The next most important requirement is attentive observation. If we hope to arrive at the truth we must not only be attentive to what the patient tells us, and to what the nurse or family may impart, but we must observe closely the appearance of the patient himself.
Ofttimes the symptom which will lead us to the remedy will be one which we may get by observation. The way the patient lies, sits, walks, talks, conducts himself generally, the appearance of discharges, the color of the eyes, hair, tongue, skin, etc, all have their place and are of the greatest importance in our record.
Upon your powers of observation will depend not only the first image of your case but also your success in conducting the case after the first prescription has been made.
The last group of three relating to the taking of the case will be the three mistakes made in examining the case, interruption of patient, asking direct questions and making answers conform to some remedy we may have in mind.
A thing of the greatest importance in securing an image of a sickness is to preserve in the simplest form what the patient tells you. Let him tell it in his own language, and unless he digresses too much from the subject do not interrupt, for by so doing you may lose a line of thought and may not be able to get him back to it again.
Then do not ask direct questions. You must never put answers into your patients’ mouths. You need to know all these particulars but without asking about it directly. Nine times out of ten the answer to a direct question will be “yes” or “no;” such answers are without value and should not be included in the record. Questions which give a choice of answers are also defective.
Making answers conform to some remedy we may have in mind: a patient comes in, tells us a few symptoms; we immediately think of a remedy and begin to ask questions, and see if we cannot get enough evidence to convict him of Belladonna, Arsenicum or whatever it may be.
It is surprising how well we can make the patient give us the symptoms we are looking for, as well as how little evidence it takes for some of us to make the conviction and give the remedy. We are more apt to blunder along this line if we do not write out our cases. The mere writing of the symptoms helps us keep cool and not pass hasty judgement.
On page 206 Tafel’s translation of Nature of Chronic Diseases we find “The physician, can, indeed, make no worse mistake than to consider too small the dose which I (forced by experience) have reduced after manifold trials and which are indicated with every antipsoric remedy. Secondly, the wrong choice of a remedy, and, Thirdly, the hastiness which does not allow each dose to act its full time.”
In remarking as to the cause of the second mistake, we will quote from the same writings, on page 207, as follows:
“As to the second chief error in the cure of chronic diseases (the unhomoeopathic choice of medicine) the homoeopathic beginner (many, I am sorry to say, remain such beginners their life long) sins chiefly through inexactness, lack of earnestness and through love of ease.”
A difficulty may arise in those obscure cases the symptoms of which have been masked by drugging, homoeopathic and otherwise, operations etc., so that these cases only present a few common symptoms, which can only guide us to a group of remedies in which the simillimum must be found after exhaustive study of the materia medica.
Many times in these cases before we can make any progress we must go back through the life of the patient to childhood and note all symptoms which preceded the pathological change that now obscures the image of your case. “Symptoms that existed in childhood and those present before any pathology existed are the corresponding symptoms of causes; as all causes are continuous into effects. They give us an image of the case from causes to pathological endings. These symptoms through childhood down to present are greatly important and describe the progress of sickness.”