EXAMINATION OF THE PATIENT

P.P. WELLS, M.D.

(H.H. VOL. V. 4/1980)

         The first duty of the healer is to ascertain what there is in the present  in the condition of the patient, which he is expected to cure; to acquaint himself thoroughly with all the facts of the case, with all their concomitants.  This duty is not only first in the order of proceeding.  It is a sine qua non in every case of specific (i.e. homœopathic) prescribing.  Till this knowledge is obtained, no other step can be taken, as all other and subsequent steps are based on this.  It is this knowledge of the facts of the case which enable the prescriber to proceed from these to his Materia Medica to find the similimum to the facts of the sickness.

        In the two schools of medicine of today, this first duty is equally recognized as paramount.  But there is this radical difference in the views of the two as to their reasons for this.  To the one it only suggests a name for his case; to the other the points gathered are indices pointing to the curing agent.  The one ceases inquiring when he has gathered sufficient facts to justify his name, however few these may be.  As opposed to this, the other school cannot stop inquiries till all the facts are brought out, because if any part be omitted from the record, it may be that in this omission are the facts most important in the diagnosis of the remedy.  At this point, in this first and paramount duty, we have the two schools as far apart from each other as possible.  The one investigates for a name, the other for a curative.  The one is content with few facts, if these justify his name; the other must have all, because all are necessary to determine the remedy for the case.  This necessity is one of the underlying principles of the philosophy of specific medicine, and without  this no practical superstructure founded on law can be raised.  The elements, and all the elements, of the sick condition must be known before any other step can be taken for its cure.

         We have said, gaining this knowledge is the first duty of the practical healer.  We add, it is the most difficult of execution; and this difficulty is only equalled by its importance.  All in specific healing depends for its successful issue on the faithfulness and thoroughness with which this duty is performed.  The difficulty and importance of this duty are so great that no care or labour devoted to it can exceed the demands true philosophy and intelligent conscience make for these in its discharge.  These are so great that no margin is found here for haste, carelessness or indolence.  Nothing can be left to chance, haphazard or guessing.  The difficulty can only be overcome by endeavours guided and controlled by the most perfect and orderly system of procedure.   Systematic is the word which should characterize these endeavours from the beginning to the end.  This necessitates a plan of procedure at the beginning which shall endure the survey of the whole field of symptomatic facts.  HAHNEMANN gave in his Organon a sketch of such plan which no subsequent teacher has supplanted or greatly improved.

         The systematic plan of procedure for the discovery of the facts of sickness which, under the guidance of law, discloses the true curative, first observes all which is perceptible to the prescriber to the appearance, manner, and action of the patient.  If in bed – his position; is he quiet or restless; does he change his position often, or does he avoid all motion; his respiration is it hurried, or normal in frequency; is it in due symmetry with the frequency of the pulse, and in the duration of inspiration and expiration?  The expression of the outlook – is it tranquil, excited or desponding; or what, if any, is the change from that which is natural to the patient.  The eyes – are they bright and sparkling or dull; are they injected or clear; are the lids swollen or natural; is the face pale or red, or neither; is it hot or cold, wet, damp or dry.  The general surface – is it hot, warm or cold, perspiring or dry; if there be eruption – of what kind, not how has it been named, but how does it look, what are the morbid phenomena attending it; the name is of no consequence to the prescriber in the duty he is now engaged in.  The voice and spirit – how are these affected, if at all; and what if any, are the modifications of their character.  The moral and intellectual functions are to be noted as all aberrations from their normal state.  Has the disposition become, since the sickness, querulous, angry, complaining, easily taking offence, weeping, or sad, as it was not before?  The intellect – is it more active or dull than has been its wont; and its perceptions and judgements clear and normal, or are these under the false impressions of delirium?  If so, what is the form the aberration assumes?  Is the delirium mild or violent, talkative or reticent; is the speech clear and distinct, or is the enunciation imperfect; are answers given promptly or are they delayed and low, or are the answers refused; is the imagination vivified by visions which have existence nowhere else; does this delusion talk to, or reach out to imaginary objects in the air?  In short, whatever in intellect or disposition which is a departure from the natural state of the sick one is a necessary part of the case to be examined into, and is to be, in exactness, a part of the equation in every homœopathic prescription, which solves the problem of a cure when it has found in the Materia Medica record the counterpart of the recorded facts of the sickness to be cured.  In this record, the aberrations of intellect and disposition are to have a conspicuous place and careful consideration, before the solution of the specific remedy is decided.

         When the perceptible phenomena of the case have been recorded, and not before, then the prescriber will listen to the history of the case, from the patient first, if possible, and then from the friends, if they have additional facts to contribute.  Never allow the two to talk at the same time, or either to create confusion by interrupting or correcting the statements of the other.  If the case in hand be a chronic disease, it may be necessary to carry the inquiry into the history of the case back into that of the patients’ ancestors, in the endeavour to reach a knowledge of the true origin and character of the case.  For example: What diseases have been prevalent in the family of the patient?  What were the sicknesses which have carried off those who have passed away, if there have been deaths of relatives.  Some diseases are transmitted from parents and grandparents to their children, and the like proclivity to certain forms of sickness are found in individuals of a common ancestry and the clue which leads the true healer to a knowledge of his similimum is not seldom found in the health history of some progenitor of the patient.  In pursuing this inquiry, it should be kept in mind that inherited sicknesses often pass the first generation of descent to reveal themselves in the second, or, perhaps in one even more remote from the original sufferer.  The true healer will therefore be very careful and persistent in his inquiries into the origin in the remotest ancestry, if need be, of the chronic case he is to treat.

         It may be not necessary to carry the inquiry into the history of the uncomplicated acute cases into that of the patient’s ancestry.  But in cases complicated with the action of aroused chronic Miasms it may be of the utmost importance to do so.  Cases are met sometimes where the clue to their similimum is only found in this inquiry.   This is followed up, and not unfrequently the cure of the acute attack and of its complicating Miasm may be found in the same remedy.

         In uncomplicated cases, the inquiry may begin at the first element of the sickness which the patient or friends noticed as the initiatory of the attack.  What were the circumstances and conditions in which this appeared and the modalities which accompanied it?  And the same inquiries are to be made as to each of the succeeding elements, as also to the order of time in which they appeared, till a knowledge of all is gained.

         The questioning of the history being completed, that of the aberrations of functions in the sick case may begin.  And here systematic procedure is indispensable to the required thoroughness and accuracy of the inquiry.  This must have a beginning, middle and end, and all between must be surveyed, that no fault of function may escape detection.  Each aberration is to be questioned as to time of appearance, circumstance and condition attending this, and with the modality which have accompanied its history with especial reference to all causes, conditions and circumstances which aggravate or relieve suffering.

         With this plan of procedure, where shall we begin?  There is no better order for the prosecution of this plan than that of the scheme adopted for the record of the Materia Medica.  This begins at the head and from this follows a natural anatomical arrangement or succession to the end.

         The mental and moral symptoms which we have noticed under the divisions of objectives phenomena may perhaps as well or better, have their place here with the other brain symptoms.  After these, the pains or heat, whatever of abnormal sensations may be present in the head, as Vertigo, throbbing; noise as the chirping of insects, etc.; fullness, tension, etc.  The pains are to be questioned as to the kind and exact location of each.  Then the phenomena of the scalp, if any are to be noted.  Then the organs of the special senses, both as to function and change in appearance or tissue.  The face as to colour, expression, or pains.  The mouth and throat, including teeth and tongue, as to appearances which are abnormal, and pains or unnatural sensations, together with whatever modifications there may be of speech, as difficulty or fluency, hoarseness, or shrillness, or total loss; of taste as sweet, bitter, sour, or a total loss, or diminished or exalted state of this function.  Then of the digestive function – note all abnormalities as to appetite, thirst, and aversions as to various articles of food and drink; all pains or morbid sensations developed during the process of digestion; all eructations, regurgitations, nausea and vomitings connected with the food or drink or which particular articles of these.  Then pains or quantity, frequency of calls to discharge this or the reverse, colour, odour, sediment; the sensations while passing the water, their character and location, whether in the vesica or urethra.

         The sexual organs and functions are to be questioned as to integrity of tissue and normality of function.

         The respiratory organs and air passages are to be investigated as to pains and abnormalities of function.  The respiratory act – are inspiration and expiration in symmetrical proportion?  Is this performed chiefly by the diaphragm or the intercostals muscles, or by both?  Is it accompanied by pain, and if so, what is its character and location?  Auscultation and percussion, though of value chiefly to diagnosis and prognosis, are not wholly useless to therapeutics.  For example, in Pneumonia, if these disclose the fibrinous exudation or that process already accomplished, certain remedies are excluded from the treatment, being no longer curative of this inflammation after it has passed this process, no mater what other symptoms there may be.  If there be cough – what is its character.  Is it dry or loose, with or without expectoration.  If with, what is its character, and is raised with ease or difficulty?  Is the cough seldom or frequent or constant?  Is it short and slight or violent and in protracted paroxysm?  What are its conditions and concomitants?

         The exterior conformation of the chest – are the two sides in symmetrical development?  Are the sub-clavicular spaces rounded out or hollow?  Are the intercostals spaces distended or normal?  Are there pains – if so, what is the character and location of them?  Are they increased or unaffected by respiratory or other motions?

         The spinal column is to be questioned as to deviations from normal structure, as to pains, if there be any, as to their exact character and location, and conditions of aggravation and relief.  If there be any other abnormal sensations, as sense of heat or cold, these are to be carefully noted.

         The extremities are to be questioned as to whatever of pains or embarrassments or loss of motion.

         The skin – as to eruptions or modifications of the transpiratory function, temperature etc.

         Sleep, - sleepiness – sleeplessness, with causes and concomitants.  Dreams, as to their character.

         Febrile phenomena, as to time of accession, and concomitants.  The symmetry of the elements of the paroxysm, or the predominance or absence of either.

         The general phenomena, as to temperament, disposition to take cold, or to be especially affected by any particular cause of sickness, or habits of body which predispose to any particular forms of sickness, as for example, Rheumatism, Neuralgia, or spasms of any kind, causes which aggravate or relieve general pains or sufferings, the special character of general pains, as pressing, burning, boring, drawing, shooting, fixed etc.  The period of exacerbation.  Acuteness, dullness, or loss or general sensation or whatever change there may be in this function.  How are general phenomena affected by change of air, i.e., in the open air or in a room?  How by motion or repose?  How by eating, drinking, sleeping, or by the performance of any bodily function?  Wherever of sick phenomena which are dependent for existence on the change of function or no particular organ.  And these general phenomena are not to be overlooked, overshadowed, obscured, or their importance underestimated, because some particular local suffering or derangement of some particular function has chiefly had the patient or his friends had has by them regarded as the object of the prescriber’s attention.  To relieve the suffering of patients is, of course, one objective of the physician’s endeavours of great importance, but as indicia pointing to the means which most certainly and speedily relieve these the greatest pains are not always the most important.  On the contrary, these are not unfrequently found in the general symptoms, where they are so easily overlooked.

         Having by this process of examination of functions and general phenomena gathered the requisite “totality of the symptoms” of a case, how shall we proceed, through them, to find out specific curative?  There are two methods practiced by doctors who equally claim to be recognized as practitioners of specific medicine.  One is to infer from the gathered facts a certain general condition of the patient or of certain of his organs or of their functions and having some regard to the Law of Similars, infer that a certain drug or drugs produce similar conditions, and therefore this, or these are the similar agent or agents the law requires for the cure.  This inferred or imagined condition of the patient this doctor calls the Pathology of his case, and having proceeded thus far on the basis of the totality, he is fully satisfied he has fulfilled the duties of a specific and scientific practice.  The truth is, in all this, the prescriber has given in this proceeding so much to guessing as demonstrates his falsehood as to loyalty to specific medicines.  This is wrong method.

         The right differs from this in that it takes this whole group of facts, clean and naked, stripped of all theory and influence, and goes to the Materia Medica record for the most similar group, in the recorded Proving of some one drug.  This found and given as the law demands, all has been done for the cure of any curable case.  This is what it is to practice, in a word with the homœopathic law.

DISCUSSION

Dr. GEE: A paper of practical importance.  As the doctor said in the beginning, an article on the same subject is found in DUNHAM’s Therapeutics but not going into the details as fully and deeply as Dr. WELLS has and certainly a paper of this sort on our desks in the shape of  a slip or card would be a very great help to all of us, as we are apt to overlook some things perhaps in the order of questioning.  One thing in Dr. WELLS’ paper occurred to me which perhaps needs a little explanation, and that was his allusion to the excellent remedies in Pneumonia.  I don’t know that we can draw a line that is distinctly marked and say that after the exudation has taken place any remedy or set of remedies may not be indicated.  I can see that a nervous disturbance calling for a remedy – just as the key of a lock – that remedy may be called upon.  I can hardly see that we can exclude a remedy without some explanation.  Perhaps the doctor did not make it as clear as he could.

Dr. WELLS:  That point was put down understandingly, and to illustrate, I would state that after the deposite of fibrin has taken place, Aconite  is never indicated, and never has been since the world was made; it is of no use and never will be.  Meeting the points suggested by Dr. GEE, of nervous symptoms calling for a remedy: Now these are best met by remedies which are related to these symptoms, and conditions of this stage of Pneumonia which is revealed by auscultation and percussion.  These revelations are symptoms which it is not wise to overlook or neglect.  The remedies which are so powerful and beneficient in the first stage, i.e., that of the deposit into the lung tissue of the inflammatory product, are now no longer in place, and if their use be longer persisted in, the result will often be pernicious and always attended by loss of time.  It may be we sometimes restrict the meaning of the word symptom or symptoms to too  narrow limits.  Objective symptoms are facts equally with subjective, in which class are found the relations of auscultation and percussion, which, in best treatment of Pneumonia, are never neglected.

Dr. GEE: It seems to me he is misunderstood; that borders very closely on pathological prescribing.  We do know that patients suffering from Pneumonia  have a nervous anxiety, an anxiety that will be indicated by the expression on the face; the heart will show weakness.  Such a condition might indicate Aconite, and if so, I would certainly give it.

Dr. WELLS:  I think  the only difference between my friend Dr. GEE and myself is that I am attempting to take in the whole view of the case and he seems to take in only a part, and that seems to me the difference.  Aconite seeming to be indicated has led me into that blunder a hundred times, and a hundred times has led me to disappointment.  But to find a remedy necessary for these new accessory symptoms, you must secure a remedy for them, and it is better to secure it at one stroke, than to go around the corner for it.

Dr. KENT:  Take a case of Pneumonia that has advanced to the stage of exudation and let that patient get a little cold sufficient to arouse him to a state of mental anxiety.  With a superficial examination you will find Aconite indicated, but just as sure as you give it you will fail.  Give Sulphur at once and you will cure your patient.  Never mind the fact that Aconite has the superficial show, I say in ninety nine cases out of one hundred give Sulphur.  When I first commenced to prescribe I gave Aconite and I never had anything but failure, and have been disappointed many times by giving it.

Dr. ALLEN:  Do you prescribe Sulphur in the second stage, or rather in the exudative stage, when the patient has taken a little cold and become nervous under those conditions?

Dr. KENT:  No, sir.

Dr. NASH:  If the Aconite  symptoms are present, are we taught anywhere to ignore them and base our prescriptions on the fact that the disease has passed to the second stage?  I think not.  I think, as Dr. WELLS says that we will very seldom find indications for Aconite there, and that we should look further.  It may be Sulphur, as Sulphur is a remedy used in the exudative stage.  So we must ignore Aconite  and look further, and we will find wherein our failure arose, and that this very superficial examination that seemed to indicate Aconite we will find covered up.  It is a fact that many patients that come into our offices can be prescribed for at once.  A patient may have eaten too much ice cream, and we know at once the cause of their trouble, and we know in a short examination what they require, and we can prescribe for them very quickly. That was a peculiarity of Dr. LIPPE; he could take in a case quickly.  When we have chronic cases and we find the case cropping out again after we have thought we had cured it, when it is absolutely necessary that we must go through this very process that the Doctor has been describing.  One of the best rules I have found is one that HAHNEMANN gave for examining a patient and that is, “Never ask the patient a question that can be answered yes or no,” because if we undertake to obtain the picture and ask questions, such as, “Have you a pain in the head?” especially of a nervous person, they always have it, and you could ask them if they had a pain almost anywhere and they always have it.  But if I call on them to tell their symptoms in their own language, and not allow them to answer yes or no, I have found it a very great help.

Dr. HOLMES:  Now the question, the examination of the patient is a point that I must confess I am a little lame on.  The great trouble in my mind is how are you going to find time to do this.  Supposing a man has afternoon office hours of only two hours duration or an evening hour of one hour duration, and in that time crowds in 12, 15 or 20 patients, and perhaps out of that number there are two, three or five patients that need just such an examination?  To me it has been impossible to do it.  I am not, like Dr. LIPPE,  a flash prescriber.  Another thing, we do not get paid so well where I come from for that work.  Say we get 50 cents for that work and it takes the whole time to examine the patient and we cannot give the time and attention to other patients these are waiting.

The President:  It is that the time required for first examinations seems excessively long; but the older we grow and the more chronic cases we have to deal with, the more positive we are that the time spent in the first examination is the best spent time.  HAHNEMANN tells us that when the first examination is well made, two-thirds of the work is done.  It is unfortunate that anyone who represents so fine and so beautiful a profession as Homœopathy should be placed under conditions where such poor compensation is received as most of us do receive and particularly the younger members of the profession.  To many it is matter of bread and butter, of course, but there is a higher motive than bread and butter, and that is to learn how to do that thing correctly; improve yourself and get yourselves in positions where you can become so proficient as to command proper compensation for your work.  My advice to the young men is not to slight your chronic cases, but rather say to your patients, if you are pushed for time, come to me on Sunday morning and I will give you an hour or more, even if you pay me nothing for it, and if I find the remedy and I cure you that will be compensation enough for me.  I once saw my father, who was in a very great hurry to go somewhere, when a young man, thin and lank came to him and said: “Doctor, I want to see you.”  My father replied, “I have no time now; you must come again.”  “But I want you to attend to my eyes right away; I have some very sore eyes here, and I want them attended to.”

         “How long have you had them?”

         “Only a week”.

         “Let me look at them a moment,” and with a rapidity that was perfectly marvellous, my father told him what was the matter with him.  The young man had symptoms and my father showered them on him, and they suited so well that this man stood in consternation and said, “Who told you all about me?”  That was artistic.  He cut that thing short.  Of course it was the wrong way to do it; but it was the way he did it at that time.    He did not ask that man, have you got this and that, but he said you have got that; you are worse in the morning; you are cross, irascible – a cross fellow – and he said I will give a powder, and he gave him Nux vomica.  Of course it was the wrong way to do it.  I do not recommend that to you; I only wish to cite that instance of a person who knows a remedy that is Materia Medica and how he can get quickly at a set of questions without making direct questions that will cut short an  examination very much; and, as HAHNEMANN once said – he never printed – show me the examination of  sick person and I will tell you if the man knows anything about Materia Medica.

Dr. BIEGLER:  I would like to add a word or two.  The manner in which Dr. WELLS has given us this outline to do our work by, is invaluable to all, but especially to the young men, if they, the young men, will take this as a foundation for their work, I will guarantee that it will not be very long before their fees will be largely increased, and that almost voluntarily.  The first prescription made right, based upon the foundation of work, and he can afterward sleep and remain quiet with his conscience and his mind will be quiet also.

Dr. WELLS:  I want to say to this young man (referring to Dr. HOLMES) and every young man; get no more work than you can do well.  Do it well and take time enough for it.

Dr. NASH:  And charge enough for it.

Dr. WELLS:  There is always time to do work well.

Dr. ALLEN:  I think that Dr. HOLMES  has struck a very vital point.  It is certainly a puzzling point to a young man.  My attention has been very forcibly called to this very point within the past month by a conversation I had with a professor of Materia Medica in one of your homœopathic colleges.  A couple of years ago I endeavoured to show him by a long and entertaining correspondence, based upon a case already reported in a medical journal, that there was a better way than he was doing, and he appeared to be a willing and apt student to learn this better way.  A month since I met him at a state society and, after a conversation, he says, “I have faithfully tried HAHNEMANN’s method of taking the case, and it won’t do for me.  It takes too long; it takes up too much time; it don’t pay.  It may do for somebody else, but it don’t do for me.”  Now that question that Dr. HOLMES put is right to the point, and we must get over it somehow and in some way, and I do not know of any better way than that which Dr. WELLS suggests, and that is, that there is always time to do work well, and if Dr. HOLMES will turn over a new leaf, and instead of taking ten patients an hour, will cut it down to one or two, and charge them properly, he will have more to do and make more money, and learn his Materia Medica faster.

Dr. STOW:  It does pay to be careful and as accurate as it is possible for a human being to be in the examination of, and in the prescribing for, the sick.  There is this thing in it, if nothing more, if at first you expend much time and get small pay and perhaps lose some because you take so much time, depend upon it, that the experience you get in looking carefully into the case will make you so expert that you can take care of twice or thrice the number of cases in a very short space of time, and the public will find it out too.  That is one great fact that should be instilled in the minds of all that have doubts in adhering to HAHNEMANN’s rules.  I believe it, because I have seen it verified in my own practice time and time again, and I am satisfied that the little success I have had in the practice of Homœopathy has been due to the very fact that where an important case comes in that I so not see into at first sight, I take my pen and paper and record everything about the case – every symptom.

Dr. BALLARD:  The question which Dr. HOLMES puts is a vital one, and it has not been answered satisfactorily to the side of the bread that has the butter on.  But I have worked that way and I have worked the other way and I find that the other way is the shortest way after all.   I had a case of neuralgia of a lady, situated on the left side of the face, and I made an examination for the case as it presented itself and this case too will sustain Dr. WELLS in his Aconite business.  I went carefully over it all externally and I prescribed for it, and so I went day after day, day after day.  I worked over it for two months.  I went over these symptoms - all skin deep.  Her friends were all the time telling her why not take Morphine.  As for that, I told her that if she resorted to Morphine she would likely become a chronic sufferer; it would not cure.  Finally I went to see her one evening and said: “There is something about your case I have not found out yet, and I want to find it out.”  She could not tell me anything.  I went into her history – her private history.  She was a widow, and I asked her something about her husband, and I learned that he had been a sea-faring man.  I asked her if she had ever had any eruptions of any kind, and she said no.  I then went from scalp to her feet over and over.  I examined her finger nails, the hands, the palms of the hands, and I saw three little spots there, and I said how long have they been there and she said, I don’t know; but I have had them a good many years: she then said that skin seems to get dead and peel off.  I gave her a dose of Thuja.  She had a paroxysm in a little while, the worst she had had.  Suffice it to say these paroxysms became less and she would suffer at longer intervals, so that within a week she was alright.  She then complained of a sore throat, and on examination I found on the inside of each tonsil as pretty a picture of a chancre as a man ever saw.  Two months were thus wasted in trying to cure that neuralgia because I did not spend the proper time in the first place,

Another case:  I was called in to see a child.  The child lies in its cradle.  If you step up to it, it snaps.  The skin is hot and dry, but not harsh.  The child did not want to be spoken to.  It had no wants for anything, only to be rocked.  The cradle must be kept in constant motion.  The child would once in a while rise up in that way.  I gave Cina expecting in 24 hours the case would be well.  The symptom remained.  I gave Cina higher, the symptoms all the time continued.  The child must be kept in violent motion, i.e., rocking.  But these same Cina symptoms became more prominent all the time.  The trouble was at the first prescription.  I did not properly take my case.  I prescribed what seemed to be indicated superficially.  My Cina having failed me I go back and find I have a patient fourteen or sixteen months old that never walked; is fair and plump.   How has the child’s health been?  I went back to the very beginning, learned the peculiarities of the child in every way; that if the child could get on egg she would eat it; some months before had blisters on the body, which coalesced in a large ulcer.  I said: “How have the child’s head and ears been?”  “Oh, soon after that it had a discharge from both ears,”  “Did the doctors cure that?”  “Oh, yes; injected Carbolic acid and that cured him”.  Now we have the case.  The tubercular meningitis which is presenting itself, is but the suppression of disease.  I gave Calcarea which restored the discharge from that child’s ears, and with that the amelioration of the brain symptoms, and that was all that was required and the child was cured.

         These cases simply illustrate what Dr. WELLS says, that you may have a case which at your first seeing your Aconite is indicated.  But stop!  You mind there is something that says, “Don’t give Aconite”; there is something else needed.  Look deeper and you will find it.

Dr. HAWLEY:  I have one suggestion to make to young men.  You should learn in the first place that your patient is not going to die in minutes and if you can’t get your case through today give him some Sac lac., take his fifty cents and have him come again.

Dr. WELLS:  To any young man in the room I would say, I know a young man once who began as others do to try and practice Homœopathy: he did not know anything about it; he had only the Organon and Materia Medicato rely on.  I have known that young man to study cases a fortnight, and then he would cure them.  Take the time, stick to it, and then you will cure.

Dr. ALLEN: I want to make one suggestion, or rather a confession.  I have been in Dr. HOLMES’ boat, and I know just how he feels.  I believe that all that have practiced ten years can testify to this, that nearly every blunder we have made has been in this taking of the case.  For a number of years I have learned to do just what Dr. HAWLEY  says, prescribe if you must, but give them Sac Lac. and give them positive directions about taking it,  and tell them to come next day, and the next day, until you are sure of your case, and then prescribe.

Dr. BALLARD:  I have done that for a month.

Dr. ALLEN:  I began with intermittent fever in that way.  It pays infinitely better to do it than it does to make a chance prescription that is more likely to miss than to hit.  A short time since a gentleman from Central Michigan wrote me a long picture of his case.  I asked for more particulars, and another long letter came, and still I was not satisfied, and I asked for more particulars.  The characteristic symptoms were these; when walking in the house, on the street, on his farm or anywhere, suddenly as though struck by a hammer or by a club, would be a blow on the right side of his head, that would always throw him to the left.  The remedy I sent him did not cure him.  I then wrote to him to come down and see me (he lived some 200 miles away), which he did, and I spent one-half day with him to the neglect of my other patients; but I got what I thought was the picture of his case.  I finally found it in Tabacum, and the two doses of Tobacco 200^th has made a very different man of him.

Dr. WELLS:  Next to the importance of taking the case and the selection of the right remedy comes the right use of it.  Now I told some one I was not coming here again, but if I do, I will bring a paper on the right use of the remedy.  I want to say now that I have not half learned that lesson.  It has been the most difficult lesson of my life.  You remember a year ago, when we were down at Long Branch, we went into the discussion of the treatment of suppressed Gonorrhoea.  I had a young man come to me about three months ago and he came in with a cane, limping, and he could just step and that was all.  He had pains in his feet and ankles and he could not walk, and he had been under what was considered homœopathic treatment for two years.  He had taken Bryonia and Rhus, and was no better.   I had a suspicion about that young man, so I asked him a plain question, and he said, “yes”.  I gave him three months ago one dose of Thuja 200 and I have given him nothing since but sugar of milk and he is cured.  He got that one dose and no more, and the secret was in letting that dose alone.

The President:  Was there any reappearance of the original symptoms in that case?

Dr. WELLS:  There was a return of moderate urethral discharge.

Dr. BALLARD:  You may remember at Long Branch last year, that Dr. GEE called on me for a case I had under treatment, and I said it was improving under a single dose of Psorinum.  That man has never had but that one dose and he is a well man.

[Courtesy:   Medical Advance, 1888]