Describe all mental or “nervous” feelings and conditions, such as likes and dislikes, desires, fears, timidity, hurried feeling, lack of interest, persistent thoughts, discouragements, discontent, over conscientiousness whether critical, irritable, easily confused, aversion to business or work, absentmindedness, changeable mood, difficulty of concentration, dullness of mind, whether easily startled or starting from sleep or when falling asleep, or from noise or being touched; whether annoyed by noise or talk of others or by children; whether easily affected by bad news; whether better or worse from mental exertion, or when occupied; whether sensitive to offense or contradiction. Describe the state of mind as to the future or to threatening troubles; attitude of mind as to associates and relatives, and the effects of same, and whether better alone or with company. Tell the peculiarities of memory; whether desire to be silent or to talk much. Tell of any emotional shocks, frights, disappointment, etc. of the present or past; how affected by a room full of people. Which of these have appeared or gotten worse since the onset of your illness?
Appetite: tell what is craved or disliked, such as salt, sweets, fats, sour, spicy things, eggs, etc. Also, thirst for much, little or nothing, and what drink is preferred. Do the symptoms remain the same or do they change character or shift from one place to another? Describe all pain; what kind, what it feels like and whether constant, changeable, or periodical; also in what direction it may go or extend, if any; whether it comes slowly or suddenly and how it leaves.
Write the time of day, night, month or season that you are better or worse, whether better before or after eating, sleeping, moving, resting, when occupied, when thinking of your complaint, etc. Write just what things or conditions make you worse and whatever relieves the pain or sickness. This is important. Just how are you affected by different kinds of weather, by cold, heat, dryness, storm coming, thunderstorms, frost, cloudiness, seashore, low or high altitudes, etc. ?
In skin, scalp or nail problems, tell the exact locations, colour, whether dry or moist, thick or thin, scaly, crippled, pimply, with or without matter, warts or growth, appearance of surrounding skin; whether itching, burning, worse or better from scratching, and what else makes it better such as heat, heat of bed, cold, exercise, wool, water, etc.
Tell of any enlarged veins, etc. Describe discharges of any part, whether slight or heavy, the colour, odour, thick or thin, gooey or sticky, causing redness or burning, rawness, colour of stain; and what makes it better or worse, and when.
Urine: whether pain before, during or after passing, colour, odour, appearance, quantity, sediment, frequency, urgency (if hurried). Bowel condition: colour, odour, hard, dry, large, pasty, bloody, frothy, slimy, thin, watery, slender, flat, etc. How often, at what times worse or better, or how affected by certain circumstances; whether difficult, incomplete, urging without result or stool slips back in, prevented by spasm of rectum, anything else peculiar.
Sensations are important. State just what kind, where, at what time they are better or worse, and whatever makes them better or worse. Tell all sensations, however slight or peculiar such as “ It feels as if….” and so on.
Women are to give age at first menstrual period, how far apart then and now; whether pain during, before or after, then and now, and where; also where the pain may extend to, as to the back, sides, groins, thighs, etc. What kind of pain , what relieves or aggravates, how often the pains come. Tell whether there have been miscarriages. Tell how you feel in general, before, during and after the periods; sex desire or aversion, whether intercourse is normal, unsatisfactory or painful.
Men are to give particulars as to male genitals, if anything is not normal, whether any former disease or abuse; emissions, etc. Tell as to the effects of heat, cold, bathing, lying down, beginning of motion, worse or better from perspiring, from lying, whether lassitude, weakness or weariness, and how affected by activity.