What one endeavours to do is to find out from the patient exactly what circumstances in any way modify the complaint, that is to say, is it influenced by any action of the patient such as movement or rest, is it affected by weather changes, or does it tend to be worst at any definite hour of the twenty-four hours. From the ordinary diagnostic point of view these facts may be of little or no importance; from the homoeopathic prescribing point of view they are the determining factors in the case.
The next point which emerges in one’s consideration of this problem is that from the homoeopathic standpoint one takes note of many factors which from a diagnostic point of view one may listen to with patients but does not consider worth while to record. For instance, from a diagnostic point of view it is of very little importance that a patient has become very irritable and trying. That he has no longer been interested in his wife and family since the onset of his particular complaint. From the homoeopathic point of view, on the other hand, this is of cardinal importance. There is another practical point which one always has to bear in mind, namely, that the patient will come complaining of some definite disability and is very unlikely to volunteer any statement about any of the concomitant disturbances which have appeared at the same time as, or since, the start of his illness. For example, the patient with the rheumatic complaint is unlikely to tell you that since the onset of this he has developed some strange aversion to particular articles of food, or that he has had digestive disturbances or a skin eruption. These are not the things for which he wants help and so they tend to be ignored, and yet from the point of view of the homoeopathic prescriber they have got to be discovered.
For these, or similar, reasons it has been necessary to evolve a systematic scheme of case taking in order that all the relevant facts will be on record and that nothing which is of value has been over-looked. Various case-taking schemes have been elaborated, but all have the same object in view. When one looks at nay of them one is appalled by the seeming impossibility of applying them rapidly. As a matter of fact, in practice the use of such a scheme saves one endless time and labor, and ensures that one’s case is adequately recorded.
The plan on which I personally work is somewhat as follows. First of all make a note of the patient’s story, dealing first of all the local conditions, then a careful, accurate description of the sensations of which he complains, with any circumstances which individualize these sensations, then the situation of the disturbance, and then any facts that he has noted which tend in any way to modify the complaint. Next anything which he can report as to the cause, duration method of onset, and can report as to the cause, duration method of onset, and progress of the complaint. Then his past personal history and his family history. That, one will see practically case-taking as it is ordinarily learned in medicine.
After having dealt with that, one takes up the patient’s general reactions, starting off first with the time, day or night, or season of the year, during which there is an aggravation. Then any general reaction to weather, temperature, atmospheric disturbances.
Then any general reaction of the patient to activities on his own part. Then any general reactions to external stimuli, for example, sensitiveness to noise, to music, to touch, etc. And lastly and general sensations such as weariness, faintness, giddiness, chilliness.
Then one rapidly runs through the various organs or systems, in every case enquiring for any alternation of function or any disturbance of sensation. For instance, under the digestive system one enquires into alterations of appetite, alterations of sensation of taste, hunger in general, effects of eating, or fasting, disturbances of the bowels, and their effects on the patient as a whole. Under the generative organs one asks into any disturbance of function, any general reactions that take place in connection with sexual relations, or menstruation, and the character of menstrual flow. Under the urinary organs, again, it is a question of enquiring into any difficulty that there is, pain or discomfort, and any alterations in the appearance of the urine. Under the respiratory organs one enquires, again, into the disturbances of respiration, the type of disturbance, what is liable to affect it, any cough, with the modalities modifying it, and its character, any alteration in the voice, again differentiated by when and how these disturbances take place, and the character of the sputum if present.
Similarly, under the circulation one enquires into any sensation which the patient experiences, such as precordial pain, palpitation, sensations of general heat and cold, and again the circumstances which modify them. Then taking up the special senses, one enquires into any increased sensitiveness, and loss of sensation, any disturbances of function, again with the modalities which modify these symptoms. Under the nervous system one enquires into any hyperaesthesia, paraesthesia, or anaesthesia, any loss of power, or paralysis, any tendency to tremor, spasm or pain, in each instance enquiring carefully into the modalities of the individual symptoms.
Under the heading of the skin one enquires into the state of the skin and any tendency to sweat, whether it is general or local, the character of the sweat, any effect produced by sweating, any tendency to eruptions or suppuration, and any disturbances, of appearance, such as colour, or local redness, or swelling. Finally in this in this group of symptoms one considers any disturbances of sleep, sleepiness occurring at definite times or under definite circumstances, sleeplessness caused by mental over-activity, pain, or any other physical disturbance, and the effects or any other physical disturbance, and the effects produced by sleep. And under the same group one considers any dreams which are constant in character.
Lastly, one takes up the examination of the mental symptoms of the case, First of all one enquires as to any change of the patient’s character, next into any disturbances of his primary instincts, or his intellect or understanding, and then as to any sign of alteration of his general mental capacity or his memory.
Having run through these various points, one then carries out a very careful physical examination. There are two important objectives one has in so doing. First of all, it is essential to make an accurate diagnosis, otherwise it is impossible to know what would be the normal progress of the disturbance from which the patient is suffering, of to advise the patient what regimen to adopt in order to help his recovery. Secondly, without an accurate physical examination it is impossible to decide what medicine can be prescribed not merely with benefit but even with safety to the patient, and in what potency the medicine should be administered.
When recounting such a scheme of case taking it sounds as if it would be impossible to apply this in ordinary practice. As a matter of fact, after a very short time working on these lines becomes purely automatic, one simply thinks one has checked this, that and the other essential. Where the reply to our queries has been negative the time taken is negligible, whereas if the query does elicit some positive information, that positive information must be taken into account in deciding on one’s treatment and may well prove to be the deciding factor between success and failure.
Some such scheme must be followed in detain in the treatment of any chronic case. The more acute the disease the more one finds that the acuteness of the disturbance tends to limit the field over which one gets any positive record. For that reason, in the treatment of acute disease it is seldom necessary to record much more than the symptoms of the actual locality, with the modalities which control them. But even in acute disease one finds that there is a very marked tendency for a change to take place in the patient’s mentality, and also in his general reactions to his surroundings. For that reason, even in acute disease these ought carefully to be inquired into.
For instance, take a case of pneumonia, one will find the patient with a certain amount of pain in the chest, one enquires into the character of the pain and the circumstances which modify it. One finds that at certain times of the twenty-four hours the patient tends to be better or worse, one finds that since the onset of the disease the patient has developed a thirst, then one enquires into the character of the thirst and the nature of the fluid desired.
With the developing of the pneumonia the patient will show some characteristic appearances of the tongue, which again have to be recorded and considered. And then one finds that every pneumonia has its own reaction to heat and cold, fresh air and stuffiness. One finds that some pneumonias are intensely restless, while others are toxic and sleepy. One finds that some cases desires to be left undisturbed while others are never at peace unless someone is about. One patient will be worrying about his business, while the next will be made ill by any mention of business responsibilities. One patient will tend to sweat profusely, while another is hot and burning. Lastly, certain remedies have a tendency to produce more pneumonic disturbances in one part of the chest then another. All these actors have to be taken into consideration. By having a general scheme at the back of one’s mind these points are run through and noted in no time at all, whereas without a scheme of this sort on which one always works one is at a loss to note the individualizing characteristics of the case which one is attempting to treat.