The Examination of the Patient

You might just as well have given Sac. lac. until you found the right remedy. You can hardly say, why did I see the remedy before, because it was not possible to see it. You can only go over a case and say, why did I not ask her if there was any odor to the urine, and if so, what it was like. I have had this very symptom come out when I have asked a dozen times about the smell of the urine, and they did not know, and yet would say after-wards their urine smelled like a horse’s urine, and they knew it all the time. “On the other hand, the patients are so accustomed to their long sufferings that they pay little or no attention to the lesser symptoms which are often characteristic of the disease and decisive in regard to the choice of a remedy.”

Of course the trouble that we have to contend with in ascertaining symptoms from patients could be drawn out to great length. You might suppose that it would be the educated class that would tell their symptoms best, but you will find the ignorant class often do better, they are simpler; they do not disguise the symptoms; they come out and tell the little details in a better way, in a way that conforms to the language of our remedies. Our remedies have been recorded in simple language to a great extent, and this simple language is often better observed by the simple-minded uncultivated people than among the aristocrats.

People who have plenty of means and much education are more excitable, they have more fear and they have tried a great many doctors. Any physicians who has a reputation is consulted for a chronic disease; and the patient who has plenty of money goes around amongst the doctors, and when he comes to tell his symptoms he tells them in the technicalities of his numerous physicians, so that when he has finished his story nothing has been gained. Only gradually can the physician lead him back into a language simple enough to describe the sufferings. They who have been sick long with their chronic ailments and have become somewhat hypochondriac will go through with this list of their diseases.

They have paid lots of money, and have lots of names, and they are loaded with drugs. The physician must deal very carefully with these slippery people, because if they are irritated they will run off. s 96. There is another kind of patient spoken of here, those that “depict their sufferings in lively colors, and make use of exaggerated terms to induce the physician to relieve them promptly. This is especially characteristic of the native Irish as a class. You will find that hey will exaggerate their symptoms, really and sincerely believing that the doctor will give them stronger medicine if they are very sick and will pay more attention to them; and if they do no exaggerate violently, probably he will turn them off with a simple remedy.

Then we have the exaggeration of symptom by sensitive people. It is an insane habit, such s belong to hysteria. The physician will be helpless in the hands of these exaggerators, because Homoeopathy consists in securing the whole truth and nothing but the truth; it is just as detrimental to get too much as to get too little. Any coloring that is expressed, whether by the patient or by the physician, will result in failure. It is true that this tendency to exaggeration must be considered as a symptom. When you have found a patient to exaggerate a few symptoms into a large number, you can simply mention in your note “tendency to exaggerate symptoms,” which is covered by some of our remedies.

Such a state is misleading, for you do not know what symptoms the patient has and what the patient has not. You may rest assured that not patient without symptoms would consult a physician; the patient would not be likely to manufacture the entire sickness; the fact that she has a desire to present herself to the physician and has a desire to exaggerate her symptoms and sufferings is in itself a disease, because no well person would do that. Hence this must be considered; perhaps it is the first and only element that can be considered of that which such patients give out. This exaggeration must be measured with direction and wisdom.

“Even the most impatient hypochondriac never invents sufferings and symptoms that are void of foundation, and the truth of this is easily ascertained by comparing the complaints he utters at different intervals while the physician gives him nothing at least that is medicinal.” Hahnemann’s plan would be to give no medicine and to compare the symptoms that the patient gives from time to time. The patient cannot memorize these various symptoms that he has gathered from other sources, but by watching and comparing fro time to time, letting the examination be far enough apart for him to forget, the physician can aspect those things that he repeats. The young physician will be misguided by these cases until he has had sufficient experience with disease to know something about the nature of symptom that ought to appear.

Another obstacle we have in the examination of the case is laziness; the patient is too lazy to wife down the symptoms when they appear, and too indolent and forgetful to remember them in the presence of the physician. The symptoms do not come up in his mind when he is in the presence of the doctor, and he is too indolent to write these symptoms down when he feels them at home. When a patient does not related symptoms well he should be instructed to write down his symptoms when they occur, and if he will not do that his physician should insist upon it, or refuse to prescribe for him. It is often quite an important thing to get the patient to write down the symptoms in memorandum form as they occur. Not to write at night what has occured during the day, but to run instantly and put the symptom down in simple language, describing the sensation, and location, and the time of day of its coming and going, and the modalities. Indolence then and forgetfulness become obstacles to the gathering of the symptoms.

Now, in the present day, there has crept upon the face of the earth such a state of false modesty and such a lack of innocence upon the whole human race that this false modesty and shame will prevent patients from telling the truth. Patients will deny having had gonorrhoea, or having been exposed to circumstances that were similar. If the whole human race had lived in innocence up to the present day our women would come to the physician with frankness and talk in perfect freedom concerning the menstrual flow, concerning even the sexual functions, concerning things of the will and of the intelligence. But as a matter of fact it is not so, it is with difficulty that the physicians can draw out these symptoms though mistaken modesty.

When a patient consults a physician, the question of modesty should be laid aside. You will find that the most innocent in mind are those that are the most easy to lay it aside, when it is not a question of modesty, but of telling the whole truth and nothing but the truth. If it be a wife, everything that is in relation to herself and husband that is abnormal should be told, and then the physician would have little to ask beyond listening to the truth. I look back over a number of people, especially among women, when seemed to be so much embarrassed upon first coming into my presence and having to talk about their symptoms that they forget everything, and it was only by considerable waiting that they became free and frank and open with me. Sometimes’ it is a difficult matter for the physician to put a patient at ease; it is a thing must be studied and considered in order to be able to say something to put a bashful patient at ease; this is quite an accomplishment with a doctor.

The physician must be possessed of an uncommon share of circumspection and tact, a knowledge of the human heart, prudence and patience, to be enabled to form to himself a true and complete image of the disease in all its details. He must live the life of the neighbor, and be known as a man of honor, as a man who may be believed and respected, as a candid man. Hahnemann says carelessness, laziness and levity will prevent the physician from going into such a state of Homoeopathy as will enable him to grasp the Materia Medica or to be conversant with his science. If he has such a reputation he will not command the respect of the people of the neighbourhood, and this will prevent him from getting the image of the sickness upon paper. Hahnemann had a wonderful knowledge of the human heart, and this is an important thing; a knowledge of the things that are in man.

It would seem that there are a good many men in the community without the slightest knowledge of the human heart. They have never given any inspection their own interiors, their heart or impulses, but have gone on wildly. To know the human heart well is largely to examine into oneself and ascertain what one’s own impulses are, what one is compelled to do under varying circumstances, what impulses one has to control in oneself in order to become a man. If a man has carried out his heart’s desires without any self-control he is man unworthy of present. If he has on the other hand controlled those impulses, he has become a man worthy of respect. In time the physician who does this will become so well acquainted with the human heart that he has sympathy and knows what constitutes the language of the affections.

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.