A rather large subject to write upon and to crowd into a small space! There are, however, a few personal remarks not usually found elsewhere, which the writer would like to get out o of his system. As the law of similars is the keystone of the homoeopathic arch, so is the “taking of the case” the keystone of homoeopathic practice. The writer likes to think of this term as including everything in the preparation of the case for the prescription, hence, it means the eliciting of all the facts, their analysis, and their synthesis into a picture which leads us to the remedy.
Any one of these divisions is difficult enough. Even to one, whose experience in analyzing cases is great enough to make this a comparatively easy task, the getting of the information is the most difficult part of the whole business. If we could have a divining rod, as did Moses, and by merely tapping the patient have the information gush forth, it would lighten matters in the majority of cases.
There are some patients so mentally numb and inarticulate that it makes the examiner feel like hitting them with a mallet, rather than a rod like that of Moses, and thereby dispense with them. Others need no rod, and the physician feels like springing up with the cry, “The dam has burst!” He is overpowered by the tide and writers cramp lays hold of his hand and arm. With the patience of an Egyptian tiller of the soil he sets about to separate the wheat from the chaff. These types are, of course, the extremes, and between them lie all sorts of variations.
To handle all types one must needs be a psychologist. The whole thing is a matter of getting into tune with the patient so that he will talk freely, by this is not meant voluminously, but with freedom from restraint.
There is the dignified person, often dignified without reason. The only way to handle him is to either be dignified with him or to gently but effectively puncture his dignity and bring him to a common level. If he his truly dignified and with reason the former method is preferable.
Others come in and joke, joke about themselves, their troubles, you and your methods, in fact about everything. Then it taxes your skill to make them serious enough to get a few facts. These people stand harmless jesting best, so do not get pointed with your jesting or try to make them serious too quickly of you will be lost.
The timid ones most be handled carefully and every effort made to inspire confidence. Gentleness, yet firmness, in both manner and speech will help to bring them out.
There are those who come in with the opposite frame of mind. They bluster and act as though they wished to put the fear of everything into your heart. They know it all. At heart they are cowards. Many a man, who is the terror of his office or his employees, is, when sick, a disgusting coward worse than any baby. This type requires a physician more aggressive than the patient, one who can deftly find weak points in the patients knowledge and make him feel small enough to “talk business.”.
The modest ones give trouble. Both mentally and physically they wish to put their heads into your office but no more than that for fear the physician might see something he should not. One woman who suffered both ways deduced me for a long time about a pain in her lower extremity to be no less than the uterus and vagina which a mid-Victorian training had taught her to shun was as one would the ophidia. Once the pain was located properly the relief was soon in coming.
The class which harms itself most is the one which deliberately conceals facts from the physician. Often the information can be brought out by indirect questioning, something it may be correctly surmised without questioning, but more often it is never found.
Each of these must be treated according to the individual aspects. Some are incorrigible and we are better off without them. All cases have to be cross-examined and the physician must become as proficient in this as his legal brother.
It has always been a personal opinion that any means to get the information was justifiable, but that any old method of handling that information was not justifiable. Dr.R.F.Rabe said that it might be permissible to look “cockeyed” to find the remedy.
If such is the case any artifice might be used to get the information for a prescription. One method the writer often uses to get the patient to tell how he is, is to describe the condition wrongly to the patient. The patient says, “Oh, no, no,” and then goes into considerable detail so that you will be sure to know just how it is. Regardless of his mental make-up he is desirous that you his symptoms rightly.
Sometimes we get a great deal by casual observation. When talking about other matters they often let something drop which furnishes an excellent clue. One of the most exasperating things is to have them give the clue as they pass out the office door.
Developing a keen observation gives a great amount of information that all the “pumping” in the world cannot give. The manner in which they tell you things, their reaction to what you say and do, and, of course, the whole gamut of observable physical symptoms furnish a gold mine of facts. To do this requires a long practice and close application.
Underlying our relation to the patient is an undeniable personal attraction or repulsion. This, no doubt, accounts for the reason that one homoeopathic physician fails where another succeeds.
The analysis of the case, as well as the synthesis of the drug picture, requires a certain artistic type of mind. We cannot go about this mechanically. It is here that what is known a skill plays the supreme role. Some artists could take three colors and paint a wonderful picture. Others with all colors and shades at hand would produce a veritable “nightmare on canvas”. Only general rules for this work can be laid down. A reprint of Gibson Miller in the Recorder is one of the best guides available to help in the evaluation of symptoms. Success depends upon its proper application.
Much of the same is true for synthesis. Kent gave the best and most reliable advice when he said to study the taken case until you saw its image as a picture in your mind.
The use of the repertory requires a word of warning. It cannot be used mechanically. This sort of use reminds one of the old corn shelling machine on the farm. Ears of corn were placed in the top and at the bottom were found two piles, one of kernels, the other of cobs.
You cannot throw symptoms into the repertory and get out the indicated remedy by simply turning the crank. Dr.Grimmer gave a case in Boston that a great amount of repertory work failed to solve, yet to one acquainted with the materia medica the prescription was arrived at instantly. We must continually study the materia medica and always refer to is as the court of last resort, especially before prescribing.
The greatest thing to cultivate in the “taking of the case” is versatility. We must be versatile and resourceful in eliciting the facts, versatile in finding clues in our analyses which will help in the syntheses, versatile in our search for the remedy. One fundamental fact that the homoeopath must always keep in mind is this: Homoeopathy of all sciences stands out against iron-clad rules and standardization, it bids for individualism from beginning to end, in its practice and in its theory.
TOLEDO, OHIO.
THE HOMOEOPATHIC DECALOGUE
1. Thou shalt have no other therapeutic guide before these commandments.
2. Thou shalt seek for the totality of morbid symptoms.
3. Thou shalt search diligently the pathogenesis of drugs.
4. Thou shalt match drugs with disease-symptoms to find the nearest similimum.
5. Thou shalt give the single remedy.
6. Thou shalt give the minimum dose.
7. Thou shalt learn to wait.
8. Thou shalt not alternate.
9. Thou shalt not unwisely repeat.
10. Thou shalt require obedience to hygienic laws.
A.R.MORGAN, M.D., before the Connecticut Homoeopathic Medical Society meeting, October 1895.
