as before explained, is simply suggestive; suggesting by the shortest, surest and most practical method, a remedy; separating and isolating it from all other medicines as having, first : the characteristic symptom or condition or « key-note « in a marked degree; secondly, and consequently, the remaining symptoms or conditions; these constituting together the totality of the case. As a medical friend expresses it in a recent letter, « the key-note gives us the pitch of the tune, but it is not the tune.«
After all, it is in this way that true Homoeopathists have ever prescribed. It is not the totality that biases the mind, so to speak, or directs the attention to a certain remedy. It is always something peculiar in the case, some prominent feature, or marked symptom that directs to a certain drug, and the totality afterwards confirms or disapproves the choice. I again repeat, therefore, that the « key-note system » does not in any way interfere with the doctrine of « the totality; » it insists, on the contrary, upon the essentiality of that doctrine, and is the guide to its being properly and practically carried out. In my recent work on Obstetrics, &c., I have endeavored to carry out this key-note system to a practical determination, so far as my, at present, limited knowledge has permitted. I have not attempted to set down under the head of each remedy in each disease, the catalogue of symptoms that might be present, but to give the characteristic peculiarities or key-notes of the remedies —such only as had been, in my experience and that of others, « tried, proved and chosen, »— so that the mind might be directed at once in the true direction, the choice to be confirmed by the totality of the symptoms; so that the true key-note being struck, all the other tones would be harmonized with it. It is in this way that I desire to be understood, and those gentlemen who have done me the honour to review my book will bear in mind that this is the true interpretation of the plan I have set forth; and if they will give it their attention, and carefully and conscientiously experiment at every fitting opportunity, they will, ere long, be ready to say yea ! and amen ! to all I have written on the subject.
A few examples, by way of illustration, may not at this juncture be misplaced. Being called in consultation recently, in a case of dysmenorrhoea, where a great variety of symptoms presented themselves, I was much struck with the devout, beseeching, earnest and ceaseless talking of the patient, and at once suggested to the attending physician the exhibition of Stramonium. Upon comparing symptoms, he replied that all her symptoms were not under the head of that remedy, but agreed to the use of stram., as he could suggest nothing else, adding that if it cured her, « he would cease to believe in the doctrine of totality. » I replied that stram. was undoubtedly the remedy, and if it were properly proven and on every variety of temperament and condition, all of her symptoms would be found in the record of its pathogenesis. Stramonium 20 was given, and it quieted her at once, and all her other symptoms speedily vanished, inversely as they had appeared. Her peculiar talking was the last symptom to manifest itself and the first to disappear, and when present in disease in either sex is a key-note to Stramonium. In cases of hemorrhage, where the blood forms itself into a resemblance to long black strings hanging from the bleeding orifice, crocus will be the remedy; not for the hemorrhage alone, but for the whole chain of symptoms presented by the patient. The hemorrhage being last to appear will be the first to be removed, and by not now interfering with the curative action in progress, giving no other medicine, and allowing a sufficient time for the action of the dose, the remaining symptoms, constituting the whole condition that has led up to the hemorrhage with its characteristic peculiarity, will be dissipated, inversely as they have appeared. When, in colicky children, an appearance of red sand is discerned in the diaper, we know that lycopodium is indicated. By the action of that remedy the whole disordered condition of the little one will be removed; the whole chain of disordered action that culminated in this phenomena of the urine. The urine indicates lycopodium, is the key-note in the case for that remedy, and the balance of the little patient’s symptoms will be found under it and be removed by it. I am permitted to refer to the following case, extracted from one of the numerous letters sent me on this subject.
In a case of typhoid fever; the last and worst of a malignant epidemic, where the disease had resisted the action of all the medicines given, and the attending and consulting physicians despaired of saving the boy,—a previously healthy, robust lad of sixteen years,—he was restored to his former rugged condition through the action of a remedy suggested solely by a « key-note » symptom. My friend writes, « as I went to his bedside one evenings I noticed a peculiar convulsive movement of the head, such as I had not before noticed in this or any other case, viz.; the head jerked itself clear of the pillow, and then fell immediately back; this being constantly repeated. I at once recalled your key-note for Stramonium. I went to my office, and on comparing the symptoms of the case with the symptomatology of that remedy, I was struck with the wonderful correspondence. I then gave repeated doses of the 3d dilution, acting on my colleagues’ advice, but in twenty-four hours saw no improvement. The 30th was then given with no favourable result. I then gave a single dose of stram., 200 at night, and was delighted to see a smile on the face of the anxious mother when I called next morning; ‘Henry became quiet,’ she said, ‘very soon after taking the medicine, and has, for the first time, slept quietly. His convalescence was steady from this period. I gave no other medicine for ten or twelve days. Stramonium saved him, and your ‘key-note’ given me in the class was my only guide to it. »
The few examples thus cited are sufficient to point out the practical workings of the key-note system. Through it alone, I hold, can the art of prescribing homoeopathically be simplified and rendered exact. By it Stapf was enabled to prescribe correctly, in the presence of an expectant and admiring class, without asking a question; for the objective key-note, revealed in the countenance of the patient, gave him full knowledge that under Cantharis the whole condition and symptoms would be found; and by it hosts of Homoeopathic -physicians since his day have been safely and quickly guided to the truly-healing medium that might have been missed if sought through more complicated channels. The force and truth of HAHNEMANN’S idea that the symptoms of disease are cured inversely as they appear, is beautifully demonstrated if viewed from the standpoint of the key-note system. Through this system the complex and difficult text of the Materia Medica is rendered pure and clear, and every shadow uplifted from its pages; by it Pathology—the servant of Homoeopathy—is brought into fullest and most vigorous usefulness, and diagnosis made exact and availing. As, in the hands of an Agassiz or a Leidy, a few bones or teeth, or the scale of a fish, are sufficient to unfold a whole chapter in the book of natural history, so in Homoeopathic practice, by the characteristic key-note emphasized by the patient, the practitioner is enabled to individualize his case and draw to his aid, thus revealed, the corresponding similar remedy having the totality of the case, and able, ceteris paribus, to cure it. I have thus attempted to demonstrate the meaning, truth and utility of the « key-note system. » Without any attempt at fine writing or display, I have endeavored, in moments of leisure stolen from hours of toil, to set forth with clearness and exactness what I believe to be, not a new doctrine, but a true one in Homeopathy; and if, by reason of this paper or the discussion that may follow it, or any inquiry that may be set on foot through its publication we may be led still farther into what I conceive to be a true path to the correct system of Homoeopathic therapeutics, I shall feel myself amply rewarded.