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It is essential to ascertain, with minuteness, the inclina tions and aversion of the patient; his desire for particular kinds of food or beverage, his degree of appetite, and whether he suffer from thirst, and experience any particular taste in the mouth; if so, at what period of the day it is noticed, and whether before, during, or after a meal. Eructations, and rising of the food, must also be enquired into, and the patient must explain when these inconveniencies principally affect him, and the taste with which they are accompanied.
Similar enquiry applies to matters ejected from the stomach, their usual appearance, consistency, taste, smell, and frequency.
The state of the bowels next demands consideration; whether relaxed, constipated, or healthy, with the color and consistency of the alvine evacuation, and whether attended with pain.
As regards the urine, when the patient has related its peculiaritios as to color, density, smell, and intervals of discharge, the physician must ascertain its appearance at the time of deposit, and subsequently the color and character of the sediment.
The next subject of enquiry, the condition of the sexual functions, is one of paramount importance, and requires the utmost delicacy and tact on the part of the physician, the more especially as it is in females that these functional derangements are the most frequent and serious, forming the basis of many other ailments. A clear and definite G2
exposition of irregularities and morbid appearances in these functions, is indispensible; but as the details will suggest themselves to every enlightened practitioner, it is not requisite for me to point them out in this place.. Suffice it to say, that sterility and impotence are usually founded upon these derangements, and afford valuable data for selecting a remedy.
Particulars relative to sleep must be gathered with similar care; and the position of the patient when in bed must be noticed: whether he lie on his back or on his side, and on which side he is more at ease, or whether he prefer much or slender covering.
Each distinct affection produces its characteristic variety in sleep, as regards its duration and soundness. In some maladies, the patient is disturbed by the slightest noise, or by the most trifling cause; in others, the sleep is profound, and he is with difficulty aroused. In some cases he talks in his sleep, cries out, groans, or complains; in others, he snores, starts up suddenly, or walks. about. These peculiarities should be noted down; neither should the appearance on awakening, if unusual, be permitted to pass unnoticed.
Should the patient be laboring under a febrile attack, the physician must not content himself with ascertaining the state of the pulse, tongue, secretion and type of the fever, but must extend his enquiries to the minutest symptoms. He must first learn whether the patient has only a sensation of chillness, or be really cold, and what
portion of the body be principally affected: he may complain of cold, either internally or externally, and yet his skin may be warm at the time. The exact period at which the cold was felt, and its continuance, should be ascertained, and whether accompanied with shivering; for all these circumstances are important, and should not escape the observation of the practitioner.
The investigation of the hot paroxism, in febrile diseases, demands a similarly rigid examination of symptoms.
The symptoms produced by, and consequent upon, the hot fit, demand the same scrupulous investigation as those of the cold.
It must be ascertained whether the patient feel a sensa. tion of internal heat whilst the surface of the body is cold; whether the heat be equally diffused, or confined to particular parts; and whether the face be pale or flushed. The duration of the paroxysm should also be enquired into, as well as its alternation with the cold fit, and whether it precede or follow it.
The sweating fit, which constitutes the third stage, must be equally well attended to.
The physician must ascertain the period of its access, and its connection with heat; the degree and quality of the perspiration; whether it be hot or cold, viscid or watery; if it possess any peculiar odour, and if one portion of the body be more under its influence than another.
In addition to these facts, the physician should also learn if any, and what external circumstances have had
an influence upon the patient; such as noise, air, heat, cold: nor must his appearance escape observation.
Thirst is a symptom entitled to peculiar consideration; and the practitioner should learn whether it were felt during the cold or hot stage, or during both. Its intensity and continuance should be inquired into, as should also the diluents which the patient may prefer or dislike.
These minute details are indispensible in homœopathic treatment, inasmuch as they furnish the means of discriminating the various shades of pathological disturbance in different constitutions, and consequently enable the physician to select a medicine in accordance with each individual characteristic.
The healthy or morbid condition of the organs of sense and vitality must all be successfully enquired into. The state of the eyes, nose, ears, mouth, as well as the whole abdominal viscera; the heart, and circulating system, must be carefully registered.
The respiratory organs; their changes as regards the function of respiration itself, or their secretions; the sensations incident to breathing; and the indications supplied by percussion, the stethoscope, should be accurately noted down.
In examining the eyes, their general expression should be noticed the appearance of the pupils, and how influenced by daylight and candlelight.
The brain and nervous system require serious attention; and if morbid symptoms should have been manifested, the
practitioner will have recourse to the like method of investigating their character: nor must he omit to note down the appearance, gestures, and complexion of the patient. The last, though not the least important in these inquiries, is to ascertain the intellectual and moral affections. The physician should learn whether he be irritable, passionate, violent or mild, patient and enduring; whether lively or melancholy, anxious or indifferent; whether there exist a disposition to shed tears, or a desire to commit suicide. Each of these morbid tendencies will denote a peculiarity in the patient, which calls for minute attention, and which forms an important subject for consideration in determining on a remedy.
Thus, these remarks will embrace the general tenor of the invalid during the interview: his moral indications, such as fear, sorrow, bursts of passion, mildness, hope, despondency.
He will remark the effect produced on the morbid phenomena by position; such as sitting, lying, standing, or moving about, either within doors, or in the open air.
He must observe the influence of food: whether the patient be principally affected in the morning before eating, after breakfast, after dinner, or only at night, and whether during or immediately subsequent to repast.
In short, the organs of the economy must be considered generally, and each examined in reference to sensation and change whether organic or functional.