The Examination of the Patient by James Tyler Kent
$ 84. The patient details his sufferings; the persons who are bout him relate what he has complained of, how he has behaved himself, and all that they have remarked in him. The physician see, hears and observes with his other senses whatever there is changed or extraordinary in the patient. He writes all this down in the very words which the latter and the persons around him make use of. He permits them to continue speaking to the end without interruption, except where they wander into useless digressions, taking care to exhort them at the commencement to speak slowly that he may be enabled to follow them in taking down whatever he deems necessary.
One of the most important things in securing the image of a sickness is to preserve in simplicity what the patient tells us in his own way unless he digresses from the important things and talks about things that are foolish and not to the point; but as long as he confines his information and in the record use his own language, only correcting his grammatical errors for the purpose of procuring the record as perfect as possible. If you use synonyms be sure that they are synonyms and cannot be perverted.
Of course, when the woman speaks of her menstrual period as “monthlies” or as her “show,” the more suitable medical term is “menses,” which is a synonym for those expression, and is more expressive than her own way of calling it “a show”. So in general terms you can substitute terms of expression so long as you do not change the idea. Of course, the changing of “legs” into “limbs” if you feel like making such a change is not a change of thought, but be sure in making a change it is not a change of thought.
It is one the most important things in forming the record of a patient to be able to read it at a subsequent examination, without being disturbed by the repeated statements of the patient. If you write a record in consecutive sentences, you will be so confused when hunting out the symptoms of the patient that you will be unable to form an image of that sickness in the mind.
It is truly impossible when the mind is full with the effort at hunting out something to listen with proper and concentrated attention. You should divide your page in such a manner that when the patient is talking to you about this thing and that thing and the other thing of her symptoms, you can with one glance of the eye look down over the page of the record and see everything there is in that page. If you record is not so arranged, it is defective. Now, a record can be so arranged by dividing the page into three columns, the first of which contains the dates and prescriptions, the second the emphatic symptoms or headings and the third things predicated of the symptoms, thus:
Date } Symptom.
} Things predicated of the symptom
} (<) (aggravation).
Remedy (>) (amelioration).
After the patient has detailed his sufferings in his own way and you have gone through them and discovered all the things that you can predicate of his symptoms then you can proceed to make enquiry of some on who has been with this patient. In a study like this with most of our private patients there has been a nurse, sometimes only a sister or a mother or a wife, who has been observing all the sick individual has complained of. “The persons who are about him relate what he has complained of, how he has behaved himself, and all that they have remarked in him.” Now, this should be listened to with great care.
It is more important in this instance to decide whether the observe is overanxious, if a wife whether she is not frightened concerning her husband and so intermingles many of her notions and fears, which you must accept with discretion. Get the nurse, if possible, to repeat the exact words of the patient. If such a thing can be done in acute sufferings it is worth more than the words or expressions of the nurse, the wife for instance, because the more interested and anxious the person is the less likely she will be to present a truthful image, not that she wants to deceive, but she is dreadfully wrought up and the more she thinks of what he has said the greater his sufferings appear to her, and she exaggerates them. It is important to have the statement from one who is disinterested. Two or three of the observers who are intelligent having been consulted and their statements recorded, the physician then notes his own observation. He should describe the urine if there is anything peculiar about that, but if the urine and stool are normal he need not care about the description of these.
It has been the study for hundreds of years to find the best way to question witnesses in court, and as a result they have settled upon certain rules for obtaining evidence. Homoeopathy also has rules for examining the case that must be followed with exactitude through private practice. Among pupils who have been taught here, I know some who have merely memorized and some have not even memorized but have fallen away. These students are violating everything they have been taught; they have gone to low potencies, making greater and greater failures, to the shame of the tutor and the science they profess of follow.
I expect some in the sound of my voice will be doing this five years from now; thus is a warning, stop before you go too far, or you will not feel the fault is your own. You will think you hypnotized and led into false ways. If you neglect making a careful examination the patient will be the first sufferer, but in the end you yourself will suffer from it, and Homoeopathy also. The questions themselves that Hahnemann gives are not important, but they are suggestive and will lead you in a certain direction. Question the patient, then the friends, and observe for yourself; if you do not obtain enough to prescribe on, go back to particulars. After much experience you will become expert in questioning patients so as to bring out the truth. Store up Materia Medica so as to use it and it will flow out as your language flows. You must put yourself on a level with the form of speech your patients use.
Be sure you have not put any words into your patient’s mouth or biased his expression., You want to know all the particulars but without asking about it directly. If you ask a direct question, you must not put the symptom in the record, for ninety-nine times out of a hundred the patient will answer by `Yes’ or `No.” If the patient’s answer is `Yes’ or `No,’ you question was badly formed. If a question brings no answer let it alone, for he does not know or has not noticed. Questions giving a choice of answers are defective.
Ascertain the precise part of the body the pain was in and the character of the pain, etc. In investigating a case there are many things to learn, the length of the attack, appearance of the discharge it it be a case of vomiting, its character, the time of day, etc., etc. Every student should go over these questions collateral questions, and practising case-taking. Leave the patient in freedom always Do not put any words into his mouth. Never allow yourself to hurry a patient; get into a fixed habit of examination, then it will stay with you.
It is only when you sustain the sharpest kind of work that you can keep your reputation and fulfil your highest use. Say as little as you can, but keep the patient talking and keep him talking close to the line, If he will only talk, you can find out symptoms in general and particular. If he goes off, bring him back to the line quietly and without disturbing him. There is not much trouble in private practice. There you will do a better average of work.
All sleep symptoms are important, they are so closely related to the mind, the transfer from sleep to waking, from cerebrum to cerebellum, is important. Old pathologists were unable to account for difficult breathing during sleep. The cerebrum rules respiration during sleep. To know the functions of the white matter and gray matter is important. A rational knowledge of anatomy is important. No homoeopath ever discouraged the true study of anatomy and physiology. It is important not only to know the superficial but the real, profound character, to enable you to recognize one symptom-image from another.
Study this paragraph, carefully and meditate upon it. If you do not form habits now, you will not from practice hereafter. You have no regular course and will get into habits you cannot break up.
The examination must be continued with due respect to the nature of the sickness and with due respect to the nature of the Materia Medica. Some symptoms have references to pathology and diagnosis, while others have reference only to the Materia Medica, and symptoms must be constantly weighed in the mind in order to establish their grade whether common or peculiar. If all are found to be common symptoms, the Materia Medica is left out.
Either the examination has not been made with respect to the Materia Medica, or the symptoms are not there at all. It makes no difference as far as cure is concerned; it matters not whether they are not present in the case or whether the doctor has not found them, the key to the prescription is not present. But if the image is round and full and complete, there are symptoms with regard to pathology, diagnosis, prognosis and Materia Medica. It will be proper later to talk of incurable, diseases, pathognomonic symptoms obscure cases, Materia Medica symptoms, etc.
When the physician comes to look over the record after an examination to get the image to classify and arrange it, he will find what is peculiar, and those symptoms that are most general, and those that are but common. These three grades appear in every complete case, and in every complete proving of a remedy. Homoeopathic study and observation will enable one to pick out these grades at a glance.
Every case has common symptoms, but peculiar symptoms may be absent and you must not expect to cure when peculiar symptoms are absent. Homoeopathy is applicable in every curable case, but the great thing is to know how to apply it. The physician must sit in judgment upon the symptoms and determine whether they are peculiar or common. If the patient’s discourse is incoherent, the question arises is he intoxicated or delirious, or is there breaking down of the brain and insanity? The flash of the eye is important; it will tell things that cannot be told by the nurse.
It is important for the physician to know the value of expressions. When the patient stares with glassy eye, is he injured about the head, is he suffering from shock, intoxication or typhoid fever or some disease in which the mind is stunned? The physician immediately proceeds to ask, “How long has the patient been in bed?” If the character is above reproach, he will not suspect intoxication; if the patient has been sick for many days with fever, tongue coated, abdomen sensitive, etc., he is fully entered upon the course of typhoid fever.
The physician must know immediately upon entering the room what the state of the patient resembles: apoplexy, coma, opium poisoning, etc. A physician is supposed to set his mind to work instantly, to ascertain the condition of the patient and what relation the symptoms maintain to the Materia Medica. If an opium poisoning there must be selected an antidote; if apoplexy, a careful taking of the symptoms in relation to the cerebral clot to prevent inflammation and symptoms relative to that state, and relative to the remedy. The patient may be intoxicated and have apoplexy at the same time.
There is no symptom in the sick room without its value, especially in acute and serious cases. Children are sometimes found in a sound sleep and cannot be aroused; the mother says the child has worms and gives Cina, for Cina has all these symptoms of stupor, difficulty in arousing, falling back to sleep. But the child fails, going into coma, the nose flaps, the chest heaves, the brow is wrinkled, there is rattling in the chest, showing the child is going into cerebral congestion. The physician now must examine on every side of the case to find the nature, to know what to expect. He who neglects this is not a true homoeopathic physician; a mere superficial application of Homoeopathy is not sufficient. After all the symptoms are written out, the physician must study the character of the fever, whether it is intermittent, continued or has come on in one sudden attack; he must know sufficient of the symptoms to judge of all these.
You will learn so much about the purport and the aspect of every motion of the human being that you will place less and less reliance on diagnostic symptoms as diagnostic symptoms, and learn more the value of symptoms as symptoms. You will be astonished to find how expert you will become about diagnosis and prognosis by studying the symptoms. You can learn something from every case you have mind; but by a process of rapid exclusion, you say it is not cholera, not haemorrhage, etc., and latterly you come to the cause of this aspect.
You can tell when it is to me for cardiac compensation to be broken in Bright’s disease; a peculiar tremulous wave that belongs to the muscles of the face and neck, a tremulous jerk of the tongue, putting about half way; the pale, cold, semi-transparent skin with cold sweat. It is important to know instantly what the cause is, for the treatment will be different, but remember that it is nothing that you need to name that makes it important.
All these symptoms have respect to remedy and to diagnostic conditions. So far as there is a morbid anatomy which can account for symptoms, so much less are those symptoms worth, as indicating a remedy; if you had no other than such symptoms, you could find no remedy.
Among the many things that interfere with the examination of the patient the most important is the taking of medicines or having done something, no matter what it is, that has been capable of changing the symptoms. Very commonly, the patient will present himself in the doctor’s office, and after giving a long array of symptoms will relate a dose of Quinine, and he thinks he is no better, and now he applies to you for relief. In acute diseases this is very bad and may interfere with finding the homoeopathic remedy.
Very often the general state collectively both drug and disease symptoms, in a very acute condition must be prescribed for, but in chronic disease the plan is different. The symptoms that arise after the taking of a dose of powerful medicine are not indicative of a remedy, they are confusing, they present no true image of the disease and hence the physician has nothing to do but wait, or at most administer a well-known antidote to the drug taken. Sometimes he must wait a considerable time until the symptoms reveal themselves and express the nature of the sickness. It is just as bad where the physician himself is a bungler as it is where the patient has taken the drugs.
The confusion arising from bad prescribing is just the same as that produced by the patient’s drugging. There are physicians going about will mix up their cases and continue to prescribe for their own drug symptoms, and who never have any idea of waiting for the true image of the disease to develop itself. Drugging is only a matter of changing symptoms and masking the case. Anything that will effect a change in the symptoms, the taking of drugs, or drinking too much wine or drinking today, or great exposure, will mask case, and this mask must wear away before the intelligent physician can make a cure.
The whole aim of the physician is to secure the language of nature. If it has been masked by medicines, it cannot be secured. Any meddling will so affect the aspect of the case that the physician cannot prescribe, and the physician who does this meddling must inevitable be driven into bad methods or into allopathy. I have looked over the work of bad prescribers and have wondered what on earth they could see in Homoeopathy to attract them; they do not cure folks. They have no cures to present.
The patients cannot well be satisfied by these things. It is true that once in a while a strong vigorous, robust patient, when he gets a homoeopathic remedy, will go on getting well through a mess of symptom changing and drugging, so that in spite of this meddlesome practice he will recover. The physician in that case, knows not what remedy to attribute to it, for he has given a great many. But only the most vigorous constitution will stand such homoeopathic villainy, go on and get well in spite of their indulgence in wine, in eating, etc.; it is wonderful what their own powers will do in throwing off disease.
In ordinary cases, however, we see no such things, confusion is brought about at once if the physician administer another medicine in place of administering placebo. At times a patient will present himself, and you will be able to get a true image of the sickness by ascertaining all the things that occured up to a given date. “Upon that date,” he says. “I took some medicine, and most of my symptoms, subsided.” They lead to another image from which you can gather nothing; a scattering has taken place.
The symptoms may cover page upon page, and yet what remedy do you see? None at all; it looks as if a number of provings of drugs had been mixed up all together, intermingling symptoms here and there without any distinctness. No individualization is possible. Now up to that date the symptoms you gathered may be just all that is necessary. Up to that date the symptoms present the image of a remedy which, it administered, may yet though sometimes it will fail at first because of the confusion, but after waiting a little it will act. After the the administration of a remedy prescribed upon symptoms in the past I have known the remedy many times to go on acting.
Again I have known that remedy to fail entirely. In such a case, wait awhile and then order will begin to come and that remedy which was indicated previous to the drugging will act. Suppose a physician comes to you and says, “Up to a certain date I was able to hold this patient’s symptoms in order with Thuja; but when the symptoms seemed to change and I gave such and such medicines, and have never seen such good results in prescribing as I did up to that period.” You must give him Thuja again, and in this way take up the thread where it was lost. Examine the image of the case where the order was lost; because that is where the image must be found. “On the contrary, the symptoms and the inconvenience which exhibited themselves previous to the use of the medicine, or several days after their discontinuance, give the true fundamental notion of the original form of the malady.”
This is the idea, get the original from of the malady. To do this, at times we have to trace through a mass of difficulties and conditions to get back to the original form of the trouble, but you must get there because you will see that in the beginning this malady, in accordance with all laws of Divine Providence, must have conformed to some remedy that had been created for its cure. The symptoms at that time stood out indicating this medicine, but since then there has been nothing but confusion, nothing that can be tied to, nothing that can be examined; it appears to have no relation to anything.
Very often we can take up the thread and get back to the remedy that was clearly indicated, even twenty years before. If that remedy was indicated then, and was not given the cure that was possible by that remedy or a similar one is the only thing to be considered; that is the only remedy in the case. Since that time the patient has been in continued turmoil from the action of drugs. Because it was twenty years ago there is no reason that you should not think of that drug. The patient’s disease has not been cured, it has only been changed and modified; but it is the same patient, and the same sickness and requires the same medicine. If the disease has been complicated by drugs, however, you cannot always get the action of that medicine which the patient needs for the disease per se, but after the drugs have been antidoted you will have to give that very medicine that you figured out and he will be cured.
It is necessary also to observe the changes all along the line of progress, to know the disease at its beginnings, it earlier manifestations, its symptoms and its endings. You find, say, most violent neuralgic pains along the course of nerves in an adult patient, and for these you administer remedies until you are tired and get only temporary relief; but you discover that in his childhood he had an eczema, and you will find it looks like Mezereum, and see its violent neuralgias are similar to those of your patient. The administration of Mezereum cures this neuralgia and brings back the eruptions that he had his babyhood, and he goes on to recovery. Without getting that view of the old scald head, you would not have thought of Mezereum.
Or, instead of Mezereum, Sepia may have had the likeness of that scald head, and he may now have the most striking and characteristic symptoms of Sepia; for behold the little things that have been put into such a turmoil by a bad drugging are under Sepia, and you put your patient on Sepia, and these last appearing symptoms go first and the eruption comes back upon the head and behind the ears, and Sepia has cured him. When these things are seen one after another in everyday practice the physician must begin to wonder if there is not some truth in it all. And as sure as you live, if you practice faithfully, carefully studying yours cases at great length, gathering in everything that was in the beginning, your cures will be so striking that the multitude will come to you to be healed. You cannot place too much importance upon the masking of a patient’s symptoms by medicines, by improper repetitions and by dosing carelessly.
s 94. “On inquiry into a state of chronic disease it is required to weigh the particular circumstances in which the patient may be placed in regard to ordinary occupation, mode of life and domestic situation.” etc. Almost everything in life is circumstantial. All of the activities of life are circumstantial, i.e., there are no activities that are not governed by circumstance. There is not business that is not governed by circumstance. The circumstances of a man’s life govern his actions and reactions, symptoms and the development of symptoms.
The body is associated with circumstances, every function is related to circumstance, and awe may say all the natural functions of life are connected with circumstances. Without these we would have nothing to prescribe upon, we would have nothing a ascertain images by, we would have nothing to form the symptoms, hence the circumstances of life and habit must be studied with a view to going into the slightest particulars. To illustrate that more particularly, and to bring it down to a practical basis, we may say that the examination of every woman relates to her eating, her stool, her menstruation, her bathing, her dress, because these are the things natural to her. These are the circumstances in which her symptoms may come or may not come.
Until the woman is educated to it she does not understand. “What do you mean, Doctor?” she says. Then I may say, “You have given me these symptoms; you say you have headache, stomachache, etc. Now will you proceed to relate to me under what circumstances this headache appears, how it is affected by your changes in dress, by the changes in weather, how it is affected before, during or after your monthly indisposition and so on.” Now, these are the natural circumstances.
In addition to these another group of circumstances comes up, a group of circumstances somewhat different, in relation to ordinary occupation. Every person will have circumstances more particular than those in general. Occupation will make changes in the circumstances of young women. She may be standing upon the floor of Wanamaker’s store all day, and this has produced a condition of prolapsus; or she may lead a sedentary life at her work as seamstress, or she may be at some other occupation, the circumstance of which will develop her psoric manifestations. Modes of life mean a great many different things. They come in as supernumeraries over and above the natural conditions and circumstances of life. The natural functions and circumstances of life have to be considered in relation to the mode of life. The mode of life comes in as the exciting cause of disease, whereby psora which is in the economy is developed in a certain peculiar direction.
The domestic is often the cause of trouble in the woman; there may be marriage to a man who is intemperate with her sexually; she may have a domestic situation that cannot be cured, and it must be examined as to its permanency and the prospect of removing it. Things that cannot be removed will develop psora, in a peculiar direction. “All these circumstances ought to be examined to discover if there is anything that could give birth to and keep up the disease, so that by its removal the cure may be facilitated.”
s 92. The patients generally call attention to the commonest things, while it is the strange and peculiar things that guide to a remedy. The symptoms most covered up from the observation of the physician are often the things guiding to the remedy, but finally they leak out in some way. The symptom is of such a character that the patient says of it. “I have always has it and did not suppose that had anything to do with my disease.” When asked “Why did you not tell me that before?” she says, “I did not suppose that amounted to anything, it is so trivial.”
The physician often hazards a remedy. He feels he must make a prescription, but has no reasonable grounds for thinking he has found the remedy because the patient’s story has been so confusing, and the symptoms that he has obtained are so common and ordinary, such as all remedies possess. With such a foundation he cannot have any assurance that he has the remedy, and, although he may have hazarded several remedies, in the case, the patient comes back uncared, month after month, and year after year. These symptoms that are withheld and seem to be so obscure, and so difficult to obtain, are the very ones that the patient thinks do not amount to anything. What seems to him to be the little symptoms are very often characteristic of the disease, and necessary for the choice of the remedy. Let me illustrate it.
A patient comes along with a pallid face, a rather sickly countenance, tired and weary, subject to headaches, disorders of the bladder and disturbances of digestion; and in spite of all your questioning, you fail to get anything that is peculiar. You set the patient to thinking and to writing down symptoms, and she comes back month after month and give her Sulphur, Lycopodium and a good medicines. You can sometimes find out whether she is a chilly or hot-blooded patient, and thus you can get a little closer among the common remedies; but the patient says a one says one day, “Doctor, it seems strange that urine smells so queer, it smells like that of horse.” Now at once you know that is Nitric acid. “How long have you had this?” “Oh, I have always had it, I did not think it amounted to anything.” If you examine the common things belonging to Nitric acid you will find that it possesses all the features of the case.
This is how a guiding symptom can be used. Nitric acid has a keynote “urine smelling strong like that of a horse;” but if you should give it upon that alone and the general symptoms were not there, you would probably remove the particular symptoms only, and they would come back after a while. Use a keynote to examine the remedy to see if it has all the other symptoms that the patient has. What I have described to you is a hypothetical case. In a busy day you will have several of these cases that you have been working at for months, and the patients have spent a lot of money of to no account.
You might just as well have given Sac. lac. until you found the right remedy. You can hardly say, why did I see the remedy before, because it was not possible to see it. You can only go over a case and say, why did I not ask her if there was any odor to the urine, and if so, what it was like. I have had this very symptom come out when I have asked a dozen times about the smell of the urine, and they did not know, and yet would say after-wards their urine smelled like a horse’s urine, and they knew it all the time. “On the other hand, the patients are so accustomed to their long sufferings that they pay little or no attention to the lesser symptoms which are often characteristic of the disease and decisive in regard to the choice of a remedy.”
Of course the trouble that we have to contend with in ascertaining symptoms from patients could be drawn out to great length. You might suppose that it would be the educated class that would tell their symptoms best, but you will find the ignorant class often do better, they are simpler; they do not disguise the symptoms; they come out and tell the little details in a better way, in a way that conforms to the language of our remedies. Our remedies have been recorded in simple language to a great extent, and this simple language is often better observed by the simple-minded uncultivated people than among the aristocrats.
People who have plenty of means and much education are more excitable, they have more fear and they have tried a great many doctors. Any physicians who has a reputation is consulted for a chronic disease; and the patient who has plenty of money goes around amongst the doctors, and when he comes to tell his symptoms he tells them in the technicalities of his numerous physicians, so that when he has finished his story nothing has been gained. Only gradually can the physician lead him back into a language simple enough to describe the sufferings. They who have been sick long with their chronic ailments and have become somewhat hypochondriac will go through with this list of their diseases.
They have paid lots of money, and have lots of names, and they are loaded with drugs. The physician must deal very carefully with these slippery people, because if they are irritated they will run off. s 96. There is another kind of patient spoken of here, those that “depict their sufferings in lively colors, and make use of exaggerated terms to induce the physician to relieve them promptly. This is especially characteristic of the native Irish as a class. You will find that hey will exaggerate their symptoms, really and sincerely believing that the doctor will give them stronger medicine if they are very sick and will pay more attention to them; and if they do no exaggerate violently, probably he will turn them off with a simple remedy.
Then we have the exaggeration of symptom by sensitive people. It is an insane habit, such s belong to hysteria. The physician will be helpless in the hands of these exaggerators, because Homoeopathy consists in securing the whole truth and nothing but the truth; it is just as detrimental to get too much as to get too little. Any coloring that is expressed, whether by the patient or by the physician, will result in failure. It is true that this tendency to exaggeration must be considered as a symptom. When you have found a patient to exaggerate a few symptoms into a large number, you can simply mention in your note “tendency to exaggerate symptoms,” which is covered by some of our remedies.
Such a state is misleading, for you do not know what symptoms the patient has and what the patient has not. You may rest assured that not patient without symptoms would consult a physician; the patient would not be likely to manufacture the entire sickness; the fact that she has a desire to present herself to the physician and has a desire to exaggerate her symptoms and sufferings is in itself a disease, because no well person would do that. Hence this must be considered; perhaps it is the first and only element that can be considered of that which such patients give out. This exaggeration must be measured with direction and wisdom.
“Even the most impatient hypochondriac never invents sufferings and symptoms that are void of foundation, and the truth of this is easily ascertained by comparing the complaints he utters at different intervals while the physician gives him nothing at least that is medicinal.” Hahnemann’s plan would be to give no medicine and to compare the symptoms that the patient gives from time to time. The patient cannot memorize these various symptoms that he has gathered from other sources, but by watching and comparing fro time to time, letting the examination be far enough apart for him to forget, the physician can aspect those things that he repeats. The young physician will be misguided by these cases until he has had sufficient experience with disease to know something about the nature of symptom that ought to appear.
Another obstacle we have in the examination of the case is laziness; the patient is too lazy to wife down the symptoms when they appear, and too indolent and forgetful to remember them in the presence of the physician. The symptoms do not come up in his mind when he is in the presence of the doctor, and he is too indolent to write these symptoms down when he feels them at home. When a patient does not related symptoms well he should be instructed to write down his symptoms when they occur, and if he will not do that his physician should insist upon it, or refuse to prescribe for him. It is often quite an important thing to get the patient to write down the symptoms in memorandum form as they occur. Not to write at night what has occured during the day, but to run instantly and put the symptom down in simple language, describing the sensation, and location, and the time of day of its coming and going, and the modalities. Indolence then and forgetfulness become obstacles to the gathering of the symptoms.
Now, in the present day, there has crept upon the face of the earth such a state of false modesty and such a lack of innocence upon the whole human race that this false modesty and shame will prevent patients from telling the truth. Patients will deny having had gonorrhoea, or having been exposed to circumstances that were similar. If the whole human race had lived in innocence up to the present day our women would come to the physician with frankness and talk in perfect freedom concerning the menstrual flow, concerning even the sexual functions, concerning things of the will and of the intelligence. But as a matter of fact it is not so, it is with difficulty that the physicians can draw out these symptoms though mistaken modesty.
When a patient consults a physician, the question of modesty should be laid aside. You will find that the most innocent in mind are those that are the most easy to lay it aside, when it is not a question of modesty, but of telling the whole truth and nothing but the truth. If it be a wife, everything that is in relation to herself and husband that is abnormal should be told, and then the physician would have little to ask beyond listening to the truth. I look back over a number of people, especially among women, when seemed to be so much embarrassed upon first coming into my presence and having to talk about their symptoms that they forget everything, and it was only by considerable waiting that they became free and frank and open with me. Sometimes’ it is a difficult matter for the physician to put a patient at ease; it is a thing must be studied and considered in order to be able to say something to put a bashful patient at ease; this is quite an accomplishment with a doctor.
The physician must be possessed of an uncommon share of circumspection and tact, a knowledge of the human heart, prudence and patience, to be enabled to form to himself a true and complete image of the disease in all its details. He must live the life of the neighbor, and be known as a man of honor, as a man who may be believed and respected, as a candid man. Hahnemann says carelessness, laziness and levity will prevent the physician from going into such a state of Homoeopathy as will enable him to grasp the Materia Medica or to be conversant with his science. If he has such a reputation he will not command the respect of the people of the neighbourhood, and this will prevent him from getting the image of the sickness upon paper. Hahnemann had a wonderful knowledge of the human heart, and this is an important thing; a knowledge of the things that are in man.
It would seem that there are a good many men in the community without the slightest knowledge of the human heart. They have never given any inspection their own interiors, their heart or impulses, but have gone on wildly. To know the human heart well is largely to examine into oneself and ascertain what one’s own impulses are, what one is compelled to do under varying circumstances, what impulses one has to control in oneself in order to become a man. If a man has carried out his heart’s desires without any self-control he is man unworthy of present. If he has on the other hand controlled those impulses, he has become a man worthy of respect. In time the physician who does this will become so well acquainted with the human heart that he has sympathy and knows what constitutes the language of the affections.
It is important to avoid getting confused by two disease images that may exist in the body at the same time. A chronic patient, for instance, may be suffering from an acute disease and the physician on being called may think that it is necessary to take the totality of the symptoms; but if he should do that in an acute disease, mixing both chronic and acute symptoms together, he will become confused and will not find the right remedy. The two things must be separated. The group of symptoms that constitutes the image and appearance of the acute miasm must now be prescribed for.
The chronic symptoms will not, of course, be present when the acute miasm is running, because the latter suppresses or suspends the chronic symptoms, but the diligent physician, not knowing the is so, might wrongly gather together all the symptoms that the patient has had in a life time. Again, on the other hand, in gathering together the chronic symptoms for a prescription it is sufficient to mention merely that the patient has had typhoid or measles or other acute miasms. Such diseases are not a part of the chronic miasm. The symptoms of the acute attack were separate and by themselves.
You must realize that the effort to prescribe for two distinct miasms will result in error. It you practice in the western part of this country you will often get confused cases, a sample of which would be about as follows: A patient has been suffering from intermittent fever, and has been treated with medicines, Quinine, Arsenic and low potencies of this and that drug, until the case has been complicated. You learn that the symptoms now are different from what they were in the beginning, that there has been a transformation scene.
You prescribe for them as they are now, regarding it as species of malaria; you prescribe for them with a view to antidoting all the drugs that he has had, and your remedy brings about a surprise; it opens out the case in a wonderful manner. The patient up to this time was unable to give you anything descriptive of the original state of his malaria, but he comes back in the course of a week or two and says: “Doctor, I am now as I was in the beginning.” “Well, what are your symptoms now?” And you will find out that one evening he has a 5 o’clock with its accompanying symptoms that last him a good portion of the night, and then he has a well day, and then next forenoon he has an 11 o’clock chill and then a well day.
If you examine each one of these states, you will find that the two chills begin in a different place, and the heat of each begins in a different place, and the symptoms of the two attack are totally different. Such a thing will seem unlikely to one who has never seen it, but one who has lived in the west and practiced accurately will see such things, unknown to those who have practiced what is called Quinine Homoeopathy. A correct prescription will disentangle these two malarial miasms and show that two exist in the body at the same time, each having conditions quite different from the other. These two can co-exist and have their own times and expressions without interfering with each other to any great extent. The big doses of quinine will complicate them and cause a general clouding of things, so helter-skelter and disorderly that nobody can tell anything about it.
If in such a case you were to attempt to prescribe a remedy that had both these groups you would fail to cure. Select the worst one, and let the other one alone, entirely ignoring it. It is a bad policy to give one remedy for one and another for the other. Single out the worst one and cover it carefully with a remedy, and you will find it disappear and the other one comes on, just a if the patient had not a remedy at all.
Now do not be in too great a hurry about removing the second one. You will find that after one has been removed the patient will improve, and the one that has remained will become more and more apparent from day to day; then prescribe for it.
This illustrates the doctrine of not prescribing for an acute and chronic trouble together. Never prescribe for any two conditions, unless they be complicated. Only chronic diseases can be complicated with each other. The acute is never complicated with the chronic; the acute suppresses the chronic and they never become complex. Of course, the allopaths will tell you about the sequelae of measles, scarlet fever, etc., but they know nothing about it, and their pathology teaches them nothing which is true concerning it. That which comes out after all self-limiting diseases have run their course is not due to the disease itself; the sequelae of measles are not due to measles, the sequelae of scarlet fever are not due to scarlet fever, but to a prior state of the patient. A psoric disorder may come after scarlet fever or measles, and must be treated as psora.
These sequelae, regardless of the disease which stirs them up, are psoric and crop out at the weakest time, which is the convalescent period. The better the acute disease is treated, the less likely there are to be any sequelae. if measles and scarlet fever are treated properly we have very little trouble afterwards. Sequelae should always be charged up to a great extent to the physician. Of course, you will find now and then some constitutions extremely psoric; almost in a condition of advanced decay, and for malignant scarlet fever in such a patient it is difficult to find a proper remedy, and then the very best physician in the world may make a mistake; yet with good treatment in ordinary cases you should not expect sequelae, such as sore eyes, running ears, etc.
It is of the greatest importance in such cases to be able to separate and distinguish one thing from another, so that you may know what you are prescribing for. You cannot prescribe an antipsoric in order to prevent sequelae following scarlet fever while the scarlet fever prevails. Prescribe first for the acute attack, and the symptoms that belong to it. It is well, however, for the physician to know all the symptoms that the patient has of a chronic character, that he may know what to expect, tat he may look at the close of the acute attack for the coming out of the old manifestations of psora, although often an entirely new group of symptoms will appear.
When at the close of scarlet fever trouble come about the ears or dropsical conditions come on; these are not a part of the scarlet fever itself, but of the state of the economy. The dropsical condition, or acute Bright’s disease, must be associated with the psoric state and the symptoms then will lead you to a constitutional remedy. If you have in view simply the Bright’s disease, you will make a mistake. You will fall into prescribing for ultimates if you have but the name of the trouble in mind, for instance giving Apis, which the books say, is a wonderful remedy for Bright’s disease, following scarlet fever.
It is a great mistake for anyone to fit remedies for complaints or states. It is a fatal error for the physician to go on the bedside of a patient with the feeling in his mind that he has cases similar to this one, and thinking thus: “In the last case I had I gave so and so, therefore I will give it to this one.” The physician must get such things entirely out of his mind. It is a common feature among oculists who profess to be homoeopaths to say: “I cured such and such a case with such and such a remedy. I will now give this patient the same remedy.” I have many times met physicians in consultations who said: “I have another patient, Mr. Z or Mr. X, who had a similar state of affairs, just such a disease as this, and I gave him so and so, but it does not work in this case.”
s 100. “With regard to a search after the totality of the symptoms in epidemic and sporadic cases, it is wholly indifferent whether anything similar ever existed before in the world or not, under any name whatever.” Keep that in your mind, underscore it half a dozen times with red ink, paint it on the wall, put an index finger to it. One of the most important things is to keep out of the mind, in an examination of the case, some other case that has appeared to be similar. If this is not done the mind will be prejudiced in spite of your best endeavours. I have to fight that with every fresh case I come to. I have a labour to keep myself from thinking about things I have cured like that before, because it would prejudice my mind.
The purpose of all that is that you will go away and examine the patient with an unprejudiced mind, that you will consider only the case before you, that you will have nothing in mind that will distract your attention, that you may not think of things that preceded it and find out from among them a remedy while examining the patient. If you are biased in your judgment and examine the patient towards a certain remedy, in many instances this will prove to be fatal. Have no remedy in mind until you have everything that you can get on paper. Have it all written down carefully and then if, upon examining it in relation to remedies, you are unable to distinguish between three or four, you can go back and re-examine the patient with reference to those three or four remedies.
That is the only possible time you try to fit a remedy, or image of a remedy, while examining a patient. Get all the symptoms first and then commence your analysis in relation to remedies. The analysis of a sickness is for the purpose of gathering together that about in which is peculiar, for the peculiar thing relate to remedies. Sicknesses have in them that which is peculiar, strange and rare, and the things in sickness that may be wondered at are things to be compared with those in the remedy that are peculiar.
Now in order to see that which is wonderful and strange it is necessary for you to have much knowledge of disease and much knowledge of Materia Medica; not so much an extensive knowledge of morbid anatomy, but a knowledge of the symptoms or the language that disease expresses itself in. “In fact, we ought to regard the pure image of each prevailing disease as a thing that is new and unknown, and study the same from its foundation, if we would really exercise the art of healing.” A great deal depends upon a physician’s ability to perceive what constitutes the miasm. If he is dull of perception he will intermingle symptoms that do not belong together. Hahnemann seems to have had the most wonderful perception, he seemed to see at a glance.
Hahnemann was skilful in this respect because he was a hard student of Materia Medica and because he proved his Materia Medica daily. He had examined the remedies carefully, he saw them, he felt them, he realized them. “We ought never to substitute hypothesis in the room of observation, never regard any case as already known.” Now we see why it is that it does not make any difference with a physician whether he has seen such diseases before or not. The homoeopathic physician is acquainted with the signs and symptoms of the man, and a different disease is only a change in the combination of them, only a change in their manner, form and representation. There is order, perfect order, in every sickness that presents itself, and it rests with the physician to find that order. The homoeopathic physician need never be taken unawares.
LECTURES ON HOMOEOPATHIC PHILOSOPHY BY JAMES TYLER KENT –
The old school of Allopathy considered about `sickness’ and `medicine’ in a particular way.
– The sphere of sickness was limited to the physical level. Only tissue changes were seen and considered.
– The source of sickness, process of sickness, the nature of sickness and the concept of real health were not studied.
– Only the result of sickness was felt with fingers, seen with eyes and observed by sense through instruments.
– The meaning of restoration of health was confined to relief in the ailments of particular organs where they appeared. – Drugs were used in crude forms to remove the ailments.
– The system was based entirely on experience. Decisions were made on opinions of individuals at different times and concensus of opinions or hypothesis.
– Pathological findings formed the basis of the diagnosis.
– The internal of man–his mental and emotional aspects were not considered.
– Symptoms–the language of sickness, at the levels of mind, emotion and body were not studied.
– Every pathological result had its corresponding bacteria.
– Doctrine of Vital Force had no place for them.
– Prime importance was given to the organs of man, and not to the man himself which constituted of body mind and emotions.
Will and understanding of man not studied and considered
Dr. Hahnemann `proved’ the drugs on healthy enlightened human bodies. He found that the drugs affected the mind, the emotions and the body and the effects are expressed through symptoms and modalities. He also found that these drugs in potency are able to remove Similar Sickness appearing in human beings. He discovered an Universal Truth; a truth based on `science’ where opinions do not matter, experiences do not form basis; source of sickness, process of sickness and the nature of sickness is explored and the correct curative agent is found.
Dr. Kent has interpreted and explained the various aspects of Hahnemann’s “Organon of the Healing Art”. His lectures are so vivid that they mirror the fundamental laws of health and healing to the mankind at all levels of understanding. This book was written about 90 years ago-but still, the concepts hold true in the present times. He was an empirical Hahnemannian. He could not compromise with the deviation from principles and philosophy and we find his criticism sometimes sharp and bitter of `Pseudo-homoeopaths’.
KEYNOTES OF PHILOSOPHY
– Man is the will and the understating and the house which he lives in is his body.
– The organs are not the man. The man is prior to the organs.
– The order of sickness as well as the order of cure is from man to his organs. The real sick man is prior to the sick sick body.
– A man is sick prior to localization of disease. When we wait for localization, the results of disease have rendered the patient incurable.
– Symptoms are but the language of nature, talking out, as it were, and showing as clearly as the daylight, the internal nature of the sickman or woman.
– Crude drugs cannot heal the sick and that what changes they effect are not real but only apparent.
– Tissue changes are of the body and are the results of the disease, they are not the disease.
– The bacteria are results of the disease. The disease cause is more subtle.
– The remedy, which will produce on healthy man similar symptoms, is the master of the situation, is the necessary antidote, will overcome the sickness, restore the will and understanding to order and cure the patient.
– Man consists in what he thinks and what he loves and there is nothing else in man.
– The physician has to `perceive’ in the disease that which is to be cured, and that is through `totality of symptoms’. He has to perceive the nature of disease and the nature of the remedy.
– Experience has only a confirmatory place. It cannot take the place of science and truth.
– All true diseases of the economy flow from centre to circumference. All miasms are true diseases.
– The active cause is within, and the apparent cause of sickness is without. If a man has no deep miasmatic influence, outer causes will not affect him.
– Homoeopathy has two parts: the science of homoeopathy are the art of homoeopathy. One has to learn the art of homoeopathy to prepare himself for the application of the science of homoeopathy.
– Vital force is constructive and formative, and in its thing in the universe has its aura. Every star and planet has it. The remedy to be homoeopathic must be similar in quality and similar in action to the disease cause.
– As soon as the internal economy is deprived in any manner of its freedom, death is threatening; where freedom is lost, death is sure to follow.
– Potency should suit the varying susceptibility of sickman.
– Any more than just enough to supply the susceptibility is a surplus and is dangerous.
– Human race has been greatly disordered in the economy because of surplus drug taking.
– Primitive cause is not in the bacteria. Bacteria themselves have a cause to appear and survive.
– Over sensitive patients are actually poisoned by the inappropriate administration of potentized medicines.
– Their chronic miasms are complicated with chronic drugging and its effect upon the vital force.
– The physician who can only hold in his memory the symptoms of a disease or a remedy will never succeed as a homoeopath.
– The majority of such as call themselves homoeopaths at the present time, are perfectly incompetent to examine a patient, and therefore incompetent to examine homoeopathy.
– It is impossible to test homoeopathy without learning how to get the disease image so before the eyes that the homoeopathic remedy can be selected.
– At the present day, there is almost no such thing as an unprejudiced mind.
– Do not prescribe until you have found the remedy that is similar to the whole case, even although it is clear in your mind that one remedy may be more similar to one particular group of symptoms and another remedy to another group.
– It is unaccountable, therefore, that some of our homoeopathic practitioners make use of palliatives that are so detrimental to the patients.