HOW GOOD ARE YOU AT CASE TAKING


Better brush up on this deep subject and cut down on the percentage of those patients who stop coming to you because you have failed to benefit them. Dont begrudge the time it takes to get all the history because there are other patients waiting to see you, or friend wife wants to step out to a show, or you have a date to play bridge at the club.


Do you realize that your failure to cure those that good homoeopathic should cure is often due to poor case taking probably as often as failure to prescribe the proper remedy ?.

Better brush up on this deep subject and cut down on the percentage of those patients who stop coming to you because you have failed to benefit them. Dont begrudge the time it takes to get all the history because there are other patients waiting to see you, or friend wife wants to step out to a show, or you have a date to play bridge at the club.

Dont miss any of the avenues that will be informative. It may be the case will be illuminated when you get the history of the patents or brothers and sisters, or wife or husband. I remember one case where I was able to cure a lady whose trouble resulted from a quarrel she had with the ladies in her church society. And now when we have so many mothers and fathers who are upset by their boys being called to the colors, dont forget that the emotions of fear can start a train of symptoms that hasnt seemingly, the slightest connection with fear.

Grief is just as devastating as fear, and fatigue, joy or anger can be the cause you must bring to light if you approach the similimum.

Suppressions dont necessarily have to be a gonorrhoea or eczema ; a suppressed foot-sweat or anger, hate, love or sexual gratification can be just as devastating. The physical therapist may have complicated the case, especially with too many x-ray treatments, and the nose and throat specialist has certainly set up a long train of complications by his argyrol packs, etc.

And dont forget that the beauticians with their henna washes have driven many a woman to an extremely nervous state. Enquire about bathing habits ; the daily and shower baths are injurious to many, but you will have hard work convincing some that this is true.

Careful inquiry into you patients habits of eating will disclose that those who have trouble along the digestive tract bolt their food or eat when fatigue or emotionally upset. Perhaps, now that they are definitely sick, this does not apply in every case, but go back into the early history and you will often find that this is true. Acutely sick infants often have the start of their trouble by having nursed from the breast of an angry mother.

After all the numerous citations I have mentioned, there are many more just as pertinent. Every case has a story to tell, and every case is a different individual.

I hope that what I have said will cause the doctors that are, as they alibi to me, “too busy” to spend do much time on a case, a thoughtful moment.

AKRON, OHIO.

DISCUSSION.

DR. GREEN : In chronic work it is a very good plan to allow twice as much time in the office for a new patient as for any other. Then if we are not through, to prescribe placebo and get the person to come back. There are a great many things the patient will tell us on the second or third visit to the office that are the very keynotes we want. We all have the experience once in a while of making the first prescription and then hear the patient give a key note pointing to some other remedy as he goes out the door, after taking the first dose.

Of course, there are many other things that might be added to what Dr. Dixon has said along the same lines. I am thinking of these eternal, trivial vexations and irritations that people have, to keep the vital force depleted- environmental difficulties.

Dr. Dixon mentioned the emotions. I came to this meeting from a very, very busy and tried Washington. The people in the government service are tired out from rushing all day, not knowing exactly where they are, doing and working amid a great many kinds of noise, then going home and living several in a room, and coming to me to pour out their woes. That is what I mean by these eternal, trivial vexations of a very complicated existence, as we are living it at the present day.

Another grand interference and important thing to take into account in taking a chronic case is vaccination. We have spoken about that before today. Vaccination has complicated many and many a case. If we are careful to listen, we will hear a patient say, “I have never felt well since I was vaccinated,” although that vaccination may have taken place twenty or thirty years ago.

Then, in connection with that, there is the treatment that the patient has had for the exanthemata in the past. He may have had false treatment. He may never have been as well since he had an attack of diphtheria or scarlet fever, or even the measles.

You know our good friend, Dr. Margaret Tyler, of London, often gives people nosodes in order to unlock the case, and she has been using those for scarlet fever or whooping cough lately. I have a patient now whose case was extremely veiled and indefinite, but she volunteered the information that she had terrible whooping cough when she was young and did not believe she had ever felt so well since. I have given her a dose of thirtieth of Pertussin at six or eight month intervals with great benefit, and I have not given her anything else because I cannot see the symptoms for any other remedy.

The same holds true, of course, for “flu” or grippe and all the different chronic coughs that we have. If we could find out something to unlock the case, in the taking of the case, that would release these things, we would cure our patients.

Then we have so many, many cases of suppressed malaria in people who are elderly or old at the present time and have lived in malarial districts in their youth. The same holds true of haemorrhoids. Many and many a case has local treatment for haemorrhoids and then comes back with the nervous system all upset, or a case of cancer or something, or heart disease or something, very serious. Of course, we know about rheumatism.

We talked about the general skin eruptions this morning. Suppression of sweat not only on the feet but anywhere on the body is mighty important I know you could all mention many other thins.

DR. SCHWARTZ : I find with women patients it is very important to ask about their beauty treatments, this enamel coloring on the nails that dries and makes the nails brittle, and something to blacken the eyebrows, and what cosmetics they use. Then they come with cases of gastroptosis. They want to be slim and look like glamour girls, and they wear a two-way stretch to hold the abdomen straight and tense like a wall. They wonder why they are constipated and have all their organs pushed down.

So I find that it is important to go into all those things. If I cannot get everything the first visit to the office, I tell them to write down things and let me known. Many times I have had them call me up and say, “Oh, there was something I did not tell you that you should know”.

I think, because we prescribe symptomatically, not depending on any pathological test, we need to be especially good observers, interpreting the symptoms that the patients do not tell us.

DR. GREEN :Have any of you read volume called The Chamber of Horrors ? It was written by a clerk who was a statistician in the Food and Drug Administration when the reform law was before Congress. I dont know how she did it, how she kept clear of being sued. Anyway, she took all the information that went through that office, and I can assure you that you that it was legion, and made chapters on the different things that came through in the cosmetic line, especially, that were dangerous to people.

She opened my eyes very widely because I had no idea there were so many kinds of thins. It was not only the Halo wash and the eyebrow applications and fingernail polishes, but all sorts of other things. She gave the statistics to prove the danger of them, by pictures any by letters and by all kinds of evidence. It was just a statistical book from one end of it to the other.

The newspaper reporters had seen exhibits of these pictures and things around the office of the old Food and Drug Administration and, of their own accord had dubbed that room “The Chamber of Horrors.” Therefore she named the book thus.

DR. SUTHERLAND : Whenever we think we are getting pretty good at homoeopathy, it is always a good idea to open the Organon and read over the whole thing from front to back, especially the section that deals with case taking. Hahnemann was the first case-taker. He put case-taking on its feet. There has never been anyone since his time that has been able to improve on his method of taking a case. We all as a matter of course and think we are really quite “some pumpkins,” as they say.

When we get a case such as I cited this morning, we find out we are not. If you dont take the time to delve into things, not only the subjective symptoms but the past history, everything, (you have got to make a complete study of the patient before you can ever hope to do anything for them) you will never be led to a remedy that is going to be useful unless you really take time. If it takes two hours, take the two hours, because it will pay dividends. You will begin to get patients you can help and you wont be bothered with a lot of little things that are comparatively minor, many of which need no remedy at all.

DR. MOORE : In connection with all this, I would just like to have the essayist explain how he, the other night, took care of twenty patients after dinner, in the evening, and gave them a careful case-taking. I want him to explain that. (Laughter).

DR. PULFORD : I have practiced practically all my career on the symptom picture method of taking a case, and I dont think that my record will fail in comparison with any other method.

For quite a while we have tried the amanuensis method of taking long histories, and all that sort of thing, but we did not get the result we got from the drug picture. The method has drawn to our office people from Canada, Mexico, Canal Zone, England, India, and down in Brazil, which we never got under the old method.

DR. DIXON : My paper was very short intentionally. All I wanted to do was to get the audience talking. I am disappointed everybody did not get up and tell at least one instance where they could add to my paper. I am sure everyone here could have done so. It is too big a field to cover in a little thumbnail sketch. My papers are always sketchy.

By the way, I asked to have Dr. Green comment on my paper because, as I know, she is par excellence in taking case reports. She has files of case reports that would do you good to look over.

Dr. Green mentioned vaccination and malaria. She did not mention douches. There has been so much perfect work in the so-called local work on the female in the office, I claim it is not more than bread and butter business. They know they can keep them coming and get some money our of them. I thoroughly disapprove of it. I think it is not the practice with the good, straight homoeopath, and I am glad of it.

We all know what a wonderful prescriber Dr. Pulford is and what wonderful results he gets. I wish I were that good. I wish I could do away with careful case-taking, but, as Hahnemann has indicated, homoeopathy is individualizing, and every individual has got to pick out his own way of getting the best results he knows, how. That is why I have to spend a lot of time getting case reports.

In answering Dr. Moores question, that is just one point I wanted to bring out. After a case is well taken and the patient is on the road to recovery all you have to do is sat, “How are you, John ? How are you feeling?” “Well, I am better”.

Then he gets a dose of placebo and I chase him out. He has not been in there five minutes. I believe that I can take care of as many patients in a good homoeopathic way as anyone else, and not spend over five or ten minutes on the one, when I have got them lined up. Most of my work is chronic work. I certainly take more time than that in the first interview with patients, and that is why I say the busy man need not say he does not have time to do that, because it pays. After the case is started on the up road, you dont have to spend but a minute.

DR. UNDERHILL : Dr. Dixons statement agrees with Dr. Thachers view point. When he (Dr. Thacher) asked me to see his patients at the time of this last illness he said, “Just remember that twenty-four out of twenty-five of them will need Sac. lac”.

Charles A. Dixon