|
§ 91
The symptoms
and feelings of the patient during a previous course of medicine
do not furnish the pure picture of the disease; but on the other
hand, those symptoms and ailments which he suffered from before
the use of the medicines, or after they had been discontinued for
several days, give the true fundamental idea of the original form
of the disease, and these especially the physician must take note
of. When the disease is of a chronic character, and the patient
has been taking medicine up to the time he is seen, the physician
may with advantage leave him some days quite without medicine, or
in the meantime administer something of an unmedicinal nature and
defer to a subsequent period the more precise scrutiny of the morbid
symptoms, in order to be able to grasp in their purity the permanent
uncontaminated symptoms of the old affection and to form a faithful
picture of the disease.
§ 92
But if
it be a disease of a rapid course, and if its serious character
admit of no delay, the physician must content himself with observing
the morbid condition, altered though it may be by medicines, if
he cannot ascertain what symptoms were present before the employment
of the medicines, - in order that he may at least form a just apprehension
of the complete picture of the disease in its actual condition,
that is to say, of the conjoint malady formed by the medicinal and
original diseases, which from the use of inappropriate drugs is
generally more serious and dangerous than was the original disease,
and hence demands prompt and efficient aid; and by thus tracing
out the complete picture of the disease he will be enabled to combat
it with a suitable homoeopathic remedy, so that the patient shall
not fall a sacrifice to the injurious drugs he was swallowed.
§ 93
If the
disease has been brought on a short time or, in the case of a chronic
affection, a considerable time previously, by some obvious cause,
then the patient - or his friends when questioned privately - will
mention it either spontaneously or when carefully interrogated.1
1 Any causes of
a disgraceful character, which the patient or his friends do not
like to confess, at least not voluntarily, the physician must endeavor
to elicit by skilfully framing his questions, or by private information.
To these belong poisoning or attempted suicide, onanism, indulgence
in ordinary or unnatural debauchery, excess in wine, cordials, punch
and other ardent beverages, or coffee, - over-indulgence in eating
generally, or in some particular food of a hurtful character, -
infection with venereal disease or itch, unfortunate love, jealousy,
domestic infelicity, worry, grief on account of some family misfortune,
ill-usage, balked revenge, injured pride, embarrassment of a pecuniary
nature, superstitious fear, - hunger, - or an imperfection in the
private parts, a rupture, a prolapse, and so forth.
§ 94
While
inquiring into the state of chronic disease, the particular circumstances
of the patient with regard to his ordinary occupations, his usual
mode of living and diet, his domestic situation, and so forth, must
be well considered and scrutinized, to ascertain what there is in
them that may tend to produce or to maintain disease, in order that
by their removal the recovery may by prompted.1
1 In chronic diseases
of females it is specially necessary to pay attention to pregnancy,
sterility, sexual desire, accouchements, miscarriages, suckling,
and the state of the menstrual discharge. With respect to the last-named
more particularly, we should not neglect to ascertain if it recurs
at too short intervals, or is delayed beyond the proper time, how
many days it lasts, whether its flow is continuous or interrupted,
what is its general quality, how dark is its color, whether there
is leucorrhoea before its appearance or after its termination, but
especially by what bodily or mental ailments, what sensations and
pains, it is preceded, accompanied or followed; if there is leucorrhoea,
what is its nature, what sensations attend its flow, in what quantity
it is, and what are the conditions and occasions under which it
occurs?
§ 95
In chronic
disease the investigation of the signs of disease above mentioned,
and of all others, must be pursued as carefully and circumstantially
as possible, and the most minute peculiarities must be attended
to, partly because in these diseases they are the most characteristic
and least resemble those of acute diseases, and if a cure is to
be affected they cannot be too accurately noted; partly because
the patients become so used to their long sufferings that they pay
little or no heed to the lesser accessory symptoms, which are often
very pregnant with meaning (characteristic) - often very useful
in determining the choice of the remedy - and regard them almost
as a necessary part of their condition, almost as health, the real
feeling of which they have well-nigh forgotten in the sometimes
fifteen or twenty years of suffering, and they can scarcely bring
themselves to believe that these accessory symptoms, these greater
or less deviations from the healthy state, can have any connection
with their principal malady.
§ 96
Besides
this, patients themselves differ so much in their dispositions,
that some, especially the so-called hypochondriacs and other persons
of great sensitiveness and impatient of suffering, portray their
symptoms in too vivid colors and, in order to induce the physician
to give them relief, describe their ailments in exaggerated expression.1
1 A pure fabrication
of symptoms and sufferings will never be met with in hypochondriacs,
even in the most impatient of them - a comparison of the sufferings
they complain of at various times when the physician gives them
nothing at all, or something quite unmedical, proves this plainly;
- but we must deduct something from their exaggeration, at all events
ascribe the strong character of their expressions to their expressions
when talking of their ailments becomes of itself an important symptom
in the list of features of which the portrait of the disease is
composed. The case is different with insane persons and rascally
feigners of disease.
§ 97
Other
individuals of an opposite character, however, partly from indolence,
partly from false modesty, partly from a kind of mildness of disposition
or weakness of mind, refrain from mentioning a number of their symptoms,
describe them in vague terms, or allege some of them to be of no
consequence.
§ 98
Now,
as certainly as we should listen particularly to the patient’s description
of his sufferings and sensations, and attach credence especially
to his own expressions wherewith he endeavors to make us understand
his ailments - because in the mouths of his friends and attendants
they are usually altered and erroneously stated, - so certainly,
on the other hand, in all diseases, but especially in the chronic
ones, the investigation of the true, complete picture and its peculiarities
demands especial circumspection, tact, knowledge of human nature,
caution in conducting the inquiry and patience in an eminent degree.
§ 99
On the
whole, the investigation of acute diseases, or of such as have existed
but a short time, is much the easiest for the physician, because
all the phenomena and deviations from the health that has been put
recently lost are still fresh in the memory of the patient and his
friends, still continue to be novel and striking. The physician
certainly requires to know everything in such cases also; but he
has much less to inquire into; they are for the most part spontaneously
detailed to him.
§ 100
In investigating
the totality of the symptoms of epidemic and sporadic diseases it
is quite immaterial whether or not something similar has ever appeared
in the world before under the same or any other name. The novelty
or peculiarity of a disease of that kind makes no difference either
in the mode of examining or of treating it, as the physician must
any way regard to pure picture of every prevailing disease as if
it were something new and unknown, and investigate it thoroughly
for itself, if he desire to practice medicine in a real and radical
manner, never substituting conjecture for actual observation, never
taking for granted that the case of disease before him is already
wholly or partially known, but always carefully examining it in
all its phases; and this mode of procedure is all the more requisite
in such cases, as a careful examination will show that every prevailing
disease is in many respects a phenomenon of a unique character,
differing vastly from all previous epidemics, to which certain names
have been falsely applied - with the exception of those epidemics
resulting from a contagious principle that always remains the same,
such as smallpox, measles, etc.
|