Taking the history of the case. Dr James William Ward

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Taking the history of
the case.
Dr James William Ward
Presented by Sylvain Cazalet

(A Lecture delivered March 3, 1937,
before the San Francisco Homœopathic Post Graduate School.)

Dr J. W. Ward

Before utilizing the
minutes given to me, I want you to have -the joy and thrill, as was
mine, of seeing the actual book that Hahnemann wrote-the pages that he
scanned, certain paragraphs that he crossed out, then replaced by
others, and finally the magnificence of his writing, almost like a steel
engraving. I have, therefore, caused this book to be taken from the
vault in order that you may see it. I do not want it removed from the
desk but one by one you may come up and look at it. Also at the same
time there is an “opportunity to see the jewels” (the several
intaglios of Hahnemann), given by Madam Hahnemann to Dr. C. de
Bœnninghausen ; thence-by way of Drs. Henry N. and Joseph Guernsey
to Dr. W. A. Dewey, in 1928. Subsequently in 1929 they came to me and
thence into the possession of the Homœopathic Foundation of California.
These have been artistically mounted through the generosity of the late
Mrs. Hattie C. Blair, whose gift made possible the beginning of the
Foundation.

The medicine case that
I hold in my hand will be of interest to you as having belonged to the
famous actress Sarah Bernhardt. This was the case she always traveled
with and it is interesting to note that it contains nothing but M’s and
CM’s and the various other higher potencies.

Dr H. N. Guernsey

Dr W. A. Dewey

The study of the Organon
has led us now for the first time to the particular division of taking
the case for homœopathic prescription. Let it first be emphasized that
Hahnemann placed great importance on “Tolle Causam”, which is
easier said than done. How then shall we remove or palliate these
effects of medical substances or disease ? Here Hahnemann steps in
to say for the first time in all history, “remove the effects and
you remove the disease, the cause of the effects”. He now proceeds
to tell the reader what to do, how to take the case, and how to sum up
the information in such a way that the physician can use it for further
study. Therefore in most painstaking terms he mentions his methods. The
details are minute. Hahnemann has given 22 paragraphs to the discussion
of this subject, and he declares in Section 83 that case-taking demands
nothing but “freedom from prejudice and sound sense”,
attention in observing and fidelity in recording the picture of the
disease. Only two things are required-“freedom from prejudice and
sound sense,” all of which are possessed by you doctors.

It is necessary to note
the difference in acute and chronic symptoms of disease. It is easier to
prescribe the indicated remedy for acute disease as the symptoms are
quite characteristic of the drug to be used. Therefore, it is
essentially with chronic disease that we are concerned today. Acute
disease has a natural tendency toward resolution while chronic disease
requires treatment for recovery.

We are interested in
the diagnosis of the correct homœopathic remedies and the discovery of
signs and symptoms through ocular and verbal examination. In the present
study we are concerned in the symptomatology which will lead us to the
required drug, therefore everything pertaining to the patient is
germaine to the subject and adds to the totality of the symptom complex.
We are inclined to think the phrase “symptom complex” is of
recent creation, but Hahnemann uses it in his Organon.
Especially are we interested in the phenomena presented by the patient
of which Hahnemann emphasizes the importance.

It is well to remember
that there are similar remedies, more similar remedies, and the most
similar remedy which is the simillimum of the case. But that which
mostly concerns us means nothing to the general pathologist or
diagnostician. Our interest is centered in specific clinical signs
presented in symptomatology. I do not wish to convey the idea that we
should disregard all that is taught by the history of the case, the
physical signs presented and pathology manifested. Of course, those are
the fundamentals of any physician’s life and he, therefore, uses them to
the highest degree and with the-greatest precision.

Hahnemann tells us that
the symptoms should be taken in an exact way, by writing them down, and
anyone who has not practiced this method knows nothing of the joy of
taking a case accurately and having the subject thoroughly in hand. So
the symptoms should be written down just as the patient details them,
and it is necessary, therefore, that we seek first of all the patient’s
own expression. Let them speak naturally without interruption and obtain
detailed statements. When you come in contact with the patients you will
find that they are automatically placed at ease through your sympathetic
attitude toward their sufferings. Reserve that dignity that belongs to
earnest work, yet maintain a human touch.

We should seek to learn
the lines of heredity, constitutional peculiarities and individual
manifestations as far as possible to get the history of the patient’s
life and that also of the parents. Go into the analysis as deeply as you
can, finding out their habits, ways, of living, bathing, exercise and
sleep. Inquire if the sleep is sound, if it is interrupted, do they feel
refreshed upon awakening, their position during sleep and the character
of their dreams. All of these details are peculiarities of the
individual, in other words, a variety of symptoms relative to their
special case. We must look upon all symptoms as the expression of
suffering organs and it is our purpose to interpret those manifestations
so that they will conform to the picture of the remedy.

I have endeavored in
the reportorial graphic before you to refer to special kinds of
symptoms. On the several charts before you, we have the general and
particular symptoms as the patient expresses them and on still another
chart you will find the modification of the expression in the language
of the repertory, for it is essential to modify the language of the
patient at times and paraphrase it into the language of the repertory.

The physician should be
very careful about leading questions !, i. e.,
questions that have for answers “yes” or “no”.
Particularly is this true when approaching the symptoms of the mind. It
is very important to get the mental complex of the patient ; the
manifestations regarding memory, emotions, disposition, and various
reactions to mental stimuli, reserving that for the last part of the
verbal examination.

The diagnosis of the
drug from the homœopathic standpoint is made up of the characteristic
symptoms that stand out foremost in the individual ; the mental
symptoms ; the various statements that the-patient expresses ;
the observations that the friends or nurses give you ; the
deductions of the physician himself and the modalities of the case These
all are required for the completion of the study. I think we-have a
right to feel that the mental group is rather more important from the
standpoint of prescribing and choosing the remedy than many or nearly
all of the others combined.

These peculiarities are
individual to the patient before you, and therefore are of great value.
Their secret habits that are not open to view, the patient will probably
tell with a great deal of reticence, and then only as you gain his
confidence. Hahnemann lays great stress upon the approach to the bedside
in order to survey the patient’s-mind. Now and then a patient speaks to
you in vague terms. You can do nothing with those expressions.

Early in the lecture I
referred to “Tolle Causam” as essential in all cases. We
realize that unless you remove the cause of the disease you will find it
difficult, in fact almost impossible, to do more than just modify the
symptoms of the patient. Keep constantly in mind the difference between
palliation and cure. Many cases recover ; comparatively few are
cured.

When I was a student I
had a preceptor who had a very move way of expressing himself. His first
instruction to the patient was “put your finger to where you be
bad”. This crude expression carries with it elements of vast value.
The fact that the patient is able to definitely locate his distress is
often suggestive to diagnosis and remedy. Frame your questions in such a
way as to draw your patient out to the point where he explains his
symptoms. Try to take the symptoms of the patient prior to his having
had any treatment, either by a previous doctor, home-prescribing, or any
patent remedy such as aspirin, etc. Having obtained those symptoms, then
get the picture as of the present and you will usually find the
difference represents the drug effects of that which they have been
using. In assuming the care of a patient who has been having home or
other care, Hahnemann says in order to obtain the true picture of the
case suspend all treatment for a time, or give some innocuous
preparation to really made the patient feel something is being done for
the time being. In this manner of dispensing Hahnemann makes clear the
many elements involved in the making up of a prescription.

We are all familiar
with the fact that it takes nine men to make a tailor and it takes
nine specialists to make a physician. We should have the help of all
that there is in the specialists. They are sub-ordinate to this most
important part of taking the case from the standpoint of homœopathic
prescribing.

Hahnemann says there
are some cases that have been maltreated and cannot be cared for
homœopathically. He gives a very important note on page 143 of the
first volume of his “Chronic Diseases,” wherein he refers to
cases of chronic nature having had a plethora of medicine ;
sleepless without drugs ; digestion disturbed and other multiple
disturbances leading to a complete wreck of their lives. Such people he
tells you are doubtfully treated by homœopathic care in as much as they
will not confirm to the necessary particulars for treatment and are
unresponsive to medication. Therefore, do not be over-confident as to
the eventual results.

The examination of the
patient with the view to the prescription can only be accomplished by
eminent patience. It is to the totality of the symptoms that you are
addressing yourself. Totality is only gained by proceeding through
minute detail, as above stated. Hahnemann refers in one of his
paragraphs of the Organon to the
fact that epidemic diseases have a very certain line of symptomatology
which may often be reached by an endemic remedy. Notwithstanding this
fact behind many of those cases is a background which becomes of
infinite importance in study to obtain the final cure of the subjective
morbid phenomena.

On entering the sick
room without asking any definite questions the trained eye observes
certain important features of the case, namely : the appearance of
the bed ; the position of the patient ; color of the
face ; expression of the eye with special reference to the pupil,
and the nervous manifestations. In observation, such as the ore-going,
symptoms of very distinct value are recorded, bearing directly on the
totality of the case.

On the other hand, the
objective symptoms are to be observed, none are revealed. It is
undoubtedly better to postpone all physical examination until after
taking the subjective symptoms. Sometimes this cannot be done with the
third person present in the room. Cause the patient to forget he is
under examination. Painstaking and sympathetic questioning will make the
patient feel he is relating his symptoms to an understanding friend.
This should be the mood and approach to the interrogation of the
attending physician.

To be the successful
doctor one must love sick people in the sense of being interested in
advising and helping them toward recovery. Life is essentially the same
today as in Hahnemann’s time. Our lives should be dedicated to service,
for that truly is the sole purpose of medical attainment, of which the
“highest and only mission is to heal the sick.” Hahnemann
refers to the physician as being calm, dignified, quiet, sympathetic,
cheerful and earnest. It is all those qualities in the physician that
make him preeminently a useful man.

The Organon
goes back to the subject of asking when, how, and where the trouble
began. It reiterates that one should avoid the leading questions and
places great emphasis upon methodical note-taking without hurrying the
patient. If you try to rush a verbal examination it leads to confusion
and contradictory statements. Good prescribing means work, correct
methods of practice and definite interest in the doing. Homœopathic
practitioners will be successful only in proportion as they educate the
public to the principles and practice of Homœopathy. Through this
channel only can we hope for the advancement of our work from the
professional and material points of view. To be successful as
prescribers avoid the pathological idea. By comprehensive
symptomatology, after all the facts have been learned, reportorial study
will determine the indicated remedy. This comprehension involves the
medical, surgical, therapeutic and hygienic features of the case. Every
clinical symptom complex you follow has its counterpart in the materia
medica, the-foundation of which is laid in the accurate taking of the
case.

We must keep our senses
alert, our minds clear, and avoid any pre-conceived ideas about the
patient’s illness. It is necessary to take an analysis of all factors in
the patient’s history just as a laboratory technician does in his
report. For instance, in making an analysis of the sputum the laboratory
notes its color, consistency, and odor. The same is true in the analysis
of a case of diarrhœa, as note is made of the character of the
discharge, color, odor, and modalities before and after the stool. In a
similar way the homœopathic observer with care and detail regards these
symptoms as valuable in the analysis. The individuality of each symptom
adds substantially to the recognition essential for the prescription. In
the analysis of a headache we learn its location, the peculiar character
of pain, whether it is dull, bursting, cutting, drawing, or stitching.
Often, patients require help in describing the nature of the pain. Bear
in mind that their every-day use of descriptive adjectives does not
often coincide with our meaning of medical terms.

Totality means the
related facts having form, coherence and individuality, and it is in
these factors that you are especially concerned. Through the totality
you are seeking a comparative picture in the materia medica. The Organon
specifies that you review each one of the symptoms given by the patient
and enlarge upon it where it is necessary. Accuracy in case-taking is a
true art and that means true science. Several paragraphs of the Organon
refer to the constitutional side or background of the patient. The
knowledge of the past is essential to analyze the present state. Disease
can generally be traced to some latent, deep-seated, underlying chronic,
or inherited tendency. The vastness of the subject is realized only in
keeping with the comprehension of the importance of knowing the
background of the patient’s life. The disease of childhood, with special
reference to vaccination should receive attention. The element of
trauma, with various results dependent thereon is of much importance.

If the patient is
confined to bed you have a much better opportunity to analyze the
symptoms and decipher the type of his emotions. The psychological
analysis adds materially to the complete viewpoint of the illness. In
other words a homœopathic physician should be a psychologist as well as
a symptomatologist. Again Hahnemann was in advance of his time as a
psychologists when he placed emphasis on symptoms of the mind. In
current advances of clinical medicine the conception of illness, and
chance of cure, has changed considerably since modern psychology started
to extend its research into the field of therapy. Psycho-analysis has
made a better understanding not only of mental illness but of the mental
symptoms as am essential part of physical suffering. The resistance of
getting well is modified by frank statements of the patient and favors
the acceptance of the sought –for help. It all means a better human
understanding supported by the full confidence of the patient.

To aid in case-taking a
substantial help is afforded from certain books, namely : Bell on
Diarrhœa Kimball on Gonorrhœa, and Allen on International Fever. These
books are classics and known as models of analysis. For reportorial
study Bœnninghausen’s. Therapeutic Pocket-book, and that still more
complete volume of Kent, are of infinite value.

Now at the conclusion
of the lecture it will be instructive to speak of the sixth edition of
Hahnemann’s Organon, with which you
are more or less familiar. It may be universally acclaimed the Organon
of the Art of Hearing, by Samuel Hahnemann, has revolutionized all
therapeutics of the world. In 1810 the first issue was printed in
Dresden and in 1922, one hundred and twelve years after the first, the
sixth edition appeared in English, Published in Philadelphia. Through
this period of years there have been six genuine and two unauthentic
editions in the German language ; in France and Spain, each nine
edition ; in Italy four edition ; in Russia two ; and in
Hungary, Portugal and Bengal each one. Four edition have appeared in
England and in America Seventeen editions, the last one being a
translation by Dr. Wm. Boericke.

The following story of
acquiring the Organon might prove
interesting. Ever since the death of Hahnemann in 1885, the impression
grew that there was in existence a sixth edition and last word of
Hahnemann. It was believed that at the time of his death he was engaged
in writing this edition. When Dr. Wm. Boericke and I visited Stuttgart
in 1901 we called upon Dr. Haehl to ascertain the authenticity of this
edition. He said he believed such a volume was in existence but had
never seen it and furthermore knew of no one who had ever seen it, as it
was in the possession of a Miss Bœnninghausen (member of a
distinguished family contemporary with Hahnemann) who considered it a
priceless treasure.

Dr W. Boericke

Dr R. Haehl

At my suggestion when
leaving Europe, Dr. Haehl promised to act as intermediary in acquiring
this volume for $1,000, at some future date, if obtainable. After
nineteen years, the day before Hahnemann’s birthday in April 1920, due
to the ravages of war, Miss Bœnninghausen agreed to dispose of the hook
at the above stipulated price, and I was immediately notified. By return
cable the money was forwarded with instructions to Dr. Haehl that it be
carefully packed for shipment via American Railway Express. The book was
considered of such inestimable value that Dr. Boericke went to New York
to receive it directly from the shippers. Twice this manuscript of
Hahnemann’s was in danger of being lost, once during the siege of Paris
in the Franco-Prussian war of 1870-1877, and again in the military
over-running of Westphalia during the World War of 1914-1918.

Later on the American
Institute of Homœopathy instructed Dr. Wm. Boericke to translate it
into English and have it published by Boericke and Tafel. Fortunately
Dr. Haehl took the precaution of having a copy made of this volume, from
which the German version was produced. This sixth edition, and the last
of the American, is preeminently a masterful work on the part of Dr. Wm.
Boericke. Hahnemann’s German as expressed was much involved, requiring
unusual ability in its translation. To Dr. Boericke must be given the
credit of producing a classical translation of Hahnemann’s Organon,
which together with its Materia Medica are the two greatest gifts of the
homœopathic school to the world.

Source :

Pacific Coast Journal of Homœopathy,
July 1937.

Copyright ©
Sylvain Cazalet 2001

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