Examination of the Patient



Beliefs and convictions may be strengthened and energy stimulated by reflecting upon the fact that our therapeutic method is efficient and successful because it is based upon immutable law. We may mentally recall and restate the law and its corollaries and review the facts upon which it is based, or, better yet, write a little essay on the subject; recall to mind or seek out illustrations and examples of its truth and adequacy; study the cases and cures reported in our literature by the masters; think of duty, loyalty to principle and consistency of practice; think of success, gained by right methods and without compromise. To *think success goes a long way toward realizing success.

Our work as physicians involves the performance of a number of related functions, all of which are subordinate to the main function of healing the sick.

As specialists in therapeutic medication we examine for the symptoms upon which the choice of the remedy depends; but as physicians we also examine for the symptoms upon which the diagnosis and prognosis depends. Our aim is to make a complete examination, including all necessary pathological investigations. Having all the facts in hand we determine what features of the case are medical, what are surgical, what are psychological, what are hygienic, what are sanitary, etc. We keep all these departments distinct in our minds as bearing upon *the case as a whole, realizing that each has its particular relations to and bearings upon all the others; and especially do we seek to realize this of the department of homoeopathic therapeutics, which for us is the most important of all, because we know it is useless to attempt to base the homoeopathic prescription upon anything except the symptoms which belong to its legitimate sphere. The generalizations of the diagnostician or the pathologist, be they ever so correct, cannot serve as the basis for the homoeopathic prescription.

*The purpose of the homoeopathic examination is to bring out the symptoms of the patient in such a way as to permit of their comparison with the symptoms of the materia medica for the purpose of selecting the similar or homeopathic remedy. Every disease has its symptomatic likeness in the materia medica. The homoeopathic materia medica is like a “rogues gallery” in which are hung up the portraits of all the pathological rogues in the world. When you catch a rogue compare his features with the portraits. Then make him “take his medicine!”

Like all rogue – catchers, when on duty our senses must all be on the alert, our minds clear, our logical faculties acute, our sympathies and prejudices held in abeyance. When all the facts are before us we may sympathize, correct, reassure and encourage as far as seems judicious and wise.

Artifice must sometimes be resorted to in the examination of a case, in order to get a the facts. Many obstacles have to be overcome. Among them is modesty, often on the part of the patient, *sometimes (rarely, nowadays!) on the part of the physician if he is young and inexperienced. I often recall with amusement my feelings as I witnessed for the first time an examination of a case of phthisis pulmonalis by my old preceptor, Dr. Wells. The part of the examination which excited my risibilities was that which referred to the character of the sputum. He inquired particularly as to its color, *odor, form and taste! It was the first time I had ever heard such questions and the first time that it had ever been brought home to me that such facts could have any bearing upon the selection of the remedy. I believed that I was not over modest, but such refinement of analysis rather disgusted me. After the patient had been prescribed for and dismissed, I frankly stated my difficulty to the old master. He laughed a little sympathetically at my ignorance and rallied me on my squeamishness. Then he soberly pointed out that the patient’s reply that the sputum “tasted sweetish” had enabled him to differentiate between two very similar remedies and make an accurate choice. He made that the text for some sadly needed instruction *in the necessity for close analysis of all the elements of the case – instruction which no one ever gave me during my college course.

Here, as an important part of the homoeopathic examination, attention should again be directed to the use and importance of *logical analysis in the symptomatic examination of the patient. The clinician analyzes symptoms for the same reason and by the same method that the pathologist analyzes a pathological specimen.

Many of the statements of the patient will be mere generalities. These are of no value to the prescriber until they have been analyzed into their elements. As stated, they are merely common symptoms without individuality. The patient will tell you, for example, that he has a headache. That, and all other similar generalities, must be analyzed so that the elements of locality, sensation and modality are brought out by properly framed questions. The patient may state that he has a discharge of some kind. After locating that anatomically, it should be analyzed into its elements of color, odor, consistency and quality (as bland, excoriating, causing itching, etc.). Similarly with a diarrhoea, so far as the character of the discharges are concerned; but here the act of discharge itself should be analyzed into its elements, and its character and concomitants in time and space fixed, by creating the divisions of “before stool,” “during stool” and “after stool.” In other words, the patient is asked to describe how he feels and what happens before, during and after the act of defecation. So in intermittent fever, for another example; the disease form is analyzed into its elements; 1. Type and periodicity (quotidian, tertian, quartan, weekly, monthly, semi-monthly, annual or semi- annual); and further as to time of day when the paroxysm appears; 2. Stages (prodrome, chill, heat, perspiration); 3. Apyrexia. In each of these divisions the phenomena are located as they appear, defining each particular symptoms as accurately as possible. Thus to discover and bring out the facts of a case and give them form and individuality *as a whole, is the art of the accomplished homoeopathic examiner. It is an illustration of what a former article means in speaking of the “totality” as consisting of “related facts, having form, coherency and individuality,” and characterizing its formation as “artistic.”

Although the facts must be gathered from the patient, their form, relations and value depend almost altogether upon the examiner. The patient, unaided, will usually give only rough, disconnected statements, crude generalities, single concrete facts and a few details – a mere formless mass. The trained examiner patiently and skilfully analyzes and completes the statements, brings out details, connects the whole and constructs the case logically and scientifically, giving it a typical form, according to a preconceived idea. That is art and true art is always scientific.

As models of analysis in special diseases, and for daily practical use, procure and study Allen on Intermittent Fever; Bell on Diarrhoea and Kimball of Gonorrhoea. In general analysis and synthesis of the entire field of materia medica, Boenninghausen’s “Therapeutic Pocket Book” and Kent’s Repertory are classics, indispensable to every homoeopathist.

Boenninghausen’s “Therapeutic Pocket Book” and his book on fever (unfortunately out of print) are the original and unsuperseded models upon which all other reliable works of this class are based.

Boenninghausen, following and working with Hahnemann, is the fountain head for the analysis and classification of symptoms from which we all draw. His name, next to that of Hahnemann, is the most illustrious in the galaxy of homoeopathic heroes. Methods of practice based upon and patterned after the work of such masters cannot fail to bring success to every practitioner who uses them and advance the cause of Homoeopathy.

Clinical Histories.- Getting a good clinical history is one of the most important parts of case taking. By the same token it is also the one most generally neglected of badly done.

In order to deal intelligently with the present we must know something of the past. We must know not only the facts of the present, perhaps acute illness, but also what led up to it. Otherwise we will often be baffled in our attempts to cure and find our patients making slow and imperfect recoveries from seemingly simple acute diseases, or settling down into states of more or less confirmed invalidism.

This is because all genuine acute diseases are in reality acute outbreaks or exacerbations of previously latent, deep-seated, underlying, chronic diseases or inherited tendencies and predispositions to disease, which exist in practically all persons, – a special subject which is dealt with elsewhere.

In examinations then, as a rule and at the appropriate time, we first get us complete a list as possible of *the patient’s previous diseases, from childhood down to the present, in as nearly chronological order as possible, with the ages at which the attacks appeared and inquire as to their nature, symptoms, duration, severity and sequelae.

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.