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 he learned elsewhere, and by their great utility have contributed much to the brilliant success of Homoeopathy, particularly in the diseases of children. The facial expression, the involuntary posture, the temperature both localized and general, alternation of colour or consistence, the state of the reflexes including sensibility, the odor 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.
Most subjective symptoms have an indefinite character or are common to many disorders, therefore deserving of little attention. It is only when an ordinary symptom appears in an extraordinary place or way that it becomes of much value.
Sensations are expressed according to the mentality of the subject and vary from the simple indefiniteness of those of childhood to the hysterical loquacity which takes on every symptom thought of : it therefore follows that the attributes of the symptoms are of far greater importance than the sensations themselves. In certain cases by paying more attention to the time, manner and circumstances under which a given symptom occurs we succeed in not only diverting the mind of the patient, but in gaining a great deal of very valuable information.
Every sickness possesses a more or less definite individuality which is reflected by those symptoms which in their nature epitomize the various attributes of the whole case, the characteristics. They may not belong to the pathogenesis of any known remedy, and even if they do, their setting may only accentuate their unsuitableness to the concrete case under consideration. Such a case must then be worked out by means of the modalities, mental symptoms, etc., then if the peculiar symptom disappears along with the others it may be kept under observation for future confirmation.
The available key-notes are inadequate to answer all purposes. It is far better to be able to see the general picture and use the key-note as a differentiating point, just as we would use a modality. The key-note characterizes the case much more than it does the remedy, because its position in the picture is always modified by the accessory symptoms. The self-same symptom may be the guiding one in certain instances and of little or no consequence in others, according to its surroundings, its modalities and origin.
The diagnostic and common symptoms as shaded by the general modalities from the ground colour of the picture, from which its special features portraying the individuality emerge with more or less distinctness. The focal point of the scene reveals its inherent genius with which the outlying parts must harmonize, if we wish to fully grasp its meaning. Running after key-notes while paying scant attention to the general harmony of the picture has spoiled many a case and leads to polypharmacy.