The Examination of the Patient

Each symptoms possesses a meaning and must be considered and interpreted from a logical and associative point of view. The physician must reason from generals to particulars and trace disease to its source. There is never room for conjecture or hypothesis with the Homoeopathy….

Mr. Chairman and colleagues! Years ago I read an article from the pen of the late Dr. P.P. Wells in which he stated it took him a quarter of a century of close study of the principles and philosophy of Homoeopathy and its Materia Medica to enable him to prescribe according to its doctrine. I had just then begun the study of Homoeopathy. I was familiar with Hughes, and kindred of works, and imagined I knew all about Homoeopathy.

I had heard from respected medical seniors that Dr. Wells was a most able homoeopathy, but knowing our confrere to be advanced in years I considered him in his dotage, and his opinions to be taken at a considerable discount. I paid, however, before his death the tribute of my respect and admiration, acknowledging to him also my previous folly and conceit.

I may further expose my ignorance of those days by the confession that I feared Hahnemann himself must have been afflicted with a similar illusion when he advocated the use of the 30th potencies. It seemed to me the height of absurdity to fancy that such infinitesimal doses could possess any remedial powers; and yet today, like many of you here, I generally use the 200th and frequently resort to even the DMM’s.

Before entering upon the topic allotted me for treatment this evening, I must say a few preliminary words touching the history and principles of Homoeopathy. Previous to Hahnemann’s time, medicine was in a chaotic state, resembling astronomy before Newton’s discovery of the laws of gravitation. Thus, many important isolated facts in therapeutics were known to the world; but all the systems were connected by illusory, illogical hypotheses. No reliable rule existed for the guidance of the practitioner, no safe principles. All was a maze of contradictory therapeutical theories.

Hippocrates, Haller and Strok had already recognized partially that some diseases were cured upon the principles of similars; but the glory of discovering it as the only law of cure was reserved for Hahnemann. To his original and practical genius the world owes the establishment of this doctrine, based upon tradition, observation and experience. After careful, painstaking researches into the action of medicinal substance upon man, Hahnemann become satisfied that drugs had the inherent power of exciting in the healthy subject diseases similar to what they cure. He now pursued his investigations with a rigorous adherence to the precepts of inductive philosophy, and demonstrated theoretically and clinically the truth of the new doctrine.

He then went further, proving the Homoeopathic principles to be in conformity with a universal law of Nature. A complete revision of the Materia Medica Pura, and The Chronic Diseases. His discovery of Homoeopathy was the result of experiment, but his subsequent development of the theoretical and practical features of the system almost approached inspiration. There can be no doubt of the solid and lasting basis upon which he erected his new structure or method of the treatment of disease. As a doctrine it is complete.

It may be wanting in some minor details, but the span of human life is the measure of man’s opportunity, and it is only a cause of wonder that he could have accomplished so much in a single life-time. All the principles of Homoeopathy are logically, systematically, and indissolubly bound together. There is nothing contradictory in any portion of it.

According to Hahnemann, life is bestowed upon the human economy by a power sin generis appropriately named by him, the vital force. This agency starts with life itself, in the original protoplasm, influencing the development of the living tissues, governing and regulating all the physiological phenomena and watching over the preservation of the individual till death.

There has been no better theory advanced of the influence governing the human system. If this vital force be distributed in its harmonious guidance of the functions of the body by some external impression, mental miasmatic, climatic or other, the processes of nature are modified and disease appears.

The vital power is immaterial dynamic in nature, like all natural forces, and can only be affected by similar immaterial or dynamic agents. Aetiological factors, consequently operate and influence this power through their virtuality. These disturbances of the vital forces manifest themselves differently in different individuals, depending upon the peculiarities or original weakness of the patient.

The vital force theory is one of the fundamental principles of Homoeopathy, the second being the application of law of similars and the third the dynamization of the drug. Homoeopathy in other words is founded upon a physiological theory, a system of pathology, a therapeutic law and a related Materia Medica.

A more minute, a deeper knowledge of man, of the morbid changes to which he is subject and the possibilities of remedial medication under the law soon taught Hahnemann that the old methods of examining patients would not suffice. From his rich stores of human observation and thought, he formulated a scheme expressed in the clearest and most concise language (Vide, Organon, paragraph 83 et sequitum).

Unless the physician master those directions as well as the principles and the philosophy of Homoeopathy he cannot practice it with any degree of success or satisfaction. The proper examination of the patient is indeed the keynote to the arch of Homoeopathy-no certainty in prescribing being possible without it. The examiner must be familiar with anatomy and pathology in order to understand the anatomical relationship of the organs of the body and their deviations from the normal or pathological changes.

He must also know chemistry to be acquainted with the constituents of the human machines, the physiology to understand the functions of the different organs, and hygiene to be able to remove or guard against morbid influences; also the laws of auxiliary medical science with the use of all instruments and appliances for the detection of diseases. Besides, the examiner must possess the spirit of observation, analytical and synthetical and be able to exercise this faculty with zeal and discrimination.

There are many precautions necessary in the investigation of the symptoms and conclusions to be drawn from them. The life of the patient or his comfort through life may depend upon the thoroughness of the examination and, therefore, all that comes under the five senses should be closely scrutinized and investigated.

The examiner must note points of resemblance as also of difference, estimating the finest shades of variance between symptoms and their connection, to learn whether they follow or alternate, rapidly shift about or change in character. In truth nothing can be overlooked, the most trivial and most important alike, both objective and subjective should be noticed and considered for we may all be sure the vital force does not throw out signals of distress without the best of reasons.

Each symptoms possesses a meaning and must be considered and interpreted from a logical and associative point of view. The physician must reason from generals to particulars and trace disease to its source. There is never room for conjecture or hypothesis with the Homoeopathy. Any surmise from pathological indication is likely to lead us astray. It may be well for our personal gratification or that of the patient to form a diagnosis, but we must be careful not to allow the name of the disease to influence our conclusions, as Hahnemann so often cautions. the totality of the symptoms is the extract record of phenomena present and must be collected and viewed as an entity. If the total of the symptoms can be found under the effects of any drug their removal will follow its administration; and hence the great importance of not omitting a single symptom from the picture of the case.

The age, sex, temperament, morbid diathesis, inherited or acquired, the moral and psychological phenomena require to be noted as well as previous diseases, errors or insufficiency of diet, climate or contagious exposures, excesses and privations, with defective physical or moral education.

The appearance of the patient, his actions and manners, position while lying, state of the skin, etc., may all be taken at a glance. But as regards the functions of the body, abnormal sensations, morbid desires and aversions, with other subjective symptoms they are elicited from the patient. The seat of pain, its nature and extent, modified by sleep, rest, motion, eating, waking, drinking, standing, heat and cold, the influence of the time of the day, mental excitement, changes of season as also the effects of confined or open air; no less than the effects of the different foods and liquids all have to be carefully attended to and considered. Suppressed eruptions or discharges must also be recognized.

While each symptom is in reality but a part of the great whole, and need to be noticed, some are of greater importance when the therapeutical question arises as we shall see. Among the most valuable, from the point of view, are the symptoms with their modalities and conditions which precede the use of remedies at the outset of the disease, those present when the disease reached its height, those following the use of drugs of special moment are the first and the last.

We must be particular to discriminate between idiosyncrasies, habitual infirmities and physical deviation from health for what may be normal in one would be morbid in another, and so forth. Some fixed plan or method must be adopted in our examinations, and Hahnemann’s cannot well be improved upon. He begins with the moral and intellectual symptoms and then takes in topographical order, the different regions of the body, starting with the head and ending at the feet. In the main the above constitutes Hahnemann’s directions and if faithfully carried out must inevitably give the examiner a complete picture of the cause which as we all know, is the open sesame to the similimum.

After we have obtained a full and complete account of the patient’s symptoms and cleared away by painstaking investigation obscure or doubtful points we must next group and classify symptoms in accordance with our estimate of their value, to facilitate our subsequent task of selecting the required remedy. Symptoms originating from the mind are to be noted down first and then those most uncommon and peculiar.

To distinguish between these and the unessential and unimportant is often very difficult and not seldom calls, as you are well aware, for great skill and discernment. As a rule the less diagnostic is a symptom the more important it is as a guide to the needed remedy. The most constant, the most recent or latent symptoms developed must be considered-they are the sine qua non. All symptoms not founded upon reliable or positive premises must be discarded; the fleeting are generally of less value.

An invaluable piece of advice the master gives us concerning the examination of patients, is to let the sufferer tell all of his pains, sensations, and so forth without interruption for he cautions us, if the patient is questioned before he was told his whole story, he may, through confusion or timidity forget some essential symptoms. Another equally important suggestion is to note down in writing all that falls from the lips of the patient, relating to his symptoms, and these, he counsels us, to take down as possible, in the patient’s own words and in the order given. Subsequently his statements may be corrected or corroborated by the attendants or friends.

The master also particularly warns us not to put leading or suggestive questions or in other words. We are to avoid making inquiries which may be answered simply in the affirmative or in the negative. I may return to this later if the patient comes under our care immediately after a course of drugging it may be necessary unless the patient be in danger or in great distress, to defer prescribing until some of the effects of the medicine have passed away. Everyone of these suggestions is worth its weight in gold-aye, a hundredfold more-as the observing Homoeopath daily realizes.

The peculiar, extra-ordinary symptom is generally the keynote leading to the totality of the case, the essence of the disease (Vide Organon, para 158.)

With your permission I shall cite some cases to illustrate this rule.

Bender P
Dr. P. Bender, author of "The Physical Examination of the Patient"