The Examination of the Patient

The examination of the patient pertains to the homeopathic case taking, which Hahnemann discussed in aphorisms 83-103. Here Kent elaborates his approach to case taking along with clinical examples and common pitfalls….

$ 84. The patient details his sufferings; the persons who are bout him relate what he has complained of, how he has behaved himself, and all that they have remarked in him. The physician see, hears and observes with his other senses whatever there is changed or extraordinary in the patient. He writes all this down in the very words which the latter and the persons around him make use of. He permits them to continue speaking to the end without interruption, except where they wander into useless digressions, taking care to exhort them at the commencement to speak slowly that he may be enabled to follow them in taking down whatever he deems necessary.

One of the most important things in securing the image of a sickness is to preserve in simplicity what the patient tells us in his own way unless he digresses from the important things and talks about things that are foolish and not to the point; but as long as he confines his information and in the record use his own language, only correcting his grammatical errors for the purpose of procuring the record as perfect as possible. If you use synonyms be sure that they are synonyms and cannot be perverted.

Of course, when the woman speaks of her menstrual period as “monthlies” or as her “show,” the more suitable medical term is “menses,” which is a synonym for those expression, and is more expressive than her own way of calling it “a show”. So in general terms you can substitute terms of expression so long as you do not change the idea. Of course, the changing of “legs” into “limbs” if you feel like making such a change is not a change of thought, but be sure in making a change it is not a change of thought.

It is one the most important things in forming the record of a patient to be able to read it at a subsequent examination, without being disturbed by the repeated statements of the patient. If you write a record in consecutive sentences, you will be so confused when hunting out the symptoms of the patient that you will be unable to form an image of that sickness in the mind.

It is truly impossible when the mind is full with the effort at hunting out something to listen with proper and concentrated attention. You should divide your page in such a manner that when the patient is talking to you about this thing and that thing and the other thing of her symptoms, you can with one glance of the eye look down over the page of the record and see everything there is in that page. If you record is not so arranged, it is defective. Now, a record can be so arranged by dividing the page into three columns, the first of which contains the dates and prescriptions, the second the emphatic symptoms or headings and the third things predicated of the symptoms, thus:

Date } Symptom.

} Things predicated of the symptom

} (<) (aggravation).

Remedy (>) (amelioration).

After the patient has detailed his sufferings in his own way and you have gone through them and discovered all the things that you can predicate of his symptoms then you can proceed to make enquiry of some on who has been with this patient. In a study like this with most of our private patients there has been a nurse, sometimes only a sister or a mother or a wife, who has been observing all the sick individual has complained of. “The persons who are about him relate what he has complained of, how he has behaved himself, and all that they have remarked in him.” Now, this should be listened to with great care.

It is more important in this instance to decide whether the observe is overanxious, if a wife whether she is not frightened concerning her husband and so intermingles many of her notions and fears, which you must accept with discretion. Get the nurse, if possible, to repeat the exact words of the patient. If such a thing can be done in acute sufferings it is worth more than the words or expressions of the nurse, the wife for instance, because the more interested and anxious the person is the less likely she will be to present a truthful image, not that she wants to deceive, but she is dreadfully wrought up and the more she thinks of what he has said the greater his sufferings appear to her, and she exaggerates them. It is important to have the statement from one who is disinterested. Two or three of the observers who are intelligent having been consulted and their statements recorded, the physician then notes his own observation. He should describe the urine if there is anything peculiar about that, but if the urine and stool are normal he need not care about the description of these.

It has been the study for hundreds of years to find the best way to question witnesses in court, and as a result they have settled upon certain rules for obtaining evidence. Homoeopathy also has rules for examining the case that must be followed with exactitude through private practice. Among pupils who have been taught here, I know some who have merely memorized and some have not even memorized but have fallen away. These students are violating everything they have been taught; they have gone to low potencies, making greater and greater failures, to the shame of the tutor and the science they profess of follow.

I expect some in the sound of my voice will be doing this five years from now; thus is a warning, stop before you go too far, or you will not feel the fault is your own. You will think you hypnotized and led into false ways. If you neglect making a careful examination the patient will be the first sufferer, but in the end you yourself will suffer from it, and Homoeopathy also. The questions themselves that Hahnemann gives are not important, but they are suggestive and will lead you in a certain direction. Question the patient, then the friends, and observe for yourself; if you do not obtain enough to prescribe on, go back to particulars. After much experience you will become expert in questioning patients so as to bring out the truth. Store up Materia Medica so as to use it and it will flow out as your language flows. You must put yourself on a level with the form of speech your patients use.

Be sure you have not put any words into your patient’s mouth or biased his expression., You want to know all the particulars but without asking about it directly. If you ask a direct question, you must not put the symptom in the record, for ninety-nine times out of a hundred the patient will answer by `Yes’ or `No.” If the patient’s answer is `Yes’ or `No,’ you question was badly formed. If a question brings no answer let it alone, for he does not know or has not noticed. Questions giving a choice of answers are defective.

Ascertain the precise part of the body the pain was in and the character of the pain, etc. In investigating a case there are many things to learn, the length of the attack, appearance of the discharge it it be a case of vomiting, its character, the time of day, etc., etc. Every student should go over these questions collateral questions, and practising case-taking. Leave the patient in freedom always Do not put any words into his mouth. Never allow yourself to hurry a patient; get into a fixed habit of examination, then it will stay with you.

It is only when you sustain the sharpest kind of work that you can keep your reputation and fulfil your highest use. Say as little as you can, but keep the patient talking and keep him talking close to the line, If he will only talk, you can find out symptoms in general and particular. If he goes off, bring him back to the line quietly and without disturbing him. There is not much trouble in private practice. There you will do a better average of work.

All sleep symptoms are important, they are so closely related to the mind, the transfer from sleep to waking, from cerebrum to cerebellum, is important. Old pathologists were unable to account for difficult breathing during sleep. The cerebrum rules respiration during sleep. To know the functions of the white matter and gray matter is important. A rational knowledge of anatomy is important. No homoeopath ever discouraged the true study of anatomy and physiology. It is important not only to know the superficial but the real, profound character, to enable you to recognize one symptom-image from another.

Study this paragraph, carefully and meditate upon it. If you do not form habits now, you will not from practice hereafter. You have no regular course and will get into habits you cannot break up.

The examination must be continued with due respect to the nature of the sickness and with due respect to the nature of the Materia Medica. Some symptoms have references to pathology and diagnosis, while others have reference only to the Materia Medica, and symptoms must be constantly weighed in the mind in order to establish their grade whether common or peculiar. If all are found to be common symptoms, the Materia Medica is left out.

Either the examination has not been made with respect to the Materia Medica, or the symptoms are not there at all. It makes no difference as far as cure is concerned; it matters not whether they are not present in the case or whether the doctor has not found them, the key to the prescription is not present. But if the image is round and full and complete, there are symptoms with regard to pathology, diagnosis, prognosis and Materia Medica. It will be proper later to talk of incurable, diseases, pathognomonic symptoms obscure cases, Materia Medica symptoms, etc.

James Tyler Kent
James Tyler Kent (1849–1916) was an American physician. Prior to his involvement with homeopathy, Kent had practiced conventional medicine in St. Louis, Missouri. He discovered and "converted" to homeopathy as a result of his wife's recovery from a serious ailment using homeopathic methods.
In 1881, Kent accepted a position as professor of anatomy at the Homeopathic College of Missouri, an institution with which he remained affiliated until 1888. In 1890, Kent moved to Pennsylvania to take a position as Dean of Professors at the Post-Graduate Homeopathic Medical School of Philadelphia. In 1897 Kent published his magnum opus, Repertory of the Homœopathic Materia Medica. Kent moved to Chicago in 1903, where he taught at Hahnemann Medical College.