This section is from the book "Hartmann's Theory Acute Diseases And Their Homoeopathic Treatment", by Charles J. Hempel. Also available from Amazon: Theory of acute diseases, and their homoeopathic treatment.
"§ 90. All the answers being committed to writing, the physician then notes down what he himself observes in the patient,+ and endeavours to ascertain if that which he observes existed or not when the latter was in health.
* Nothing is more unpleasant for a physician, than an incomplete or even incorrect image of the disease. If he have an incorrect impression of the disease in the beginning of the treatment, he will find it difficult to correct that impression while the treatment is going on. He will never be able to select the proper remedy for the disease, and his treatment will necessarily fail.-Hartmann.
"+ For example - How he behaved during the time of the visit. Was he, irritable, peevish, quarrelsome, hasty, grieved, anxious, despairing, sad calm, or resigned? Did he appear overcome with sleep, or lost in reverie? Was he hoarse? Did he speak low? Was his discourse incoherent, or how was it? Of what colour was the countenance, the eyes, and the skin, generally? What degree of vivacity was there visible in the face and eyes? How was the tongue, the respiration, the smell from the mouth, or the hearing? Were the pupils of the eyes dilated or contracted? Did they contract and dilate quickly in light and darkness, and in what degree? What was the state of the pulse? * What was the condition of the abdomen? Was the skin moist and warm, cold or dry, upon this or that part of the body, or was it so all over? Did the patient lie with his head thrown back, with his mouth wholly or half open, with his arms crossed above his head; was he on his back, or in what position was he ? Did he raise himself with difficulty? In short the physician is to keep notes of every thing he has observed that is strange and remarkable."
After having taken down an exact record of the symptoms of a case, it is essential to investigate the causa occasionalis, be it a permanently existing, material or an immaterial, dynamic cause, having ceased to be present. We further require to consider the business of the patient (whether the disease be occasioned by it), his moral disposition, mode of life. We ought to inquire whether the patient is moderate in eating and drinking, in his amusements, or whether he has imposed upon himself hurtful privations? whether he has injured himself by venereal excesses? We have further to ascertain whether disappointed love, jealousy, domestic quarrels, chagrin, grief, abusive treatment, suppressed vengeance, humbled pride, loss of property, etc., have been instrumental in occasioning the disease?
A correct knowledge of the hereditary disposition, age and temperament of the patient is likewise of great importance. If the patient be a female, the physician has to inquire into the condition of the menses, whether the menstrual period is too long or too short, how many days the menses flow, whether they flow uninterruptedly or at intervals, whether they are copious or scanty, of what colour, whether they are accompanied, preceded or succeeded by leucor-rhoea? Whether they are accompanied with moral or physical sufferings, and what are the peculiar pains and sensations which manifest themselves before, during, or after the appearance of the menses? What is the appearance of the leucorrhoeal discharge, with what sensations it is accompanied, whether it is abundant or scanty, and under what circumstances or by what causes it is especially excited? Whether the patient is sterile, or whether she has been pregnant and how often? Whether she has miscarried? What was the condition of her breasts, milk, etc.? What is the strength of her sexual desire? In diseases of the sexual organs the physician ought always to institute an examination of the parts both internal and external.
* The physician examines the pulse, the condition of the heart, whether it beats normally or abnormally, the chest, the abdomen, and does not neglect any of the manipulations or instruments by means of which the internal phenomena of the. disease are more or less correctly ascertained. - Hartmann.
Inquiry ought to be made about the diseases with which the patient may have been afflicted previously, both in acute and chronic diseases, especially, however, in the latter, with a view of ascertaining whether preceding diseases have led to the present malady, or to what an extent they complicate it. An inquiry into the previous diseases of the patient sometimes leads us to a correct knowledge of the disease in chronic cases, and even helps us in selecting the remedies which We ought to use in the treatment of those cases. Although we do not admit that seven-eighths of all chronic diseases owe their existence to the psoric miasm, yet it is undoubtedly true that the suppression of a previous cutaneous eruption, scabies, herpes, tineat scrophulosis, etc. induces a vast number of chronic diseases which make their appearance shortly after the eruption had been suppressed, the assertions of many great doctors to the contrary notwithstanding, who pretend that the itch is a mere external disease which is caused by the acarus and can be cured by simply destroying that insect by any, even mechanical means. The homoeopathic physician cannot accept such theories, although he may, on the other hand, feel justified in believing that Hahnemann goes too far in considering the psoric miasm as a morbific principle which is coeval with mankind and has affected more or less every organism. One thing is certain, the influence which previous diseases may have upon the present one, has to be carefully investigated.
If, in examining a patient, the physician should discover symptoms pointing to the use of a certain drug which is frequently employed in domestic and allopathic practice, it is the physician's duty to inquire whether large doses of that drug have not already been taken. Such drugs are: Valerian, Chamomile, Mercurius, and mercurial preparations used either internally or externally, Iodine and Iodine ointment, Sulphur, Opium, China and Quinine, Digitalis, Prussic acid, Cathartics, etc.
If any, especially an acute disease should prevail, its character or genius requires to be noticed with care, inasmuch as it will influence more or less the character of the disease which we are called upon to treat and may be a clue to the practitioner for the selection of the adequate remedial agent.
To institute in every, even trivial case, such a rigorous examination as has been here described, would involve a useless loss of time and would be very fatiguing to the patient. Our intention has simply been to state what sort of an examination should be made in a complicated case, leaving it to the intelligent and conscientious physician to condense the examination as much as a judicious appreciation of the case by means of his physiological, pathological and therapeutic knowledge will permit. A carefully instituted examination is the touchstone of a true artist in homoeopathic practice.
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