Konsultan: Mohamed Hatta Abu Bakar, HMD
Dr Samuel HAHNEMANN (1755-1843)
LECTURE 24 : The examination of the patient (continued)
Some symptoms have reference 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, pathognomic 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 givesCina, 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 access to.
Is it a waxy face ?
An avalanche of cases come into mind ; but by a process of rapid exclusion, you say it is not cholera, not hemorrhage, etc., and latterly you come to the cause of this aspect.
You can tell when it is time for cardiac compensation to be broken in Bright's disease ; a peculiar tremulous wavethat belongs to the muscles of the face and neck, a tremulous jerk of the tongue, putting it out 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 who 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 toddy or great exposure, will mask the 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 allect the aspect of the case that the physician cannot prescribe, and the physician who does this meddling must inevitably 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 or be able to get a true image of the sickness by ascertaining all the things that occurred 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, if administered, may yet act, though sometimes it will fail at first because of the confusion, but after waiting a little it will act.
After 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 withThuja ; but then 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 himThuja 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 inconveniences which exhibited themselves previous to the use of the medicines, 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 form 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 ofDivine 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 diseaseper 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, its earlier manifestations, its symptoms and as 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 likeMezereum, and see its violent neuralgias are similar to those of your patient.
The administration ofMezereum cures this neuralgia and brings back the eruption that he had in his babyhood, and he goes on to recovery.
Without getting that view of the old scald head, you would not have thought ofMezereum.
Or, instead ofMezereum, 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 tinder 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 your 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.
Organon § 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 no 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 we 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 to 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 m any 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."
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CD Naskhah Contoh © HBI Health & Homoeopathy Centre 2004