Art of Interrogation

Discussion on case taking of acute and chronic cases by Pierre Schmidt. Many examples that show how different types of patients need to be interrogated….

Today I shall discuss the art of interrogation but first I shall mention one or two points about homoeopathic treatment.

The remedy you select may be of mineral or vegetable or animal origin or a nosode. If you are considering a mineral remedy, before giving a mineral remedy, please try to begin the treatment of your case always with a vegetable remedy. There is only one exception to this rule and that is Lycopodium. It is a vegetable remedy but please generally avoid beginning the treatment of a case with Lycopodium. With Lycopodium it is the experience of the old homoeopaths – it is so deep in action, like Sulphur and Calcarea, comprising the 3 big remedies of our materia medica – that when you begin with such a remedy you create a turmoil and you may have sometimes an aggravation that you do not wish so sharp.

And so, you have to be cautious not to begin with Lycopodium unless it is absolutely indicated I make also an exception there, because all remedies in the materia medica have two phases – an acute phase and a chronic phase. We have an acute Sulphur an acute Lycopodium, an acute Arsenic and so on. Sometimes even a deep acting remedy may be indicated for a short while in an inflammation or something of that kind but it has to be prescribed carefully. I remember a friend in Lyons who made two mistakes.

In the first case, the patient was a lady doctor who had a very high temperature. It was 43 degree C. She had at the same time a crisis of acute cholecystitis and pneumonia, and she was delirious and in a very bad state. She had received all kinds of remedies and at last the doctor had given her Lycopodium. In the acute phase with cholecystitis and lung trouble it is such a risk. At the moment when the patient is trying to help herself, to give the remedy so deep in action is dangerous of course.

The result was very quick – the delirium became worse, she could not recognise any one, and she was in such a bad state with high fever, trembling and sometimes with semi-convulsions that a priest was called into give her benediction before she died. And at this time we were asked to see the lady. I go every month to Lyons which is some 200 miles from Geneva, to deliver lectures to 40 to 42 physicians there and this was one of my students is Lyons so I said the only thing to do now is to antidote the Lycopodium. Of course Lycopodium was her own drug but especially because it has an action on the liver, you know it aggravated the case.

She had terrible pains, she was shrieking, she was in a really bad state. Now she was extremely agitated, she was very red in the face, she did not know what she was saying. And with this high fever, she was also very thirsty. So I thought the best thing is to give Aconite 10,000 first and then wait and see what we can do. Then she began to recover a little consciousness, she began to pray and she said to us: “Now I wish to pray with you” and she was always speaking of praying. So with this high fever, this agitation this praying, it was typically stramonium. So we gave a 10,000 of Stramonium two days after the Aconite and this moved us a little towards better situation.

But, when we came to see her after the Stramonium, she still had a very high fever because of the lung condition. It seems that the pain in the liver was a little better but she was extremely nervous and stood up with a 42 degree C fever to tell us: “Oh I do not know why you are coming. I am extremely well. I have nothing, no trouble. I am cured. I thank you very much. You are very kind. But there is no need to come now,” and so on, but she did not realise that she was so sick.

This is typical indication as you know of Arnica. So we gave her Arnica 10,000 She rallied very beautifully and started bringing out some Lycopodium symptoms probably she had too much of Lycopodium. But by and by we could see she was better and after about two weeks she was again on her feet, cured. And now it is three years she is quite well. She was very pleased. It had been a mistake to give her Lycopodium at that moment.

In the second case, the son of this physician, who had given the Lycopodium had a sore throat which began on the right side and went to the left, with a very dry mouth. He was very thirsty with a very bloated stomach and he was asking for water all the time. He was I do not know why having irritation in the throat. The throat had one or two little white patches and was very red with no ulceration but he had terrible pain on swallowing. He could not swallow.

There were some indications for Lycopodium and so his father gave him Lycopodium. But in such situation you should rarely begin treatment with Lycopodium. Please generally begin treatment with Lycopodium. Please generally begin with something else. You can give Aconite you can give Bryonia, Belladonna Pulsatilla, any remedy in the vegetable kingdom except Lycopodium so, he was growing worse not better, and day after day the fever went up, he was not able to swallow a little even and he was emaciating. The father was anxious the mother was worried and they were not at all pleased So, I came and I looked at the case and I must say frankly that by taking the symptoms carefully I found it was a plain case of Lycopodium.

Now what to do? We waited three days and were watching the case. I thought of many things to do, I thought I would do what Hahnemann did for the rest of his life. There is a way to give remedy which is less harmful and less reaction making – that is by inhalation. So, we gave Lycopodium but not the 200 th which had been given already but one inhalation of the 10,000th because he had it already lower so I gave him just one nice whiff one little inhalation. But now, how do you apply the inhaling method? Hahnemann said, take one single globule of poppy seed size in a clean new bottle not a washed bottle in which something else had been kept but a new fresh bottle that has never known any remedy which is absolutely virginal.

In this you put some drops of the potency in alcohol and you hold this under the nose – one good inspiration there and you stop. You must realise that you are actually inundating the system with the medicinal energy. You are putting this on a surface of 81 square metres which is the total lung surface. In the evening the fever went down and the next day the boy was completely cured. His fever had been going on for 4 days you know and now in a very short time he was cured.

This is an exception of an acute Lycopodium case. So I tell you, habitually pay attention to Lycopodium and do not give it very easily Yes, yes, Hahnemann said: “Give if possible an acute remedy which is not psoric for acute cases and try to search first in the vegetable kingdom. Now, if you cannot get such a remedy you may give a remedy like pulsatilla or Lachesis get such a remedy you may give a remedy like pulsatilla or Lachesis from the plant or the animal kingdom if necessary.

But for the beginning you may use your Aconite, your Belladonna, your small remedies, we sill call them small remedies, good remedies – very high in standing when they cure, they are then the kings of the situation – but still we call them small remedies, because their action is short. We do not risk any aggravation or engrafting something else on the system by repeating them. So that is why it is good to use them. Now, when you have an acute case begin with a remedy from the vegetable kingdom.

If this acute illness only came once in patient’s life, it is quite alright but if it is a recurrent disease – throat or headache or anything like that – the time to give that remedy is always right after the acute crisis. That is the time when the body has tried to throw the toxic stuff away and is the best time to let the remedy act properly. So that is why when he has an acute case the art of the physician lies in taking care only of the symptoms of the moment, of the acute symptoms that he has before him, not to take into consideration that the patient has had tuberculosis or cancer – these are besides the acute things.

Please think the situation is bursting out, it is like a flare up. The symptoms are clear the desires and aversions are typical. So give at this time, please, consideration only to the acute symptoms to the symptoms of the patient at the moment. And this is not the time to take into consideration the chronic case – the tendency of the family the mother the father, anything else. It is only when you have no results that it shows you it is not a pure typical acute case but is an exacerbation of the chronic disease.

And here we make a distinction. Between the chronic and acute there is a bridge and in the middle of the bridge is what we call the exacerbation of the chronic disease which sometimes flares up. There you can give your remedy which first is the acute one, is that all the remedies have acute and chronic phases and we must try to find what are the indications of the acute phase. Well they will be very useful. Now so far about the question of the acute remedies and chronic remedies.

In the art of interrogation, of course the aim of the physician is to try to face five different kinds of questions which we must always have in mind very well. Of course for the acute phases observe what you see and listen to what you hear. You must remember that Hahnemann said something very interesting in his Organon: “when you come either for acute or for chronic for acute especially, you have always a symptom, a symptom that you see yourself. As a physician, you examine the patient and you see what are the symptoms. But this is not sufficient. If the patient. But this also is not sufficient.

Sometimes there are some things that the physician cannot know and cannot observe. If the patient has epileptic fits at night, how will you know this by looking at the patient; he won’t know this himself it is the mother, it is the father someone of the family who can tell you. So you must know the symptoms of the patient, the symptoms you discover yourself or that he tells you and the symptoms that a family member or someone else observes and tells you either about his walk his behaviour or his way of doing thing etc. So we must have these kinds of symptoms to start with.

Now in the Organon Hahnemann was saying something interesting too, that many people did not note something by which we recognise a disease – by the symptoms of three kinds. He says recognise three kinds of symptoms: “Symptoms signs and accidents.” You know this Organs has been translated now for 175 years and yet nobody has ever understood what signs, symptoms and accidents mean. What is a sign? We know the signs of pregnancy. Yes, these are physiological signs. These are not symptoms because symptoms refers to disease.

There is the sign of health. It is not at all a pathological sign. Now, in disease we have pathological signs. Hahnemann said very clearly “You know Opium produces constipation hard stool” Why did Hahnemann say so? You know Hahnemann never says something without reflecting very much. You know, constipation is something and hard stool is something else. Some people have inactivity of rectum and so have constipation even with soft stool. They are constipated in quality and quantity. So you must be very careful to know what is really meant by Hahnemann when he says, “Opium produces constipation following hard stool.”

The sign is what we call the objective symptom while the symptom is subjective. Subjective symptoms are the symptoms described by the patient. An objective symptom is that which not only the patient can see but physician can also see very well, But he cannot know if you have a headache – he cannot know if your pain is pricking stitching darting or stinging or whatever kind of pain it is. It is you who tell him, so it is a subjective symptoms. So this comes under the symptom. And what is an accident? Accident is a symptoms which has nothing to do with a chronic miasm; it is something which comes from an external source.

Suppose, you burn you hand it is an accident. It is not a symptom, it is not a sign, it is what you call an accident. It is not a disease that comes by the disturbance of the vital force, like whooping cough. So a burn like a prick of a needle which gives an infection or a sting from a busy bee or wasp is an accident it comes from outside. Now if you take some poison yourself this is an accident. It has nothing to do with the vital force. If you take away the cause, the thing goes away by itself. But you cannot take the cause away from a grief, you cannot take away easily something following indignation. This is something to do with the vital Force and this is a subjective symptom. And you know that contrary to ordinary medicine apart from the psychiatrist, we are also very much interested in those mental symptoms – the psychosomatic aspects, For us they are very important because they predicate the patient.

And for the us when we take a case we must forget everything else. When the patient asks me, “Have you treated many cases of asthma before or this kind of skin disease before?” I say, “Good Gracious! I hope I have not.” Because I am not like some physicians who say, “The more I see a kind of disease, the more I am able to treat it.” It is just the contrary in homeopathy. We are like judges. “Because this one has stolen something is he guilty like that one? May be that one is guilty this one not”. Therefore everybody has his own case. We must study each case by itself. If somebody else has asthma and this one also has asthma the cause may be absolutely different and your task is to forget the twenty cases of this disease.

You had seen last week and to take this case as a new one. So when you have had many cases of disease it is more difficult to take the new case because you will have to forget the cases that you have treated and not just copy and give the same remedy because it does not help. So what we must do in Homoeopathy is to be very careful Every case by itself is a new case – you must forget everything before and after. But you know we are so prejudiced that when we see a case we think may be it is pulsatilla and you ask her, “Are you thirstless? Do you dislike fat and salt? ” And you know you are making the greatest mistake, that is to put into the mouth of the patient the answer because you like to find it is pulsatilla.

I remember Dr. Mable asking. “When you hear a tap open, do you feel a desire to urinate?” Of course, you would like to give Lyssin if the patient answers, “Yes Again he was asking the patient, “Are you not sure that when you are near river you feel like urinating?’ You know in this way, by such questions we are bringing out only very forced material. You must be absolutely independent and neutral in your questioning. But as our mind is generally prejudiced there is a way to get rid of it. I will tell you the secret.

When you are taking the case of the patient and you see it is pulsatilla you write in the corner of your case paper, there pulsatilla. Now, after ten minutes, it is typically Nux vomica, so you put down Nux vomica. Then you see symptoms of Arsenic you put down Arsenic So you are astonished at the end of the questioning because you have twenty different remedies now that come on because of course they are symptoms of these remedies that you remember. Therefore, your memory is very good. But in spite of being good, you cannot know fifteen hundred pages of the repertory. So first because we have put down remedies our mind is free, we are neutral and then after this we begin to study the case with a certain consideration and according to Kent’s and Hahnemann’s method. Well we sill come to that later. But the main thing is first to take note of all your observation absolutely neutrally.

Now, Dr. Gladwin as well as Dr. Austin who were my teachers told me to divide the page into two parts. To the left, you write all the pathological symptoms the pathognomonic symptoms of the disease. The patient has tuberculosis he is coughing, he is emaciating, he has sweat and so on. So you write down on one side, on the left side, everything that pertains to the diseases. For this you must know the disease you must be a good allopath first. It is not a question of allopathy or homoeopathy but it is a question of knowing your Medicine. so your write down very carefully all the symptoms on the right side which are the non-pathognomonic symptoms – the symptoms that are not habitually occurring in the disease.

Let us say the patient is a tuberculosis patient and he has a desire for vinegar, I do not know what this desire has to do with tuberculosis. Or suppose this patient cannot tolerate fats. Why? For what reason this tuberculous patient who habitually likes fats very much is now averse to fats? We do not know. So these things you know are important which make you say, “Now pet us take a patient who is paralysed, you touch the limb which is paralysed and you find it warm Habitually, a paralysed member is cold. Now what is this funny thing? We have a description in every book, it is written that when you have a hemiplegia the paralysed side is colder than the other, but in this case it is not so – this is unusual! – So in this way you just notice these symptoms which are peculiar which you do not predicate with the name of the disease they predicate the patient himself.

There is the key of our success. You may not even know know for what he is coming – for a rheumatism of the neck a headache or anything else. You may even forget disease condition when you prescribe the remedy on those non-pathognomonic symptoms, funny symptoms. So please pay very much attention always to the non-pathognomonic symptoms. To understand this you must know your medicine well because you must know what is the disease usually like – whether it is enteritis or cholera or anything. You must know what are the symptoms of disease but, if you find something that has nothing to do with this disease so that predicates the patient, please value it. And you will make your best cures when you can find such symptoms.

I may say here when a patient in any disease has still many non- pathognomonic symptoms (symptoms of himself) there is a hope of cure. But unfortunately in cases at the end and in many chronic diseases e.g. multiple sclerosis there are almost no symptoms of the patient. You have only symptoms of the disease. All those individualising symptoms fade away. These cases then become difficult to cure. That is why I insist that you find the non- pathognomonic symptoms.

The first thing after having heard the patient is to allow him to tell all about the disease. Ofcourse, I suppose you ask him first what are the things for which he is coming to consult you. Then you let him talk. If they talk too long, ask them to come again. They will always come and then they are finished you must not be pleased with it. You must ask, `what is more?” when he has ceased, still ask him, “Tell me more.” So you must ask, you must express from them every detail, till they tell everything about their sickness, all they may know about their disease.

You may find sometimes that after every symptom has been taken down, a lady patient coming back again with a long list of symptoms giving again a different story. Otherwise, she will tell you that you have not had the time to listen to her, you were in a great hurry. So when I see it is along case I always say, ” All right. Come along another time.” So when they come three, four or five times they begin to feel that they have described their illness enough.

Pierre Schmidt
Pierre Schmidt M.D.(1894-1987)
Dr. Schmidt was introduced to the results of homeopathic treatment during the 1918 flu epidemic while living in London. There he met both J. H. Clarke and John Weir.
In 1922 he came to the United States and began his studies with Alonzo Austin and Frederica Gladwin, who had been a pupil of Kent's. He became the first graduate of the American Foundation for Homeopathy course for doctors. Returning to his native land he set up practice in Geneva, Switzerland. He was responsible for reintroducing classical homeopathy into Europe, teaching several generations of physicians, including Elizabeth Wright Hubbard.
Dr. Schmidt helped edit the "Final General Repertory" of Kent, and translated the Organon into French. In 1925, he was one of the main founders of the Liga Medicorum Homoeopathic Internationalis (LIGA).