Organon § 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 had it and I 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 uncured, 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 many 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 one day,
"Doctor, it seems strange that urine smells so queer, it smells like that of a 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 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 not 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 afterwards 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 physician 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.
Organon § 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 they 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 not exaggerate violently, probably he will turn them off with a simple remedy.
Then we have the exaggeration of symptoms by sensitive people.
It is an insane habit, such as 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 no 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 discretion and wisdom.
"Even the most impatient hypochrondriac 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 from time to time, letting the examination be far enough apart for him to forget, the physician can accept those things that he repent.
The young physician will be misguided by these cases until he has had sufficient experience with disease to know something about the nature of symptoms that ought to appear.
Another obstacle we have in the examination of the case is laziness ; the patient is too lazy to write 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 relate 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 occurred 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 through 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, who 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 considerate 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 that 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 circurnspection 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 neighborhood, 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 human heart, 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 to 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 a man unworthy of respect.
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.
by James Tyler Kent