§ 93
If the disease has been brought on a short time or, in the case of a chronic affection, a considerable time previously, by some obvious cause, then the patient - or his friends when questioned privately - will mention it either spontaneously or when carefully interrogated.
11 Any
causes of a disgraceful character, which the patient or his friends do not like to
confess, at least not voluntarily, the physician must endeavor to elicit by skilfully
framing his questions, or by private information. To these belong poisoning or attempted
suicide, onanism, indulgence in ordinary or unnatural debauchery, excess in wine,
cordials, punch and other ardent beverages, or coffee, - over-indulgence in eating
generally, or in some particular food of a hurtful character, - infection with venereal
disease or itch, unfortunate love, jealousy, domestic infelicity, worry, grief on account
of some family misfortune, ill-usage, balked revenge, injured pride, embarrassment of a
pecuniary nature, superstitious fear, - hunger, - or an imperfection in the private parts,
a rupture, a prolapse, and so forth.
While inquiring into the state of chronic disease, the particular circumstances of the patient with regard to his ordinary occupations, his usual mode of living and diet, his domestic situation, and so forth, must be well considered and scrutinized, to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may by prompted.1
1 In
chronic diseases of females it is specially necessary to pay attention to pregnancy,
sterility, sexual desire, accouchements, miscarriages, suckling, and the state of the
menstrual discharge. With respect to the last-named more particularly, we should not
neglect to ascertain if it recurs at too short intervals, or is delayed beyond the proper
time, how many days it lasts, whether its flow is continuous or interrupted, what is its
general quality, how dark is its color, whether there is leucorrhoea before its appearance
or after its termination, but especially by what bodily or mental ailments, what
sensations and pains, it is preceded, accompanied or followed; if there is leucorrhoea,
what is its nature, what sensations attend its flow, in what quantity it is, and what are
the conditions and occasions under which it occurs?
In chronic disease the investigation of the signs of disease above
mentioned, and of all others, must be pursued as carefully and circumstantially as
possible, and the most minute peculiarities must be attended to, partly because in these
diseases they are the most characteristic and least resemble those of acute diseases, and
if a cure is to be affected they cannot be too accurately noted; partly because the
patients become so used to their long sufferings that they pay little or no heed to the
lesser accessory symptoms, which are often very pregnant with meaning (characteristic) -
often very useful in determining the choice of the remedy - and regard them almost as a
necessary part of their condition, almost as health, the real feeling of which they have
well-nigh forgotten in the sometimes fifteen or twenty years of suffering, and they can
scarcely bring themselves to believe that these accessory symptoms, these greater or less
deviations from the healthy state, can have any connection with their principal malady.
Besides this, patients themselves differ so much in their dispositions, that some, especially the so-called hypochondriacs and other persons of great sensitiveness and impatient of suffering, portray their symptoms in too vivid colors and, in order to induce the physician to give them relief, describe their ailments in exaggerated expression.1
1 A
pure fabrication of symptoms and sufferings will never be met with in hypochondriacs, even
in the most impatient of them - a comparison of the sufferings they complain of at various
times when the physician gives them nothing at all, or something quite unmedical, proves
this plainly; - but we must deduct something from their exaggeration, at all events
ascribe the strong character of their expressions to their expressions when talking of
their ailments becomes of itself an important symptom in the list of features of which the
portrait of the disease is composed. The case is different with insane persons and
rascally feigners of disease.
Other individuals of an opposite character, however, partly from
indolence, partly from false modesty, partly from a kind of mildness of disposition or
weakness of mind, refrain from mentioning a number of their symptoms, describe them in
vague terms, or allege some of them to be of no consequence.
Now, as certainly as we should listen particularly to the
patient’s description of his sufferings and sensations, and attach credence
especially to his own expressions wherewith he endeavors to make us understand his
ailments - because in the mouths of his friends and attendants they are usually altered
and erroneously stated, - so certainly, on the other hand, in all diseases, but especially
in the chronic ones, the investigation of the true, complete picture and its peculiarities
demands especial circumspection, tact, knowledge of human nature, caution in conducting
the inquiry and patience in an eminent degree.
On the whole, the investigation of acute diseases, or of such as have existed but a short time, is much the easiest for the physician, because all the phenomena and deviations from the health that has been put recently lost are still fresh in the memory of the patient and his friends, still continue to be novel and striking. The physician certainly requires to know everything in such cases also; but he has much less to inquire into; they are for the most part spontaneously detailed to him.