[ Read before the Bureau of Homoeopathy, I.H.A., June 20, 1951].
A.H. GRIMMER, M.D.
When a case has been fully and properly taken it is time to evaluate the symptoms in the order of their importance. Prior to such an appraisal, the taking of the case, the manner and method employed to obtain the symptoms of case, is most vital in importance. Symptoms obtained without the Hahnemannian technique are of doubtful value and may be false and misleading. Any and all given symptoms must represent a statement of facts; and these facts must be brought fort after the manner of judicial procedure.
The patient tells his story without interruption, unless he is loquacious and wandering, when he must be carefully guided to his task with an indirect line of questioning by the physician. Direct questions tend to suggest and the patient may answer without sufficient thought. Any question answered by “Yes” or “No” is of doubtful value to the homoeopath.
Sometimes the physician may be compelled to ask three or four indirect questions to ascertain the verity or sureness of one symptoms. To illustrate: in order to know to what temperature group the patient belongs the physician will ask, “How sensitive to cold are you? How are you affected by a hot room? how does the suns heat affect you? How much clothing do you require to keep warm?
How are you affected by changes in the weather? What can you say about the temperature of your hands and feet?” In this way the physician can with certainty ascertain to which group his patient belongs. Is he a cold patient with deficient vital heat, or is he warm blooded and made worse by over heating, or is he one who is sensitive to both extremes of temperature?.
The mental and emotional symptoms may be obtained in a similar way: “How easily moved to tears are your? How does music affect you? How does noise or light affect you? How does darkness affect you? How restless are you? What can you say of your memory?” Thus, when symptoms are obtained this way they are genuine and reliable and constitute facts which can be fitted to the facts of the Materia Medica.
When the symptoms of a case history are obtained properly, then the physician may begin to appraise and weight the relative value of the symptoms for the selection of the homoeopathic remedy.
The writer has followed the general outline for the grading and evaluating of symptoms devised by Dr. James Tyler Kent and has found that method logical and concise and most helpful in the selection of the needed remedy.
In that plan there are three classes of symptoms as follows: General, which relate to the patient as a whole, such as his bodily reaction to environment, his mental and emotional states, his aversions and desires, his body secretions and discharges. PArticular, which relate to organs and parts. Common, which are common to the provings of many remedies, or to disease conditions (diagnostic).
These three groups of symptoms are each made up of three grades: first, second and third. Thus, the first grade generals are those that are rare and peculiar, or those to the will, the loves, the hates, the fears, the desires and aversions belong to the loves, the hates, the fears, the desires and aversions belong to the first grade.
The second grade generals are those pertaining to the rational mind or intellect; the body reactions to environment; the physical appetites; the sexual symptoms; the body secretions and discharges, because such are elaborated by the organism as a whole; the modalities as to time and condition of aggravation and amelioration. The third grade generals are the common symptoms found in disease such as headache, malaise, fever, chill, sweat, etc.; or those symptoms common to the provings of many remedies. Common symptoms may be expressed in general symptoms of the patient as a whole, or they may be found in the particular parts of the body.
The high grade particulars are those that are rare and unusual, such as inflammation with little or no pain, thirst without fever, itching skin with no eruption. The modalities constitute the second grade particulars and the common symptoms the third grade.
This is but a brief outline of classifying symptoms for remedy selection. But all the teachers and master prescribers from Hahnemann down have stressed the unusual and rare symptoms as the ones of importance, because they are characteristic of the sick patient as well as of the remedy he needs for his cure.
This subject has been presented many times by much more proficient teachers and prescribers than I am, but I bring to you my humble efforts and trust we may have some discussion of his very vital subject so that all together we may bring forth better and simpler means to reach the desired goal, a surer and quicker way to find the similimum.
DR. ALLAN D. SUTHERLAND (Brattleboro, Vt.]: Mr. Chairman, the only trouble with Dr. Grimmers papers is that he says it all. There is nothing left to discuss. It is a very excellent review of an exacting method of evaluating symptoms, and should shorten the work of the physician very markedly.
DR. LUCY S. CLARK [Cleveland, Ohio]: Sometimes the younger physicians trained in methods of case-taking and great care on examination, are startled by the difference of emphasis in homoeopathic case-taking, and in the postgraduate school, when I was there, one of the most impressive things to me and to some of the other, younger students was an example of case-taking done in the class. Then the case was worked out by the Kent method and Boenninghausen method. It was very instructive and interesting to see how Dr. Hubbard took the case.
I wonder if taking a case at a meeting such as this, just as a demonstration, might not be very helpful to some of us who have not had as full a training in homoeopathic case-taking as we might.
DR. J.W. WAFFENSMITH [New Haven, Conn.]: In my humble opinion the greatest homoeopathic school that this country has ever seen was Hering Medical College. I tool my graduate work, which consisted of one year, in that school, under the tutorship of a faculty that was all strictly Hahnemannian. Among the teachers of that time, assistant to Professor Kent, was our good Dr. Grimmer. He taught us the basic principles of the taking of the case, as I fully and clearly remember, and have followed ever since. That was part of his work in Hering College, just as he gave it to us today.
Now, it seems to me that if we follow basically these instructions that have been given to us by Kent and his assistant, and the many other great characters who have taught us homoeopathy, we will more succinctly, more quickly, and more definitely get to the indicated remedy, with the least amount of difficulty, than by any other method which we may have given to us.
DR. ARTHUR WELLER (Orange, N.J.]: I should like to comment on that paper. I think it was wonderful, because I have found in my long practice that the peculiar symptoms of the individual, regardless of the disease for which you are prescribing, mean so much. Many times, in order to get the symptoms from the individuals, you have to ask all the questions, as the essayist has said.
I have built many a case for Silicea around sweaty feet, but most patients dont tell you that. You have to ask how excessive the perspiration is, and what about the feet, and if the wife is along, say, “What do you know about that? ” and she says, “They smell to heaven.” That drives you to Silicea, and it does the work and clears up the conditions which have been there.
Dr. Rabe is a good friend of mine. I dont think he is here. He does work along peculiar symptoms.
A patient came to me from Morristown. She didnt know I was homoeopath, and I asked so many questions that finally she asked, “You are a homoeopath?”.
I said, “How did you know?”.
She said, “The homoeopaths are the only ones who know how to ask questions.” [Laughter].
DR. RALPH W. BOHN [Helmuth, N.Y.]: I should like to say something about psychiatric case prescribing. We are handicapped in that our patients are very often fully accessible, and sometimes their replies are deliberately misleading, so our prescribing must very often be done on an objective case level. It is very difficult sometimes to get the cooperation of the patient. It may take a matter of weeks before you have their cooperation so that they are willing to work with you.
Of course, many amusing things occur along this line. There was one patient- we shall call her Miss Jones-who was middle-aged, a very rigid schoolteacher, catatonic. She sat bolt upright in bed, turned to the right and stared out of the window all day long, day after day. I would go through the ward and address her politely, “Good morning, Miss Jones! How are you?” No response. After three or four days of that, I said, “Now, Miss Jones, we might just as well get acquainted, because we have to work together, Suppose to turn around and look at me”.
She turned around very deliberately and looked at my feet and her eyes travelled up to my face and her gaze rested there a while, and she said, “How very discouraging,” and turned back to the window. [Laughter].
DR. F. K. BELLOKOSSY (Denver, Colo.]: There are many pitfalls, especially if we dont take the case completely. We may question a patient and in the course of the questioning decide on the remedy because the first symptoms may be so clearly indicating one remedy, and if we dont proceed with questioning, we will not find those symptoms that may contraindicate that same remedy to which we were first turning in our mind.
Hering said that we must take all the symptoms. In order to do that it is very bad if we hurry; therefore one has to go through the whole questionnaire. If that is not done, one can miss the remedy. Often a peculiar and strange symptom may lie in some particular symptom, and if we dont question, we wont get to that symptom.
I made such a mistake not long ago. A patient had such symptoms that I saw immediately he was a Phosphorus patient, but when he came back after I gave him the remedy, he had no results, and I questioned more, and I found that the patient was an Ignatia patient, and that mistake was made because I didnt question him long enough.
Some remedies may be given because they are so strongly indicated by some symptom, but there are other symptoms in that same case counterindicated, and we must then evaluate in that way to get at the right remedy.
DR. HENRY R. SACKETT (St. Petersburg. Fla.]: I have had some very interesting schoolteachers. One was mentioned here. One would declare that these two schoolteachers in their thirties were of the purely Pulsatilla type, but I knew both of them well enough to know that it wasnt matter of drugs, homoeopathic or otherwise; it was a matter of their programme, which I happened to know was not scientifically correct, and I asked asked each to write out her programme from the time she got up in the morning until she went to bed at night and let me have it. That was to include what they ate and when they ate it, and what they did and when they did it.
After I got those, in each case I revised their program 100 per cent because it was 100 per cent wrong, and I gave them a new program and told them to report in a week. I didnt give them anything and in week they were perfectly well; in other words, knowing your patient, knowing the patients occupation, knowing the patients surroundings, is extremely vital. That hasnt anything to do with drugs at all, any more than a person who puts on too many pounds because he or she eats too much. That isnt matter of drugs. That is a matter of common sense. Eat less and take off the extra twenty-five pounds.
DR. C. SEAVER SMITH [New Haven, Conn.]: The schoolteacher case reminds me of two things. I have so many schoolteachers that among themselves they call themselves “The Smith Club”.
I have one who turns her head to the right, so I have her sit at my right, in other words, at the right side of my desk so she has to turn my way when she does talk. I would be interested to know it if you remember the remedy for Miss Jones. It might help me with her.
A method I have effective in obtaining the particular remedy is to have them tell me the next time, the second time they come in, of any symptom that they have forgotten to tell me. Frequently in interviewing a patient, the patient is so nervously upset that he or she forgets to tell you the symptoms, and it is very difficult to dig out the particulars, and they can come back frequently the second time and tell you a symptom which is key to the remedy, and if you ask why they didnt you that symptom the first time, they will say, “Oh, I have had that so many years, I just didnt even think of it”.
DR. EDWARD C. WHITMONT [New York, N.Y.]: There are a few remarks I should like to make. To us the importance of the evaluation of symptoms seems perfectly self-understood, but I have followed the writing of continental, particularly self-understood, but I have followed the writing of continental, particularly of German, Homoeopathy, which has reached a height of popularity now, but you would not believe how much confusion there is concerning proper case taking.
Any principle of what symptoms to accept and what not, any systematic way of going about it, seems to be apparently unknown. It is still controversial whether there is any point in taking a case, not from the clinical but from the symptoms end standpoint; the result, of course, is mixing of remedies. The majority of those homoeopaths will not even believe that a high potency really acts. The most experienced ones say that, if you get your remedy exactly, the high potencies will be effective, but apparently a great number of the men are not able to get the exact similimum because they have not been taught case taking from generalities; the Kentian principles seem to be practically unknown outside of the English-speaking countries. This is a fact we are rarely aware of.
We are highly privileged to have Kents method at our disposal. However, as a challenge to our method, we must also remember that the remedies that are not polychrests and are poorly proven cannot be prescribed by the Kentian method; and this applies to quite a number of the less known, less thought of remedies. Also, when sufficient generalities, modalities and so forth are not available in a case, the exact Kentian method cannot be used.
DR. GRIMMER [Chicago, Ill.] (closing): Thanks you for your discussion. Dr. Bohn presented something that every homoeopathic physician meets, especially in the mental states, severe abnormalities of mental conditions. Then we cannot take too much consideration of what the patient says, but we can observe what he does. Sometimes that will tell us more than anything he may say. We sometimes have to go back, and we always should go back, into the antecedents, his friends, his relatives, the close ones who have observed him from the beginning of his trouble, and have seen the things that he had, maybe in early childhood, which are very guiding sometimes in some of these obscure cases.
If you go back along the line, you will pick up something that will be quite guiding. I am glad the doctor brought this out, because we have those stumbling blocks in many conditions that we meet with. Hahnemann tells us then to go back and study those things in their beginnings. If we can get the beginnings of our troubles, sometimes the whole thing is simplified.
Dr. Bellokossys remarks about going into the case very deeply are correct, but I know when I was only a student in homoeopathy at Dr. Blackwoods Clinic-he had a big general clinic and used to assign students to certain patients who came in-I was given an Irish lady to take care of, and after I got through examining her, she came out boiling mad and said, “It is worse than going to a father confessor, the way they ask questions,” but I found her remedy and she forgave me afterwards for asking so many questions!.