The thorough examination of the patient from every possible angle should be carried through, not for the gross diagnostic symptoms, important as these may be from diagnostic and hygienic points of view. From the curative point of view we should not fail to elicit all the possible clues that may lead us to the remedy. Subjective and objective symptoms are to be elicited and recorded. Sometimes this will require the utmost ingenuity to elicit the necessary intelligent replies without leading questions. The physician’s degree of success in obtaining the proper symptom picture lies in his skill and patience. We cannot rush these patients through. We must be good listeners. Get the patient to talking, and tactfully keep him talking about the symptoms rather than wandering far afield. Then cultivate your powers of listening and give your powers of observation full sway, to form the complete picture of the little details and habits of your patient. It has been said that criminal lawyers should be medical men; it is eminently necessary, however, that homoeopathic physicians be past masters of the art of cross- examination; and the observance of the patient’s every movement and expression should be a matter of record.
Before leaving the case, go over again the family history, the personal history, the mental and physical symptoms. Consider the temperament, the habits, the occupation, the personality of the patient. Ask yourself if you have skipped anything. See that you have questioned every item, every function; question the modalities in particular. Go over the previous drug treatment and consider that. Remember that the nature and sensation of the symptoms, the time of day, the positions and circumstances under which symptoms appear, are the most important modifiers of any given case.
To clarify these general instructions, let us take up the matter in greater detail, and go over together the following requirements.
In chronic work it is necessary to take into consideration the general symptoms. By general symptoms we mean those symptoms which pertain to the patient as a whole, or to the complaint which he brings to us. In order to get a complete picture of the case as a whole let us consider these elements:
The aggravations, the periodicity, the seasons aggravations, weather aggravations as to sun, wind, cold, dry, wet, fog, etc.; changes of weather, as cold to warm or warm to cold; changes of weather as before, during or after storms, such as thunderstorms, rain, snow, etc.; the tendency to develop certain conditions, such as the tendency to take cold, sore throats, headaches, etc.; the reactions of fresh air, such as craving for or aggravation from; reactions to positions in rest or in action, such as worse walking, or better lying with arms raised; these reactions in relation to position include also riding in trains, in cars, in vessels; conditions of appetite and the cravings or aversions of aggravations from certain foods; the effects of vaccination or serum treatment; reactions to bathing; effect of altitude, seashore, or mountain; the amount of clothing required, during the day and at night; the rapidity with which wounds heal if the patient is subject to haemorrhages; the reaction of the patient to the presence of others, whether he prefers to be alone or in company, or whether worse being alone or in assembly; the sides affected.
How about the thermic reactions of the patients? Is he hot or cold, in general or under varying circumstances? If there are variations of temperature do they involve the whole or part of the body? Is his skin moist or dry? If he perspires, under what conditions? Freely or scantily? All over or only in certain parts? Is the perspiration offensive, exhausting, greasy, hot or cold? Is he better or worse during or after? How is the sweat related in time to the chill and heat? Is the chill (or heat) partial or general? Is there shivering of a apart or in general, and does this occur with or without chill? Is there thirst? In what relation of time to the heat, chill and or sweat?
Note should be made of the aversions and cravings; the type of sleep and dreams; the positions of the body in sleep; how the patient wakens from sleep and his condition after waking. With either a man or woman patient, the abnormalities of the sexual functions should be noted. Then the strange, rare, and peculiar symptoms should be sought out.
I have left until the last mention of the essential part of the case-taking, the comprehension of the mental symptoms. To a great extent these are symptoms that must be observed from the attitude of the patient. Another reason for leaving these until the last is that during the examination you have probably been able to get the confidence of your patients to a greater degree and they will give you more fully their confidence. Find if they are subject to hallucinations or fixed ideas, especially any fears that are persistent. Take into consideration irritability, or a change in disposition; if you can unearth traits of jealousy, or absent- mindedness, these must be seriously considered. Sadness, ailments arising from grief, vexation, sudden joy, are important. Is the patient over-insistent upon the patient over-insistent upon the minor details of life as to scrupulous cleanliness, etc.? Or is the contrary true?
Your patient should readily reveal many of these most important things to you if you have been tactful and have secured his confidence.
I refer you a wonderful questionnaire compiled by Dr. Pierre Schmidt. This will assist you in securing the information you desire, and if you will study this carefully it will prove a valuable guide in directing your questioning, *after the patient has finished telling you all he thought was necessary to your treatment of the case.
It is well to reiterate the instruction: Do not interrupt you patient while he is telling all he knows of his case, except is so far as he may require guidance to keep him to the subject in hand. The physician’s questioning comes afterward, and it is here that we must complete the picture of the case.
What are the essentials to record in taking the case? (*Answer: The general symptoms; the modalities; the sensations; the concomitants)
Why should we have a written record of each case? (*Answer: So that we may view the case as a complete whole, (I) for our first prescription; (2) for future reference, so that we may note progress.)
Why do we need to pay little attention to the chronic symptoms in taking an acute case? (*Answer: We take each case as completely as possible, for when an acute seizure is present the chronic symptoms usually retire in to the background, so that we need only prescribe for the totality as presented.) When do we find the chronic symptoms portrayed most clearly? (*Answer: At the end of an acute attack the chronic symptoms usually show themselves clearly, even more clearly than at other times; the conditions following an acute attack are not the result of a cute attack, but because Nature has cleared the patient to a great or less degree by the acute explosion and his leaves a clear picture of the chronic condition.).
