The proficiency of the physician’s daily work, rather than the flash of genius which makes an occasional brilliant cure, is the final measure of the successful practitioner. His abilities will very largely depend upon the powers of observation and proficiency in details.
No branch of medical research will enhance this more than the exhaustive study of physical diagnosis, for it bears a’ close and many sided relationship to our symptomatology. In a sense therapeutics and physical diagnosis are mutually interdependent, the one helping to interpret and define the other. It therefore follows that the diagnosis should be as accurate as the fitting of the remedy. We must not only diagnose sickness in its larger sense but the comprehension of its picture will most certainly limit our grasp of the remedies from which a choice may be made. This is especially true of localized affections.
Different drugs affect different parts, tissues and functions of the organism, but the final reason why one depresses and another excites, or one either heightens or lowers activity according to dose and circumstances, remains substantially unknown in spite of researches into drug. affinity which seemingly push it further and further into obscurity. The study of regions implies a discovery of the seat of the disease and of the remedies related thereto. A large number of drugs are known principally by their regional effects; many of them are imperfectly proven and crudely applied because their drug image is not well rounded out.
They are often prescribed for specific, antipathic, palliative or suppressive effects. This is especially although not exclusively, true of the use of low potencies or crude drugs. In a general way drugs which affect the same or similar tissues bear a certain relation to each other and are differentiated through the mental sphere and the modalities. Each holds some other as its acute or chronic counterpart; the mental state of the one being generally the opposite to that of the other. Baryta carb, in common with Apis affects the lymphatic system, but their respective mental states are almost diametrically opposite. While the former stamps its dyscrasic character upon the mind and countenance, the latter is its acute complement. The Baryta carb.·constitution takes on Apis symptoms when the lymphatics show the presence of a blood infection. Similarly the chronic Sepia patient displays Lachesis symptoms in the presence of alcoholism.
In ordinary parlance we speak of the aetiology of disease, but for us these old school ideas are far too narrow because the radius from which we draw our information is wide and may include any influence whatsoever. Things, in themselves apparently very trivial may become of the greatest import when related to the beginnings of disease. Sickness arises from extrinsic as well as autogenetic causes. The former are in a general way more accessible and therefore more accurately defined. They embrace the susceptibility to certain external influences which pervert the vital force, injuries, the state of the weather, heat, cold, dampness, physical exertion, etc.
TAKlNG THE CASE
Autogenetic causes often have mental states as their starting point; the effects of grief, worry or fright are good examples. Emotional states may be the beginning of a long train of untoward manifestations for which the similimum can not be perceived until they are given a proper place in the pedigree of the disease and as the mind does not always readily disclose such things they may be difficult to discover.
Whether the causes come from without or arise from within, the homeopathic similimum cannot be chosen with safety without taking them fully into account. The great miasms belong to this class.
Closely related to the cause, are the circumstances under which disease, and the conditions which modify it, makes its appearance. These are commonly known as the modalities; they individualise and define every sickness as well as every drug, hence the most suitable medicine can not be chosen while they remain unknown. They include such modifying agents as the effect of posture, the different kinds of motion, the various forms of heat and cold, the effects of the weather, of bathing, washing, getting wet or any modifying agent whatsoever. Many odd or strange modifying influences also occur; they belong to but few remedies and are not often seen in practice, but possess the highest value.A striking instance of this kind is found under Clematis which has an eczema which is moist during the increasing moon but dries up during the waning moon. We now know that this modality belongs almost exclusively to Clematis and that any symptoms having it will almost certainly belong to this great antisycotic, whether it be a skin eruption or a goitre. Conditions which modify or excite mental symptoms are not exceeded in importance by any others. To these belong the influence of the emotions, of fright, grief, solitude or company, thinking of the disease, consolation, vexation, etc., on the mind, “Pain which excites to anger” is an excellent example.
The mind is a subjective as well as an objective index which reveals the bias which rules the whole case. Rarely do we see a mental exaltation of depression coupled with an opposite physical state, but when we do its remarkableness points the indication. The relative activity of the intellect combined with its moral trend is an invaluable aid and should always if possible be ascertained.
A study of the mental symptoms should include the gross objective changes noted by the attendants as well as a close scrutiny and interpretation of the speech, action and countenance by the physician, for the mind mirrors itself with great accuracy in the different modes and manners of physical expression. An intonation of the voice may sometimes explain the source and meaning of a particular symptom, so intricate are the mental processes. It is to be remembered that changes in the ordinary moods are points of departure whose value depends upon their variation from the normal or every day condition.
As a group the concomitants contain many anomalous and peculiar symptoms. They are often so distinctive of a-remedy as to render the name of the disease under which a peculiar symptom may occur of little moment. Nevertheless the modalities, mental accompaniments and duration of an unusual symptom govern its position. When these go to make up an harmonious picture it becomes a true characteristic, otherwise it has only a negative value. Sometimes the affected organ seems overwhelmed by the impact of the disease and the vital powers can find expression through the concomitants only; then they become of supreme, importance as the almost sole guide for the selection of the remedy.
The value of a concomitant is often fixed by its age. The acute or more recent ones are of course the most guiding, for within their genesis lies bound up the type of the similimum. Remedies suitable for acute vital disturbances stand in an accessory relation to the constitutional or antipsoric drugs. They are capable of correcting the irregular expenditure of energy which may temporarily be imperilling the life of the patient but are mostly impotent to remove the great fundamental dyscrasias which they nevertheless have the power to uncover or arouse into activity. To combat the latter we have the great antipsorics of Hahnemann and unless we have at least some comprehension of the correlative relation of the two classes we may find ourselves opening a Pandora’s box. The alternater and mixer, owing to the spurious teaching so long prevalent, often has the embarrassment of finding himself in this predicament, that is, if he is capable of seeing it.
The presence of an old constitutional symptom belonging to the miasms, although it may be peculiar, should not mislead us into following it during an acute illness, unless because of its malign presence the drug pictured by the recent sickness fails to act.
In making an examination it is generally best to allow a free statement of the case in the patient’s own way while we take pencil memoranda of the salient points, gradually filling in the deficiencies by such questions as the notes suggest.
As every sickness, whether natural or induced, is the child of a combination of events which never again produces its exact self, it follows that the best indicated remedy is the one holding the closest similitude thereto in location, origin, modality, mental condition, concomitants, peculiarities and time.
Objective phenomena, being exempt from self-interpretation and allowing the largest scope to the acumen of the examiner are withal the least deceptive and should receive our first and best attention. They teach lessons not to be learned elsewhere, and by their great utility have contributed much to the brilliant success of Homeopathy, particularly in the diseases of children. The facial expression, the involuntary posture, the temperature both localized and general, alterations of colour or consistence, the state of the reflexes including sensibility, the odour of the patient, etc., are but a few of the points to be noted. Nothing should escape the observer, for faulty examinations are the main cause of failure.