The Art of Interrogation -the Homoeopathic Consultation by Pierre Schmidt

Book review of The Art of Interrogation -the Homoeopathic Consultation by Pierre Schmidt includes pharmacopallaxy (repetition of dose)

Pierre Schmidt, M.D.

• Published by B. JAIN PUBLISHERS (P) LTD.
• Revised edition 2007
• Reprint  edition 2009
• Published by Kuldeep jain for B. JAIN PUBLISHERS (P) LTD.
• Printed in India by J.J Offset printers 

The art of interrogation
The author  learned through frequent homeopathic dispensaries and hospitals how very rarely indeed did the practitioners really know how to apply exactly the teachings recommended by the Master, concerning the interrogation of the sick and homeopathic semiology; for, must we, after having listened to the patient, direct the interrogation in a given direction, either on the side of a presumed pathological diagnosis or toward a remedy suggested by the first recital made by the patient?

Here in this book the author point out the importance of systematic interrogation.

Now that homoeopathy is developing and growing, everywhere we hear young practitioners asking: “But how to question the patient” “What are the most useful and indispensable questions to ask ?” What is the difference between the allopathic and the homoeopathic consultation ?”

We have certainly many precious practical suggestions concerning the questionnaire ; Hahnemann, in his Organon, devotes more than sixty three paragraphs1 where he speaks about the examination of the patient. Von Boenninghausen gives us excellent advice how to take the case. Jahr furnishes also a questionnaire, as well as others like Mure, Perussel, Molinari, Landry, Claude, then, more recently, Close and Kent, this last the only one who gives us a full questionnaire comprising more than thirty-two pages, entitled “What the Doctor Needs to Know in order to Make a Successful Prescription.”

Finally, there is that of Dr. Margaret Tyler.

The famous lecture of Constantine Hering, published in 1833 in the “Bibliotbeque Homceopathique de Geneve,” in which he sets forth the theme how to trace the picture of the disease, his rules being summed up in four words :—

To listen, to write, to question, to co-ordinate.

• The author’s purpose being essentially to aim at the most useful and exclusively practical side of the question in general.
• This book is not discussing  the art of listening to the patient, not the ,best way to write one’s observations, nor yet the technique of the study and the co-ordination of the symptoms, or the question of the physical examination. It discusses only with the third precept the questioning, or examination, strictly speaking.
• The author  have compiled a questionnaire after years of the study of  chronic cases.
• The main purpose of the allopathic consultation is to establish a pathological diagnosis, to label the disease in the most modern nosological fashion. without it no treatment should be attempted.
• It is the hunting after end-products, after the results of disease.
• If these results are not still manifested in a precise objective manner, and if the sick person suffers from functional troubles only, or even if these are not yet present and the patient is only complaining of subjective troubles, his case is arbitrarily decided. It is a nervous, psychic, imaginary case !

But in the homoeopathic consultation, we are not at all satisfied with this investigation only. Its object is to establish how a given morbid affection has developed itself in a given subject, and to explore all the possible details of the evolution of such a disease in an individual, and how precisely this patient differs from all the others bearing the same diagnosis.

A homoeopath will inquire into all details which differentiate  particular patient from the ten others having same diagonosis;  In case of diphtheria, one would have the membranes on the right side, another on the left, and another on the velum of the palate. The appearance of the membrane may vary in colour from green to yellow, black or white, according to the case ; in others the consistency may, however, change, but especially interesting for the homoeopath are the functional and subjective troubles of the patient. One may have burning or shooting pains, or may complain of dryness or rawness. Certain patients may alleviate their pain by drinking cold water or warm, or by eating solid food. The extension of the trouble from left to right or vice versa or from the throat to the larynx or to the nose, all these differences may lead to a different homoeopathic remedy.

Many details, forsooth seemingly of secondary importance, if not quite useless for the Allopath, gives not only of precise diagnosis of the disease but especially the diagnosis of the given patient, and the homoeopathic physician will be able to find his own and particular remedy .

There exist more than fifty-six remedies for diphtheria, but there is a very small number corresponding really to all the symptoms pertaining to this particular patient. And this is where the task of the homoeopath begins.

The best question-naire to be utilized by the physician in his current daily practice. A questionnaire which will satisfy the following desiderata :—

(1) The minimum of the best questions to be asked a patient when the time is limited.

(2) Most important and most necesary those questions to discover, not the pathological diagnosis but the therapeutic diagnosis, the general remedy corresponding to the patient.

(3) The questions to be asked, those for which we are sure to find a correspondence in our repertories and materia medica.

The interrogation, above all, must be methodical.

Of course, it goes without saying that the questions asked must be according to the purest principles of homoeo-pathy, i.e.,:—

(a) To avoid direct questions for we know, if the patient answers with yes or no, the question is badly formed.

(b) Never to ask a question putting an answer, so to say, into the patient’s mouth, thus making sure not to bias his answer.

(c) To avoid all questions where the patient is obliged to choose between two different alternatives, and respect the sacred rule to leave the patient always his own choice.

Of course , the physician must put himself, as Dr. Kent says, on the level of language comprehended by his patient. His attitude of seriousness and benevolence must help to stimulate the confidence of his patient.

On the other hand, he must know sufficiently his materia medica, so that his questions will be adapted to the comparison he will have to make further on. “Store up your materia medica so as to use it, and it will flow out as your language flows,” in the well-known words of Kent.

The physician, by his manner of interrogation and general questions, must do everything, to let the patient himself characterize the particular facts. “Say as little as you can, but keep the patient talking and help him to come close to the line and keep to the point.”

Never allow yourself to hurry a patient, establish a fixed habit of examination that will stay with you.

Things o avoid  in case taking  

(1) Direct questions : (a) Are you thirsty ? (b) Are you irritable ? (c) Have you pain in the stomach ?

(2) Suggestive questions: {a) You do not stand the cold very well, do you ? (b) You surely prefer to be con-soled ? (c) I suppose that you don’t like too greasy and too rich food ?

(3) Questions where the patient must choose : (a) Do you prefer dry or wet weather ? (b) Do you dream about sad or cheerful things? (c) Are your menses dark or light ?

To know if the questions are well asked and, consequently, well answered ?

There are two ways of knowing :—

(1) During all the interrogation, the physician must carefully watch his patient and observe the way he answers.

the intonation of his voice, the play and expression of his physiognomy, especially in mouth and eyes, must be carefully observed and grasped.

(2) During the interrogation, the physician should carefully note and  write  all the answers of his patient and  He can under- line or mark with a cross those which are of importance to be further cross-questioned or verified in order to be assured that the patient has really well understood and well answered the question.

Way of cross-questions. For example:—

If the patient has told you that he feels worse after meals, you may ask him: ” If you have an important matter to decide or a delicate letter to write, or some important call to make, would you’ do it at 2 p.m.?”

If he told you that he was sleeping with his hands outstretched over his head, you may ask him: ” During sleep, would the warmth of the bed clothes cause your hands to perspire ?”

Regarding dose and repetition

1. As Hahnemann said, treat every disease with one single remedy and one single dose.
2. The repetition of the remedy require positive and strong reasons. Repetition must be based on , susceptibility of the patient,the less sensitive the patient, the more one is permitted to repeat.
3. The repetition of the remedy depends also on the nature of the remedy.
4. The repetition of the remedy must be submitted to the nature of the disease as well as to the nature of the remedy.
5. The repetition of the remedy depends on the duration of the action of the remedy. Everyone knows that Calcarea has a longer duration of action than Ignatia .
6. The repetition of the remedy depends on its dyna-mization (potency).
7. In chronic diseases one must be very careful with the repetition , repeat at long intervals, rather than too shortly.
8. In acute diseases experience teaches us that the repetition can be done more frequently. Nevertheless many beautiful cases have been cured with one single dose or a few doses. (High fever, great pain, great fear, strong fits of anger or emotional excitement shorten the action of a remedy and indicate repetition.)
9. Hahnemann has repeated :

And nothing is more guilty than to repeat blindly and rontinarily a remedy, one must be guided always by the reaction of the patient and observe carefully the direction and Course of the symptoms, . . . One must be very careful not to use prevision in the indications of the homoeopathic remedies and should always base bis prescription on the actual totality; it is impossible to prescribe different remedies in advance, either mixed or alternated for this is a practice absolutely aside from the principles of our doctrine it is only empiricism, and the work of the most pitiful routine………………’ The homoeopathic physician ought to examine the symptoms every time he prescribes; otherwise he cannot know whether the same remedy is indicated a second time, or whether a medicine is at all appropriate*

10. The most important thing about the repetition is the careful observation of the patient and disease. More harm has been done by repeating doses than by giving too rarely a remedy.
11. We must add, as Hahnemann says; There are exceptions to the rule, which it is, however, not the business of every beginner to discover.
12. very careful observation, patience, knowledge and also courage are the qualities required for a master in prescribing. The homoeopathic physician is surely knows how to watch and wait, after having given his remedy. as Kent beautifully describes it in his chapter concerning the second prescription:

“No repetition is to be considered unless the record has been again fully studied, unless the first examination, and all the things that have since arisen, have been carefully restudied that they may be brought again to the mind of the physician.”