There is another class whose statements are plus or minus what exactness would require. Almost all of our descriptive language is figurative.
We describe sensations certainly according to our idea of what effect would be produced by certain oppressions upon our sensory nerves. e.g., burning, boring, piercing. this involves an act of the imagination. We are differently endowed with the imaginative faculty. Some persons cannot clothe a sensation in figurative language, and are therefore almost unable to describe their subjective symptoms, and are very difficult patients. Others, again, naturally express themselves in his way, and, where imagination is controlled by good judgment, are excellent patients, because they describe their symptoms well. this is a matter dependent upon natural endowment, and not upon education or culture. Some persons who cannot construct a sentence grammatically will give us most graphic statements of symptoms, while others who have borne off the honours of a university are utterly at a loss for the means to express what they feel.
Finally, some persons have a natural fervor and tropical luxuriance of expression, which leads them to intensify their statements and exaggerate their sensations.
And some, like the Pharisee who believed he should be heard for his much speaking, think to attract our attention, and excite us to greater effort in their behalf, if they magnify their sufferings and tell us a pitiful tale. Others, on the contrary, of a more frigid temperament, give us a statement unduly meagre in its Artic barrenness; or else, fearing to seem unmanly if they complain with emphasis of suffering which is perhaps the lot of all men, understate their case and belittle their symptoms.
In estimating your patients in these regards, judging while the tale is being told, what manner of man you have to deal with, what allowances you must make, what additions, what corrections, you will have full scope for your utmost sagacity and savoir-faire; and of the value of this estimate of your patient I cannot speak too highly. I have often seen the thoroughly scientific man led astray and bamboozled, where one far inferior to him in scientific knowledge detected the peculiarities of the patient, made the necessary corrections, got an accurate view of the case, and then the prescription was easy. Why, sometimes the patient will, in good faith, state a symptom so incompatible with others that we know and must declare it impossible, and so it is finally admitted to be by the patient.
If it be necessary to make this estimate of the patient, so must we likewise of his friends, who, besides having the peculiarities already spoken of, may be unfriendly to us or to our mode of treatment, and may thus be reticent or reluctant witnesses, or may even mislead us willfully.
We make this estimate of our patient and his friends while he and they are stating the case to us;and this statement we should as far as possible allow then to make in their own way, and in their own order and language, carefully avoiding interruption, unless they wander too far from the point.
We must avoid interrupting them by questions, by doubts, or even by signs of too ready comprehension of what they are telling us. It will of course happen that they skip over important details, that they incompletely describe points that we need to understand fully. But we should not these as subjects for future questics, and forbear breaking in upon the train of our patient’s thoughts, lest once broken he may out be able to reconstruct it. when he has finished we may, by careful questioning, lead him to-supply the deficiencies.
We must avoid leading questions, and at the same time must not be so abstract and bald that for lack of an inkling of our meaning, the patient becomes discouraged, and despairs of satisfying us. It is never our object, as it may be that of the lawyer, to show our own cleverness at the patients expense, and to bamboozle him. We must, on the other hand, make him feel, as soon and as completely as possible, hat we are his best friend, standing thee to aid him in so reviewing his case that we may apply the cure. And so we must encourage his diffidence, turn the flank of his reticence, lend imagination to his matter of fact mind, or curb the flights of his fancy, as may be required.
We want a statement of the case in graphic, figurative language, not in the abstract terms of science, It does not help us to hear that the patient has a congestive or an inflammatory pain (however correct these conceptions may be); but a burning or a bursting pain is available. Nor does it specially enlighten us to know that the patient feel now just as he did in last year’s attack, unless indeed we attended him then.
Having received the patient’s statement and made our own observations. We have a picture of the case, more or less complete. what are we to do with it? What is the next step? We have now one series of phenomena. The law tells us that the drug which will cure that patient must be capable of producing in the healthy a similar series of phenomena.
Seeking the means to cure the patient then, we look among drug proving for a similar series of phenomena. Let us suppose that we find one which corresponds pretty well. Not exactly, however, for here are certain symptoms characteristic of that drug, of which the patient as regards those symptoms. No! his symptoms in that line are quite different. We try another similar drug, comparing its symptoms with the patient’s and questioning the patient still further; and thus the comparing and trying proceed until we find a fit. This is a mental process, so expenditious sometimes that we are hardly aware how extensively we engaged in it. But it shows how difficulty it is to take a case unless we have some knowledge of the materia medica, and how much an extensive knowledge of materia medica aids us in taking the case; and this explains why the masters in our art have given us such model cases. (In consultations, a doctor will send his taking of the case. We cannot prescribe from it. We must take the case ourselves). In thus fitting the case and the remedy be honest with ourselves, just as in getting shoes for your children. Do no warp or squeeze to make a fit. And now, before we go further, let us ask what are the symptoms generally which give the case its individual character, and determine our choice of the remedy. Are they the pathognomonic ones? They cannot be unless we are o treat every case of disease named by a common name with one and the same remedy. Are they those which are nostalgically characteristic? No, for the same reason. they are the trifling symptoms,. arising probably from the peculiarity of the individual patient, which make the case different from that of the patient’s neighbor. They may be a sensation or a condition. If it be metrorrhagia, the mere fact that the flow is worse at night may determine the choice between two such remedies as Calcarea and Magnesia.
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.