Examination of the Patient

The technique of an examination for the purpose of diagnosing the disease is quite different from that of the examination for making the homoeopathic prescription….

We take up, in a general manner, the subject of the examination of the patient for the special purpose of making a homoeopathic prescription.

At first thought it would seem as if this subject should have been presented before the general subject of symptomatology, treated in the preceding article, inasmuch as the purpose of any examination of the patient is to discover signs and symptoms. It is evident, however, that we cannot intelligently and logically take up the study of methods of examining patients for a homoeopathic prescription until we have learned what symptoms are, from the homoeopathic standpoint, and decided upon some adequate form of classification. We shall be more successful in our search for anything if we know what we are looking for.

The story is told of John Burroughs, the late venerable dean of American naturalists, that on one occasion he was visiting the home of an admirer, who lived in the suburbs of one of our large cities. His hostess, professing her great love of birds, bewailed their disappearance from her neighborhood. She had not seen a bird for such a long, long time. The wicked boys and the marauding cats had driven them all away! “Uncle John” looked sympathetic, but said nothing. Shortly afterward he put on his hat, tucked his note book and opera glasses in his pocket and went out for an hour’s walk. On his return he invited his hostess to sit down beside him, produced his note book and showed her a list of nearly twenty different species of birds which he had observed during his hour’s walk, within a half mile of her home! The difference between Mr. Burroughs and his hostess was simply that he not only knew *what to look for, but *where and *how to look for it; and so he easily found what was hidden from her eyes.

So it is in examining a patient. The student who knows the nature, constitution, forms and varieties of symptoms necessary for the homoeopathic prescription will find many things in a case which another, specially trained perhaps only in pathology and general diagnosis, will entirely overlook; because pathology and diagnosis do not seek for nor take into consideration the phenomena which are most significant from the standpoint of the homoeopathic prescriber. The “modalities” or “characteristic conditions,” for example, which we have seen to be of the highest importance in selecting the homoeopathic remedy, mean little or nothing to the pathologist or general diagnostician. The same might be said of mental and subjective symptoms. Thus we have to separate and classify the various kinds of symptoms revealed by a complete general examination, and vary our methods of examination according to the particular end in view.

The technique of an examination for the purpose of diagnosticating the disease is quite different from that of the examination for making the homoeopathic prescription.

The diagnosis of disease by modern methods is based largely upon physical signs, tests and reactions, involving the use of many instruments of precision, in which the patient takes no active part, and of which he has no knowledge. The selection of the homoeopathic remedy, on the other hand, is based very largely and sometimes almost entirely upon the phenomena, or deductions drawn from the phenomena, of subjective, conscious experience, perceived only by the patient and stated by him to the examiner. Nearly all of the objective phenomena possessing value from the standpoint of homoeopathic therapeutics are of such character that they require the exercise of only the physical senses and ordinary powers of observation by the patient, his friends, or the physician himself. This distinction should be kept clearly in mind. Examinations for the purpose of pathological study and for diagnosis are necessary and important in their several fields; but from the standpoint of homoeopathic pharmaco-therapeutics, their importance is relative, not absolute. Aside from the physical and organic localization of disease, they furnish comparatively little that is of value to the homoeopathic prescriber in his special work of selecting the symptomatically similar medicine.

Let not the pathologist, therefore, criticize the methods or findings of the prescriber, nor the diagnostician assume that his findings are sufficient for the materia-medicist; but let each regard these matters in the spirit and from the standpoint of the *physician. For the physician, as an ideal, is greater than any medical specialist. The specialties in medicine only exist in order that, by combining them, the ideal of the perfect physician may not die and disappear from among men. However doubtful we may be of the necessity of the real value of the results, it is true that in the vast extension of so-called medical science it has become impossible for any one man to grasp and master it all. Therefore medicine has been divided into so many specialties that we might paraphrase the old proverb, “it takes nine tailors to make a man” into a new medical proverb: “It takes nine specialists to make a physician.

The general practitioner, if one dare to follow that ancient and honorable calling, must act in several capacities – as hygiemist, sanitarian, pathologist, psychiatrist, diagnostician, therapeutist, and perhaps even surgeon and obstetrician; but in each of these departments he may be compelled to fill up the measure of his own technical shortcomings by recourse to the specialists. He is the wise physician who recognizes his own personal and technical limitations and judiciously uses the services of others who are specially qualified in some particular branch. And he is the wise specialist who recognize *his limitations – who realizes that, after all, no matter how expert he may be in his branch he is only, as it were, a part of a physician in the broad sense of the word. Modesty pays good dividends in the long run.

In this spirit we may all co-operate for the best interests of our profession and our patients, and agree with Hahnemann in the postulate of the first paragraph of the “Organon:” *”The highest and only mission of the physician is to heal the sick.” Every medical specialty is subordinate to that ideal. The work of the homoeopathic prescriber, dealing specifically (as it does) with the application of medicines to disease according to a definite principle for the purpose of curing such conditions as are amenable to medicines, must ever remain one of the most important of the functions fulfilled by the physician. Although the related branches of medicine – hygiene, prophylaxis, sanitation, surgery, physical therapeutics, etc., have made great strides, the time is yet far distant when pharmaco-therapeutics will become unnecessary.

It follows that the pharmaco-therapeutist must be a specialist in the sense of becoming an expert in his department and this, let it be said, is the crying need of the profession.

With diagnostic and pathological examinations and symptoms, as such, this article has nothing to do, except to show their general relation to homoeopathic prescribing. The purpose of this article is to teach the principles of “case-taking” and how to determine, from the record of an examination of a case, what symptoms are most useful as indications for the curative medicine under the homoeopathic principle. Some points on the method of conducting an examination in such a manner as to discover and develop these symptoms for use in prescribing will now be presented.

In the present state of the science of pharmaco-therapeutics and with our materia medica in its present form, the most important thing to be remembered in examining a patient for a homoeopathic prescription is that, with very few exceptions, the most valuable indications for the remedy are to be found:

1. In those subjective morbid sensations and phenomena which come within the sphere of the patient’s own experience and are perceptible to him alone.

2. In those objective signs of disease which are perceptible to the unaided or natural senses of ourselves, the patient or others.

For the first we must, of course, depend entirely upon the statements of the patient himself. The findings of the thermometer, the stethoscope, the microscope, and the various other diagnostic instruments give us very little, as yet, that is directly available for the selection of the remedy. Their principal value is in determinating the diagnosis and pathology of the case as bearing upon the prognosis and general auxiliary treatment. They also point out or more accurately define the anatomical basis of the prescription and aid us in correctly localizing symptoms.

It follows, therefore, in our special examination, that we should at once endeavor to put ourselves upon such a footing and in such personal relation to the patient as will best favor a full, frank revelation by him of all the circumstances and conditions that led up to his illness; and an equally full, simple and frank statement of his sufferings as they seem to him. The problem is here largely psychological. It is well in some cases to briefly explain to a new patient the special purpose of a homoeopathic examination and to point out how it differs from the ordinary examination, especially by including mental and subjective symptoms and certain conditions that are usually ignored.

Stuart Close
Stuart M. Close (1860-1929)
Dr. Close was born November 24, 1860 and came to study homeopathy after the death of his father in 1879. His mother remarried a homoeopathic physician who turned Close's interests from law to medicine.

His stepfather helped him study the Organon and he attended medical school in California for two years. Finishing his studies at New York Homeopathic College he graduated in 1885. Completing his homeopathic education. Close preceptored with B. Fincke and P. P. Wells.

Setting up practice in Brooklyn, Dr. Close went on to found the Brooklyn Homoeopathic Union in 1897. This group devoted itself to the study of pure Hahnemannian homeopathy.

In 1905 Dr. Close was elected president of the International Hahnemannian Association. He was also the editor of the Department of Homeopathic Philosophy for the Homeopathic Recorder. Dr. Close taught homeopathic philosophy at New York Homeopathic Medical College from 1909-1913.

Dr. Close's lectures at New York Homeopathic were first published in the Homeopathic Recorder and later formed the basis for his masterpiece on homeopathic philosophy, The Genius of Homeopathy.

Dr. Close passed away on June 26, 1929 after a full and productive career in homeopathy.