phenomena are located as they appear, defining each particular symptom as accurately as possible. Thus to discover and bring out the facts of a case and give them form and individuality as a whole, is the art of the accomplished homœopathic examiner. It is an illustration of what a former article means in speaking of the "totality" as consisting of "related fact, having form, coherency and individuality," and characterizing its formation as "artistic."
Although the facts must be gathered from the patient, their form, relations and value depend almost altogether upon the examiner. The patient, unaided, will usually give only rough, disconnected statements, crude generalities, single concrete facts and a few details-a mere formless mass. The trained examiner patiently and skillfully analyzes and completes the statements, brings out details, connects the whole and constructs the case logically and scientifically, giving it a typical form, according to a preconceived idea. That is art and true art is always scientific.
As models of analysis in special diseases, and for daily practical use, procure and study Allen on Intermittent Fever; Bell on Diarrhœa and Kimball on Gonorrhea. In general analysis and synthesis of the entire field of materia medica, Bœnninghausen's "Therapeutic Pocket Book" and Kent's Repertory are classics, indispensable to every homœopathist.
Bœnninghausen's "Therapeutic Pocket Book" and his book on fever (unfortunately out of print) are the original and unsuperseded models upon which all other reliable works of this class are based.
Bœnninghausen, following and working with Hahnemann, is the fountain head for the analysis and classification of symptoms from which we all draw. His name, next to that of Hahnemann, is the most illustrious in the galaxy of homœopathic heroes. Methods of practice based upon and patterned after the work of such masters cannot fail to bring success to every practitioner who uses them and advance the cause of Homœopathy.
* * * * *
Clinical Histories. - Getting a good clinical history is one of the most important parts of case taking. By the same token it is also the one most generally neglected or badly done.
Si m ili b is In d ia
130
In order to deal intelligently with the present we must know something of the past. We mustknow not only the facts of the present perhaps acute illness, but also what led up to it. Otherwise we will often be baffled in our attempts to cure and find our patients making slow and imperfect recoveries from seemingly simple acute diseases, or settling down into states of more or less confirmed invalidism.
This is because all genuine acute diseases are in reality acute outbreaks or exacerbations of previously latent, deep-seated, underlying, chronic diseases or inherited tendencies and predispositions to disease, which exist in practically all persons, - a special subject which is dealt with elsewhere.
In examinations then, as a rule and at the appropriate time, we first get as complete a list as possible of the patient's previous diseases, from childhood down to the present, in as nearly chronological order as possible, with the ages at which the attacks appeared and inquire as to their nature, symptoms, duration, severity and sequelæ.
We should inquire carefully not only as to acute eruptive,. infectious, inflammatory or febrile diseases, including the so called "children's diseases," but about the more chronic and obscure ailments, including skin diseases; organ and glandular diseases (tonsilitis, adenitis, etc.); nervous diseases (epilepsy, "convulsions," chorea, paralytic conditions, etc.); catarrhs and "discharges" from any of the mucous outlets; bone or joint diseases and rachitis; and disorders of the sexual sphere, especially syphilis and gonorrhœa.
In women and girls we should inquire about the menses, age at which established and
regularity of the periods, note all deviations from the normal and ascertain the time and influence of marriage, childbirth, etc.
We should not forget to inquire if and when the patient has been vaccinated and learn what course the implanted disease took. At the same time we should inquire if any other inoculations with serums or vaccines have been performed. Many troubles may be traced back to vaccinations and inoculations, intentional or accidental.
The kind of treatment the patient has had for the diseases experienced and the principal drugs used should be learned, if possible. It may be necessary to antidote some of them.
The occupation and habits of the patient; diet, exercise, sleep, use of tea, coffee, tobacco, stimulants, narcotics, etc., should. be noted.
It is important to ascertain whether the patient has met with any accidents or mechanical injuries, or has suffered any mental shock or trial, such as grief, fright, anxiety or worry, business losses or reverses,' unhappy domestic experiences, disappointment in love, etc., and fix the dates and sequence. Such experiences have a powerful influence in causing or predisposing to disease besides being valuable to the prescriber as guiding symptoms.
Next it is important to ascertain the family history, that is, a brief history of the diseases causes of death, predispositions and tendencies to disease and individual peculiarities not only of
Si m ili b is In d ia
131
the patient's brothers and sisters, but of his father, mother, uncles and aunts and his grandparents,if possible.
All this is General History and should make up a part of the office record of every case. In some cases it will be necessary to go minutely and thoroughly into the history and phenomena of particular phases of preceding diseases in order to get the facts necessary for an intelligent homœopathic prescription.
Such an examination should be made not only for its great practical and scientific value, but for its psychological influence upon patients. Patients will be much more likely to remain permanently With the physician and his hold upon them will be much stronger if he has thorough and comprehensive histories of their cases in his files and impresses that fact upon them. It gives them confidence in his professional ability and skill.
Patients like to feel that their physician, "knows all about them;" that be is not interested in them and their families, personally and professionally, but that he takes pains to learn and keep in touch with all their individual peculiarities There is no surer way to build up a permanent, lucrative and substantial practice than by doing this work. It goes without saying that the fee for such a first examination must be commensurate with the time and skill employed and that it will be paid without grumbling, for every intelligent patient will see that he is getting good service and good value for his money.
Printed blanks, systematically covering the points outlined, modified according to individual judgment and need will greatly facilitate the process of good history and case taking. They should be of standard letter size, with blank sheets of the same size for expansion of individual cases and kept together, with all correspondence relating to each case, in folders, in one of the modern, indexed, vertical-filing cabinets, for constant reference. Individual records are filed alphabetically under the name of each patient. It is not well to try to keep case records on little three by four or four by five cards as some do. There should be ample space to do the subject justice. Standard letter size sheets, 8 x 10, give plenty of space, match ordinary correspondence and fit the standard vertical cabinets.
The examiner should be constantly on the alert and observing while making an oral examination. The patient may be unconscious or delirious; Or an infant, unable to talk; or insane. He may be malingering or trying to deceive as to the real nature or cause of his disease. Knowledge of the natural history and phenomena of disease will aid in forming a true picture of the disease.
As a prescriber the homœopathician is always seeking that in the case which is peculiar, uncommon, characteristic, individual. That may be noticed in some casual expression of the patient as he talks, revealing his mood or state of mind, or the origin of his trouble; it may be found in the color, form or expression of his countenance; or in his attitude, gait, or physical demeanor.
If the patient is confined to bed, the examiner will observe his position in bed, his manner of moving or turning, his respiration, the state of his skin, color or odor of perspiration, odor of
Si m ili b is In d ia
132
exhalations, from mouth or body, physical appearance of excretions, relation of the patient'ssensations to atmosphere and temperature is shown in amount of covering, ventilation of room, ice bags, hot water bottle, etc., - all these, and many other little points, noticeable by the alert examiner, perhaps without asking a question, will be valuable guides in the choice of the remedy. They should be recorded as such.
The mental state, conscious and subconscious, is revealed by the general behavior, the conversation, the expression of the countenance, the desires and aversions and the manner of sleeping, as well as by the voluntary verbal expressions. Mental symptoms are of the highest importance. Expertness in observing and analyzing these features of disease should be cultivated because right conclusions and effective treatment often depend more upon the physician's own observations and directions, than upon anything that others or even the patient are able to tell him. In the matter of mood or temper of the mind, for instance, he will be able to judge from the patient's manner of relating or expressing his sufferings and his behavior toward his attendants, whether he is sad or cheerful; calm or anxious, confident or afraid, indifferent, morose, censorious, malicious, irritable, suspicious, or jealous.
As to the intellect, he can observe for himself whether the patient is dull, stupid, unconscious, excited, delirious, distracted, confused etc. All the foregoing points are covered by the rubrics in any good repertory and they must be covered by the remedy selected.
All these and their allied conditions are most valuable and characteristic as therapeutic indications. They should be observed and noted carefully. Every case should be approached with this thought and the mind kept active and alert while talking with the patient and his friends. Such work as this has its pleasures, aside, from its scientific relations. "The greatest study of man is man." Most of us like to "study human nature" and rather pride ourselves on our sagacity in "sizing up" the people we meet by a study of their physiognomy, manner, etc. The homœopathic prescriber will find it to his advantage to cultivate the art of psychological analysis, and may well take pride in it when he is able to do as part of his medical work systematically also.
It is taken for granted that the physical examination of a :patient will be made thoroughly and systematically also and the findings added to the record. As that subject does not come within the scope of this work, no, further attention will be accorded to it.
If he has succeeded in impressing upon his readers the necessity and advantages of always making thorough and systematic examinations and keeping full, written records of cases the author will feel that his purpose has been accomplished. Nothing conduces more strongly to professional honor and reputation and to success in practice. An honestly earned reputation for making careful examinations, for "taking an interest in the case," for always being thorough and painstaking, is one of the most valuable assets a physician can have, and one which may be legitimately capitalized to his financial benefit.
Si m ili b is In d ia
133
Chapter XIII
Homœopathic Posology
By posology (from the Greek, posos, how much) we mean the science or doctrine of dosage.
Small doses and homœopathy are commonly regarded as synonymous terms. If they who
have such an idea of it are favorably inclined toward homœopathy, it is as likely to be because they have heard that the medicines are "pleasant to take" as for any other reason. While such an impression, taken with what, it involves, is not altogether undesirable, it is to be regretted that a broader basis of judgment has not been furnished by those whose duty it is to instruct the public in the principles of homœopathy. Had this been done such a juvenile conception would not exist, and homœopathy would be more widely appreciated.
It is not to be denied that the subject of the dose in homœopathy is a very important one. The three essential elements of the system are the principle, the remedy and the dose; -and the three are of equal importance. Posology, and the related subject of Potentiation were the subjects of so much misunderstanding, discussion and controversy in the early - days of homœopathy that the profession, after being divided into two opposing camps grew tired of the subject. It came to be regarded as a kind of "Gordian Knot," to be cut by each individual as best he could with the instrument at his disposal. Hahnemann himself at one time, almost in despair of ever being able to bring his followers to an agreement on the subject, cut the knot by proposing to treat all cases with the thirtieth potency. Following this suggestion others tacitly adopted a dosage confined to one, or a very limited range of potencies. The materialistically minded restricted themselves to the crude tinctures and triturations, or the very low dilutions, ranging from 1x to 6x. Others ranged from the third to the thirtieth potencies, while another small class of metaphysical tendency used only the very high potencies, ranging. from the two hundredth to the millionth, each according to his personal predilection.
Such a state of affairs is unfortunate. Assuming that there is a difference in the action of the various doses of medicines, and that a series of potencies or preparations of the different medicines has been available for use; it follows that the entire series should be open to every practitioner, and that each man should be competent, willing and ready to use any potency or preparation of the remedy indicated in a given case, without prejudice. If he confines himself to one or two potencies, be they low, medium, or high, he is limiting his own usefulness and depriving his patient of valuable means of relief and cure.
Under homœopathic principles any potency may be required in any case. It is as unreasonable to expect to cure all cases with any two or three potencies as it is to expect to cure all cases with any two or three remedies. In either case, those who follow such a course are governed more by the love of ease and their prejudices than they are by their desire for efficiency.
The selection of the dose is as much an integral part of the process of making a homœopathic prescription as the selection of the remedy, and often quite as important. A well selected remedy may fail utterly, or even do injury, because of wrong dosage. Dose as well as remedy must be adjusted to the patient's need.
Si m ili b is In d ia
134
The homœopathic doctrine of dosage, like the law of cure, was based upon the discovery ofthe opposite action of large and small doses of medicine. It is another application it medicine of, the Law of Mutual Action - the third Newtonian law of motion - "Action and Reaction are Equal and Opposite." Every one at all acquainted with the action of drugs knows, for example, that Ipecac in large doses causes nausea and vomiting and in small doses, under certain conditions, will cure the same; that Opium in large doses will cause a deep sleep or narcosis, arid in small doses, under certain, conditions, will cure the same.
Closely allied to this is the so-called primary and secondary action of drugs, in, which we see many drugs, in the first or primary stage of their action producing one group of symptoms, and in the second stage a directly opposite set of phenomena; as when the deep sleep of the primary action of Opium is followed by a much longer lasting wakefulness; or where the diarrhea induced by a cathartic is followed by a longer lasting constipation. This applies, of course, only to drugs given in tangible form and considerable quantities, in what are called "physiological doses."
Although the physiological antagonism between large and small doses is an illustration of the homœopathic law of posology, the use of drugs in "physiological doses" has nothing to do with their homœopathic use, because homœopathic remedies are never used in "physiological doses." This statement is true, even in those cases where the low reacting power of the patient some-, times requires material doses of the homœopathic remedy. It would be more accurate to say that homœopathic medicines are never used for their "physiological effect."
It is necessary to a clear understanding of the subject that a distinction be made between three
terms, physiological, therapeutic, and pathogenetic, used by the two schools of medicine to express the nature of the action of the drugs. There is a demoralizing tendency even in the homœopathic school to use these terms without discrimination.
The word "physiological" as currently used in medicine in relation to drug action and dosage is misleading and inaccurate, The Word has a reassuring sound, pleasantly suggestive of something normal and healthy. Its use tends to obscure, or keep in the background, the fact that the kind of drug action so designated is essentially a toxic action and therefore really painful and injurious.
The "physiological action" of a drug is not its therapeutic or curative action. It is exactly the
opposite of a curative action., and is never employed in homœopathic practice for therapeutic purposes. The use of the word "physiological" in connection with drug action and drug dosage
tends to mislead the unwary and justify the use of measures which would otherwise be regarded as illegitimate. In one word, is it a euphemism. Inasmuch as the action of the '.'physiological" dose and the purpose for which it is given is avowedly to produce drug symptoms, in, a direct and positive manner, that fact should be clearly expressed in the name,' in order that there may be no misunderstanding.
The homœopathic school has recognized the wisdom and justice of taking this position, and has complied with the requirements of scientific accuracy in nomenclature by the adoption and use of the word "pathogenetic" (Gr., pathos, suffering, and genesis origin, "producing suffering")
Si m ili b is In d ia