Do not shake elderly cases the very toes with deep-acting remedies in high attenuations. Avoid consideration of end results or ultimates. Get back to first principles, even if it means retaking the case, with every attention from birth to the present illness. Common symptoms without modalities are useless. Emphasize mental and physical generals; if these are strong do not let your remedy contradict.

By case-taking we mean what Hahnemann termed “that individualizing examination of each case of disease as it appears”. Each case of diseases is to be regarded as unique and distinct. Hahnemann adds: this demands from the physician nothing but freedom from prejudice, sound sense, attention in observing, and exactness in tracing the picture of the disease as he sees, hears and observes is altered and unusual in the patient.

And he further adds:

in all diseases, and especially in chronic diseases, the discovery of the true and complete disease picture and of its individualities demands particular insight, scepticism, knowledge of human nature, weariness in inquiry and patience of the profoundest kind.

1. Let the patient tell the story of his complaints and altered health without interruption, so far as possible. Record complete notes and leave room for expansion and additions. Take plenty of time. Put the patient at his ease. Be a sympathetic listener: yet observe acutely every movement and expression. When the story hesitates, silence is the best cure to bring out more; or later, an occasional judicious, “What else can you tell me?”.

2. Now, round out the case picture and seek further individualization, but avoid leading questions; avoid alternating questions; avoid questioning along the line of a remedy; avoid questioning at random. Add testimony from family, nurse or companion. Cultivate your ability in cross-examination. Look into causes. Consider the family and personal history. Weight carefully the circumstances of the patient in regard to his usual occupation, his mode of living, household surrounding. Seek out any factors that my be exciting or maintaining the disease. Have the ailments been a result of grief, of fright, of an unhappy childhood, anger, injury, shock jealousy, or suppressed discharges?

Discover the reaction of the patient in general, that is, himself, in regard to his bodily environment. How is he affected by heat, cold, dampness, temperature or seasonal changes, seashore or draft? Is there any periodicity? How about position, motion, rest, time of day, etc.? What aggravates him in general? Are there any ameliorations? Has he any cravings? Are there any decided aversions? What alterations are there in his mental state? Check up on his loves and hates, his disturbances of will, intellect and memory. Do you find intellectual or emotional aberrations? How about fears, desire for solitude or company?

Is there marked restlessness, hurry, irritability or intolerance of pain? Or do you find sensitiveness or despair, suicidal thoughts and aggravation from consolation? Further, as regards physical environment, how does he react to touch, pressure, jar, light, odor, or noise? What is the effect of sleep, eating, drinking? Does he lie on the painful or painless side? What is the effect of mental exertion or excitement? Under objective indications, note particularly: behavior, position, whether quiet or restless, any twitchings, gait. Expression of the face? Condition of the skin? Sweating local or general? Hunger? Thirst? Suppressed discharges? Sleep? Stupor? Delirium? Relationship of pulse to temperature and respiration? Record especially any menstrual symptoms and those of any of the special senses.

3. Go into minute detail regarding every item in your record. The most minute peculiarities are especially characteristic. But up a totality which means the completed symptomatic complex including location, sensations, modalities and concomitants, if any. Each symptom is a component of a generally outlined picture. Each symptom must be completely described as you dissect out the disease picture. Note time of day aggravations or ameliorations, Note with care various functions, such as digestive, sexual, sleep and skin. some parts of the body will probably have been mentioned in the patients chief complaint.

These particulars may greatly guide in remedy discrimination. Each section of the body, from head to food, should have all discomforts detailed in full. As regards particulars, search again for the effect of bodily environment. Do not omit time aggravations or ameliorations. Any qualification is a modifier of the disease. Each symptom is to be examined and completely described until all possible information may be had as to character, location and modalities. Menstrual symptoms, sleep and dreams, food desires or aversions may be greatly affected by external circumstance or occasion.

Proceed until the examination of the patient has been thorough and painstakingly accurate from every possible angle. The modifications as shown by aggravation or amelioration are equally important whether the symptom be mental, physical, a question of temperament or personality or of habits or occupations. Question every system and function in detail as to nature, sensations, time of day and according to position and circumstances, to get a complete symptom image. This must be the reflection, externally, of the essence of the malady.

The totality finally arrived at for analysis has within it, if taken completely and accurately, that individuality that separates if from any other case of disease. Do not look for a material disease from material causes. Concentrate on the individual-not on form of disease or hypothetical hypothesis. Remember disease is of dynamic origin, to be attacked by the dynamic of a drug. Look over the symptom picture and discard those symptoms due to drugging; or any found in the pathogenesis of the last remedy given. Do not be afraid to wait. Has your investigation of the patient suggested indiscretions in diet? Give them first attention. Are there habits of occupation or life that are harmful or causative? Regulate the mode of living.

How about obstacles in the way of recovery? Remove them. What in the symptomatology indicates suppression of discharges? Can you unravel the entangled skein? Give consideration to psoric, sycotic or syphilitic remedies. Unlock the miasmatic manacles even if it takes long treatment. Dont expect to pick your remedies from pathological symptoms. Hahnemann aptly says, “the knowledge of disease, the knowledge of drugs, and the knowledge of their employment constitute medicine”. Since the emphasis is on the individual look for him first in the totality.

Question yourself as to whether symptoms show definite relation to a prior grief, fright, anger, injury or mortification. Delineate the patients personality. Understand the homoeopathic concept. Brush up on your philosophy. There are many subtleties in the intricate ramifications of the record.

As you go to the materia medica or repertorize on your way, lay emphasis on those symptoms relative in general to the mind and environment of man. Underlain rare, strange or peculiar symptoms whether particulars, mental or physical generals or even common symptoms especially qualified. Analyze as to the nature and trend of the disorder. Note the latest symptoms and expect these to go first in your treatment if curative. Weight the resistance of the sufferer. What are his reactive possibilities?

Do not shake elderly cases the very toes with deep-acting remedies in high attenuations. Avoid consideration of end results or ultimates. Get back to first principles, even if it means retaking the case, with every attention from birth to the present illness. Common symptoms without modalities are useless. Emphasize mental and physical generals; if these are strong do not let your remedy contradict. Especially mark strange, rare and peculiar symptoms which are distinguishingly characteristic. Modalities and concomitants complete the selective group. Look for the same intensity in the remedy as in the patient, but remember each symptom is a component of a generally outlined picture.

Finally and always focus upon the immaterial and spirit like force which alone guides to a true picture of the case. BOSTON, MASS.

Ray W. Spalding