Examination of the Patient



We should inquire carefully not only as to acute eruptive, infectious, inflammatory or febrile diseases, including the so – called “children’s diseases,” but about the more chronic and obscure ailments, including skin diseases; organ and glandular diseases (tonsilitis, adenitis, etc.); nervous diseases (epilepsy, “convulsions,” chorea, paralytic conditions, etc.); catarrhs and “discharges” from any of the mucous outlets; bone or joint diseases and rachitis; all disorders of the sexual sphere, *especially syphilis and gonorrhoea.

In women and girls we should inquire about the menses, age at which established and regularity of the periods, note all deviations from the normal and ascertain the time and influence of marriage, childbirth, etc.

We should not forget to inquire if and when the patient *has been vaccinated and learn what course the implanted disease took. At the same time we should inquire if any other inoculations with serums or vaccines have been performed. Many troubles may be traced back to vaccinations and inoculations, intentional or accidental.

The kind of treatment the patient has had for the diseases experienced and the principal drugs used should be learned, if possible. It may be necessary to antidote some of them.

The occupation and habits of the patient; diet, exercise sleep, use of tea, coffee, tobacco, stimulants, narcotics, etc., should be noted.

It is important to ascertain whether the patient has met with any accidents or mechanical injuries, or has suffered any mental shock or trial, such as grief, fright, anxiety or worry, business losses or reverses, unhappy domestic experiences, disappointment in love, etc., and fix the dates and sequence. Such experiences have a powerful influence in causing or predisposing to disease besides being valuable to the prescriber as guiding symptoms.

Next it is important to ascertain the *family history: that is, a brief history of the diseases, causes of death, predispositions and tendencies to disease and individual peculiarities not only of the patient’s brothers and sisters, but of his father, mother, uncles and aunts and his grandparents, if possible.

All this is *General History and should make up a part of the office record of every case. In some cases it will be necessary to go minutely and thoroughly into the history and phenomena of particular phases of preceding disease in order to get the facts necessary for an intelligent homoeopathic prescription.

Such an examination should be made not only for its great practical and scientific value, but for its psychological influence upon patients. Patients will be much more likely to remain permanently with the physician and his hold upon them will be much stronger if he has through and comprehensive histories of their cases in his files and impresses that fact upon them. It gives them confidence in his professional ability and skill.

Patients like to feel their physician, “knows all about them;” that he is not only interested in them and their families, personally and professionally, but that he takes pains to learn and keep in touch with all their individual peculiarities. There is no surer way to build up a permanent, lucrative and substantial practice than by doing this work. It goes without saying that the fee for such a first examination must be commensurate with the time and skill employed and that it will be paid without grumbling, for every intelligent patient will see that he is getting good service and good value for his money.

Printed blanks, systematically covering the point outlined, modified according to individual judgment and need will greatly facilitate the process of good history and case taking. They should be of standard letter size, with blank sheets of the same size for expansion of individual cases and kept together, with all correspondence relating to each case, in folders, in one of the modern, indexed, vertical-filing cabinets, for constant reference.Individual records are filed alphabetically under the name of each patient. It is not well to try to keep case records on little three by four or four by five cards as some do. There should be ample space to do the subject justice. Standard letter size sheets, 8x 10, give plenty of space, match ordinary correspondence and fit the standard vertical cabinets.

The examiner should be constantly on the alert and observing while making an oral examination. The patient may be unconscious or delirious; or an infant, unable to talk; or insane. He may be malignering or trying to deceive as to the real nature or cause of his disease. Knowledge of the natural history and phenomena of disease. Knowledge of the natural history and phenomena of disease will aid in forming a true picture of the disease.

As a prescriber the homoeopathician is always seeking that in the case which is peculiar, uncommon, characteristic, individual. That may be noticed in some casual expression of the patient as he talks, revealing his mood or state of mind, or the origin of his trouble; it may be found in the color, form, or expression of his countenance; or in his attitude, gait, or physical demeanor.

If the patient is confined to bed, the examiner will observe his position in bed, his manner of moving or turning, his respiration, the state of his skin, color or odor of perspiration, odor of exhalations from mouth or body, physical appearance of excretions, relation of the patient’s sensations to atmosphere and temperature is shown in amount of covering, ventilation of room, ice bags, hot water bottle, etc., – all these, and many other little points, noticeable by the alert examiner, perhaps without asking a question, will be valuable guides in the choice of the remedy. They should be recorded as such.

The mental state, conscious and subconscious, is revealed by the general behaviour, the conversation, the expression of the countenance, the desires and aversions and the manner of sleeping, as well as by the voluntary verbal expressions. Mental symptoms are of the highest importance. Expertness in observing and analyzing these features of disease should be cultivated because right conclusions and effective treatment often depend more upon the physician’s own observations and directions, than upon anything that others or even the patient are able to tell him. In the matter of mood or temper of the mind, for instance, he will be able to judge from the patient’s manner of relating or expressing his sufferings and his behavior toward his attendants, whether he is sad or cheerful; calm or anxious, confident or afraid, indifferent, morose, censorious, malicious, irritable, suspicious, or jealous.

As to the intellect, he can observe for himself whether the patient is dull, stupid, unconscious, excited, delirious, distracted, confused, etc. All the foregoing points are covered by the rubrics in any good repertory and they must be covered by the remedy selected.

All these and their allied conditions are most valuable and characteristic as therapeutic indications. They should be observed and noted carefully. Every case should be approached with this thought and the mind kept active and alert while talking with the patient and his friends.

Such work as this has its pleasures, aside from its scientific relations. “The greatest study of man is man.” Most of us like to “study human nature” and rather pride ourselves on our sagacity in “sizing up” the people we meet by a study of their physiognomy, manner, etc. The homoeopathic prescriber will find it to his advantage to cultivate the art of psychological analysis, and may well take pride in it when he is able to do this part of his medical work systematically also.

It is taken for granted that the physical examination of a patient will be made thoroughly and systematically also and the findings added to the record. As that subject does not come within the scope of this work, no further attention will be accorded to it.

If he has succeeded in impressing upon his readers the necessity and advantages of always making thorough and systematic examinations and keeping full, written records of cases the author will feel that his purpose has been accomplished. Nothing conduces more strongly to professional honor and reputation and to success in practice. An honestly earned reputation for making careful examinations, for “taking an interest in the case,” for always being through and painstaking, is one of the most valuable assets a physician can have, and one which may be legitimately capitalized to his financial benefit.

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.