(***SEE *Organon, Paragraphs 83-104.) In taking the case, the homoeopathic physician has two objects in view. First, there is the object of diagnosis. This is to place your difficulty in a group class. The homoeopathic physician can have no other object in making a diagnosis than to classify the symptoms under a group head, since the homoeopathic physician never uses his diagnosis for therapeutic purposes. In this he differs from the ordinary school of medicine, which uses the diagnosis as a guide to the desired therapy, certain group conditions determined by the diagnosis determining the therapy to be applied.
With the homoeopathic physician, the group is never treated as a unit; the individual patient, into whatever diagnostic group he may fall, is treated as an individual, and the therapeutic measures are directed according to the individual symptoms.
Therefore, the second and greater object in the taking the case is to select the true symptoms of the patient, and to clarify them so that we can make a definite picture of the ills of the patient.
Many of the things of which we speak, when it comes to taking the case, may seem very commonplace, but there is nothing in the practice of homoeopathy upon which so much depends as the thorough comprehension of the background that we must have in taking the case, and getting the case properly before us for analysis. The presentation of the case should include the whole picture. We cannot depend upon our memory in taking the case. The picture must be preserved in indelible form, in a form which we may go over in review without the danger of leaving out any important symptom; we must be able to turn back to any individual symptom or group of symptoms at any time. So as the first requisite in taking the case, you must have your record cards with you to note down the case as it is taken. So much depends upon this record that you cannot afford not to take the time for properly recording the case.
In making the first prescription, this record is all-important; and in the making of subsequent prescriptions and in reviewing the case so that we may know the sequence of symptoms and the order of disappearance of the symptoms, we cannot move with any degree of assurance unless we have the record in accessible form.
The attitude of the physician should be one of absolute rest and poise, with no preconceived ideas nor prejudices. He should be in a quiet, listening attitude, and as the case is presented to him he should have no previous impressions as to what remedy the patient will require, because this of itself would bias his judgment.
The first thing to note is the patient’s name, age, sex, vocation and, if possible, avocation. Then we are often greatly helped by getting a record of the family; that is, the age of the parents, their general health, and cause of death if they are deceased. This applies to brothers and sisters also; and we must not neglect to get a picture of the types of ailments from which they have suffered. We often get a good picture of hereditary tendencies in this way. Find out, if possible, if there is or has been blood relationships between ancestors. Consanguinity plays an important part in hereditary tendencies as well as in making your prescription (*Phosphorus).
Now we are ready to proceed with the record of the patient himself. Let us begin to record his past illnesses. What illnesses has he had? How about his recovery from each illness? Particularly note whether he reports himself as fully recovering from illnesses, or whether he says he “has not been well since” any particular illness.
Now ask the patient to tell you in his own words how he became ill and exactly how he feels. Do not offer any interruption, lest you break his thread of thought. As you record the symptoms, leave space between them so that you can fill in later answers to questions as it may be necessary. If he comes to a point where he seems to hesitate, simply ask, “What else?” Continue this system of interested listening until he (seemingly) has exhausted his story.
Then you are ready to review the case as it has been given to you. Perhaps before we go into the next step, the questioning by the doctor, it will be well to state the things we must ***NEVER do. We cannot place too much emphasis upon the absolute necessity of leaving these things undone.
I. Avoid all leading questions. By leading questions, I mean questions that suggest answers to the patient, or suggest that you want to bring out certain answers. Some patients are desperately anxious to have answers suggested to them and the physician must be constantly on his guard to avoid doing so.
2. Never ask direct questions, that may be answered with a direct affirmative or negative.
3. Never ask alternating questions.
4. Avoid questioning along the line of a remedy. Sometimes we may get a clue from the statement of a symptom that may suggest a certain remedy, and we must be very cautious not to allow this to prejudice us in favour of the remedy suggested by questioning the patient along this line, and thus perhaps bias the patient in his replies.
5. While you are dealing with one symptom, confine yourself to that symptom. Never skip from one symptom to another at random, as it confuses the patient and scatters the physician’s ideas.
Now we will return to the necessity of rounding out the symptom picture in our record. Some symptoms may have been given with a fair degree of completeness; others are very incomplete. We must complete, as far as possible, every symptom that has been presented, and for this careful questioning is necessary. Each symptom must be rounded out as to time and place; the sensations; the kind of distress; the type of pain; all of the modalities connected with it; the probable causation, that is, what the patient thinks was the start of the trouble. Under the modalities, we must secure the aggravations and ameliorations of each individual symptom, so far as possible. Not the least important is the emotional reaction of the patient.
When we work out the recording of the case in this way, we cover all the parts of the man, and can see the picture as a whole. We must leave nothing uncovered. In order to do this, we may have to bring into play the testimony of the family or nurse on symptoms or conditions that may have a bearing of considerable value. However, this source of information must always be scanned with a great deal of circumspection and we must weigh the integrity of the source as being worthy of consideration.
With the most careful recording and the most cautious questioning we may be unable to find complete symptoms and may be unable to build up more than a sketch of the patient himself. We will deal with this in a later chapter.
In acute illnesses, take the acute symptoms, carefully record each one, and find out all there is to know about them. Likewise in the chronic picture, record all the symptoms as far back as you can dig out the symptoms, and the sequence of the symptom pictures, and prescribe for that state. However, if you are dealing with an acute condition, limit yourself to dealing with the acute state alone and do not at the same time attempt to dip into what has been a chronic state. Acute manifestations show themselves with surprising clearness, and to include chronic symptoms that have been manifest at other periods will but confuse the picture.
Remember, we must prescribe for the totality of the symptom picture and not for any one symptom alone, but for the complete picture as it is presented in the individual. In an acute explosion the chronic picture will retreat completely; therefore, in treating the complete picture that is present there will be no need to take the chronic picture into consideration. At the close of the acute attack we again see the chronic picture. Then will be the time to deal with it. In fact, there is no time in the history of the case when we can see the picture of the chronic underlying condition so plainly as at the end of an acute attack, after the acute conditions have subsided. Therefore, after dealing properly with the acute attack, and waiting until it subsides, we will be in a position to see clearly the picture of the chronic case. This condition following acute illness is much more apt to be the manifestation of the chronic condition than it is to be the aftermath of acute conditions, as is popularly supposed.
In considering the totality we cannot over-emphasize the necessity of getting the complete description of each symptom, as to its location, character, and modalities. The modalities, the aggravations and ameliorations, are the most important. Next in order come the character of the sensations.
The most important symptoms, of course, are the general symptoms that pertain to the patient as a whole. Then come the aggravations and ameliorations. The mental symptoms rank very highly for the reason that they point to the man himself, and they may be classed under the generals to a marked degree.