A pen picture of case taking

Dr Rajni Gandha

Homoeopathy is a science based on certain laws and principles. However, it is essentially an art in its application as each individual interview is entirely different from the others. Taking up the case is the primary object of

Homoeopathy is a science based on certain laws and principles. However, it is essentially an art in its application as each individual interview is entirely different from the others. Taking up the case is the primary object of

Homoeopathy is a science based on certain laws and principles. However, it is essentially an art in its application as each individual interview is entirely different from the others. Taking up the case is the primary object of homoeopathic physician. It is the most difficult task which can only be accomplished with immense patience under a proper supervision and training.

KEY WORDS– Individualisation, case receiving, case format.

DEFINITION- 

A logical  process of examining an individual, knowing the sick and his sickness in every aspect.

OBJECTIVES –

1. Proper diagnosis can be made.
2. Prognosis can be determined.
3. Totality of symptoms can be framed (Individualisation can be made).
4. Treatment outline can be made.
5. Dominant miasm can be assessed.
6. Potency selection can be done on the basis of pathological changes (on the basis of pathological changes).
7. Proper advice can be given about the diet and regimen.
8. Second prescription can be made.

PRE-REQUISITES – 

1. A record book to record each and every symptom. (Why? As human brain is limited and we cannot remember all the minute details of each case.)

2. A good rapport with the patient so that he can confide in you.

3. Sound senses, immense patience and the very skill to interrogate.

4. Refrain from prejudice.

5. The ability to assess the statements made by the patient or the attendants so that he may get rid of exaggerated symptoms in hypochondriac patients and to inquire about symptoms from stoic patients.

6. To maintain the confidentiality.

GENERAL DIRECTIONS- 

“ EVERYWHERE THE MOST STRIKING, UNCOMMON, PECULIAR AND RARE SYMPTOMS SHOULD BE COLLECTED. “

A.) What the patient gives you?

  The detailed history of suffering with the exact sensations they feel.

B.) What the attendant gives you?

They say about all the altered behaviours they have noticed and the symptoms they have heard him complaining of.

C.) Physician’s duty- 

1. Tell the patient to speak slowly so that you can record all  the important details precisely.

2.  Write down all that the patient and his attendants have told in the most simple words with exactly the same      expressions, only correcting his grammatical errors.

3. Use of synonyms should not change the theme.

4. Be quite and allow them to speak without any interruption unless they wander off to other matters. (Why? As every   interruption results in the breakage in the chain of thought and they may not be able to say again the same matter in precisely the same manner).

5. Write every symptom in a fresh new line. Keep sufficient gap so that, later, if required, anything can be added to these symptoms in order to complete it.

D.) Physician’s duty after the narrator stops– 

1. When they have finished saying on their own accord, return back to each symptom and if required,  by further inquires obtain more precise information to complete each symptom. That is, all the symptoms should have their precise location, exact kind of sensation, modalities (aggravating and ameliorating factors), concomitants (That is, symptoms which are present with the chief complaint but bears no pathological relation with it. Eg: involuntary urination  while coughing), duration, causes, extension, etc.

Eg: If the patient complains of headache then inquire about where it occurs? Which kind of pain it is?    How long it lasts? At what period of time the pain occurs? etc.

2. Refrain from asking any direct (leading) question. That is, do not ask any question which suggest s answer to the patient or which can be answered as yes or no.

Eg: Do you get anger? Instead you may ask- “what about anger?”

Sometimes due to ignorance or just to please the physician, they may answer in affirmative which may mislead the physician and a false portrait of the disease may be obtained thereby leading to an inaccurate treatment. You may ask collateral questions, that is, questions which are not direct but gives you the answer of what you want to know.

3. If in these details nothing has been mentioned about some parts or the functions of the body or the mental state, then the physician can ask regarding those parts and functions.

4. The state of disposition or mind should be inquired from the patient and the attendants using general expressions so that it does not suggest any answer and they enter into the detail.

Eg: How about the sleep? What about anger? How does he reacts when he gets anger? How does he feel if somebody consoles him? etc.

5. While taking note of MIND symptoms, all the aspects should be inquired-

a. Will– It includes:

– Love: company desires, desires for mental work, desire to be silent, etc.

– Hate: aversion to answer, to friends, to certain persons, to husband, etc.

– Fear: fear of using voice, from music, nausea after, etc.

b. Understanding–  It includes:

– Delusions: elevated in the air; that he was killed, roasted and eaten; that he is divided into two parts, that she will murder her family, etc

– Delirium: on closing the eyes, with fear of men, miscarriage after, repeats the same sentence, etc.

c. Memory–

– Active: ideas abundant, on closing the eyes, chill during, perspiration during, etc.

– Weakness: sudden and periodical, forgets his own name, forgets well known streets, etc.

6. When you have finished taking note of all these, note down all the alterations you have noticed while receiving the case and enquire about it.  E.g: restless, moaning, speech, how he behaved during the enquiries? How was he talking? How was his expressions? etc.

7. Generals- Symptoms that pertains to the patient as a whole.

a. Food- cravings, desire, aversion and intolerance.

b. Appetite and thirst.

c. Thermal state- (It is not about which season they like but it is to inquire about which season they can bear.  Sometimes after excessive drug abuse, it becomes difficult to ascertain their exact thermal state and they seems to be ambi thermal, which should be inquired consciously.)

d. Sleep – positions, dreams (which have come more often).

e. Perspiration- odour, staining, etc.

f. Others- flushes of heat, lack of vital heat, etc.

g. In females- 

– History of pregnancies, miscarraiges, suckling, sexual functioning, etc.

– Menstrual history- Nature of discharge (colours, clot, etc), interval between the menstrual cycles, how many days it lasts, general quantity, etc.

– Leucorrhoea- If it is present? Colour and nature, any relation with menstrual cycle, etc.

 8. Particular symptoms- symptoms related to the parts, and not to the whole but should be of qualified or characteristic. It can be covered under following heads:

a. What?- what it is exactly? E.g: Pain, heaviness, swelling, itching, etc.

b. Where? – The precise location or spot of the complaint. E.g: Forehead, temple, occiput, etc.

c. How?- The exact sensation at that point.

Eg : stitching, splinter like, lump, numbness, burning, etc.

d. When? (aggravation and amelioration) – It can be divided into two :

i. Based on time-   ¤ In a day- 1am, 3 am, 4 to 8 pm, daytime, morning, evening, night, etc

¤ Periodic- 7th day, 14th day, 28th day, everyday at same hour, annually, etc.

¤ Weather – in summer, in winter, change of  weather, change of temperature,etc.

ii. Based on conditions-    rest and motion, pressure, riding, binding, heat and cold, closed room, external warmth, covering, uncovering, bathing, air open, etc.

9. Inquiry of accessory symptoms- 

Sometimes the patient becomes so used to of their long sufferings that it becomes a part and parcel of their life and they pay little or no heed to these symptoms, which may be very characteristic and useful in determing the choice of remedy, so these should be inquired carefully.

10. Elicit the particulars of the patient regarding-

a. Past history–

– in chronological order.

– developmental history, that is, history of developmental milestones(whether delayed, normal or abnormal).

E.g : slow learning to talk or walk, etc.

– medical history including history of vaccination, any surgery, any mechanical injury, any snake bite, any poisonous insect bite, any accident, removal of warts, mental shock, etc.

– their course.

– mode of treatment and result.

Significance- This gives an idea regarding-

– the original portrait of the disease.

– the general level of health and his vitality.

– Tubercular and veneral history may need appropriate nosodes, if other symptoms are not indicating any remedy.

Eg : Thuja, Tub., syphil, etc.

–Not well since…. It gives an idea about lowered vitality of the patient and even indicate some remedies from our materia medica. It can also be taken as metastasis.

Eg : carbo veg., pulsatilla, abrotanum, etc.

– It gives the detail about the miasmatic background.

b. Family history- 

– Take note of all the disease conditions his family members (with whom he has blood relationship) have suffered.

Eg : Father, Mother, Siblings, Paternal and Maternal grand parents, Uncles, etc.

Significance- It gives you the following detail-

– the miasmatic background.

– the predisposition and the tendency of disease.

11. Inquire about their occupation, mode of living, domestic conditions, etc. It helps you to ascertain what is there in them which may produce or maintain disease and removal of which may accelerate recovery process.

12. In hypochondriacs- 

– These are the patients who present their sufferings in an exaggerated form, often due to impatient of sufferings and to get aid from the physician.

– In these cases, you cannot get the original portrait of disease so you should give them something unmedicated, if possible.

– When the patient comes next it will be easier to compare the previous and present pictures, hence, a more precise picture can be obtained.

13. Stoic patients- 

– Person who refrain from giving their complete disease picture partly from indolence, partly from mildness of disposition or may be due to weakness of mind.

– In these patients you should make them to enter into the details through your skill to obtain the required picture.

14. In chronic diseases- If the patient has been taking medicine upto the time he has come to you, you may leave him somedays with unmedicated pills, if possible. In this way, you get time to scrutinize more morbid symptoms and you may get somewhat original picture of the sickness.

15. In acute diseases- Though it needs serious and prompt aid, it is much more easier and less time consuming to get a complete picture of the disease as the deviations in health remains fresh in the memory of the patient and they give the details spontaneously.

In sporadic and epidemic diseases- Investigate the case thoroughly as a new and unknown case as every case will show some unique and differentiating character from the others (it only remains same when it results from any contagious source, e.g. small pox, measles, etc.) 

E.) A sketch of case taking form- 

     1. Preliminary data-

a. Name (for future reference)

b. Age (some diseases are common in specific age group-      eg: urine retention in newborns, problems related to sexual functioning in adolescence, cataract in old age, etc.)

c. Sex              d. Occupation             d. Education

e. Religion       f. marital status          g. Address

h. Date of case taking

2. Presenting complaint with the history of it-

It can be noted under separate heading along with-

a. Aetiology (causation and ailments from),

b. Progression of the disease (appearance of symptoms) in a sequential order.

• Mind-
• Head (vertigo)-
• Eyes (Vision)-
•  Ears (Hearing) –
• Nose (Smell)-
•  Face-
• Mouth (teeth and saliva) –
• Throat –
• Appetite –
• Stomach (craving/ desires/ aversions/ intolerance) –
• Abdomen –
• Bowels –
• Urine (Urinart tract disorders and Urinart tract disorders and kidney functioning) –
• Genitalia (male and female)-
• Respiration-
• Cough (expectoration)-
• Chest-
• Neck –
• Back-
• Extremities-
• Skin –
• Perspiration-
• Fever –
• Sleep-
• Dreams –

3. Generals-

4. Past history-

5. Family history-

6. Investigations (Physical examination findings and lab investigation reports)-

SUMMARY-
A well-taken case provides the clear image of the patient, the mechanism of the evolution of disease and eventually a proper tool which can be used to rescue the suffering individual. It has to be done with great skill seeking rare, peculiar and characteristic symptoms from all the aspect. If a case has been taken without any preconceived ideas, it will provide you with a certain group of remedies and it makes your job much easier at the end.

‘FOLLOW THESE RULES WITH EXACTITUDE THROUGH PRACTICE,IF YOU NEGLECT MAKING A CAREFUL EXAMINATION- THE PATIENT WILL BE THE FIRST SUFFERER, BUT AT THE END YOU YOURSELF WILL SUFFER FROM IT& HOMOEOPATHY ALSO – DR. J. T. KENT

REFERENCES-

1. HAHNEMANN SAMUEL, ORGANON OF MEDICINE, new edition, modern homoeopathic publication, 2006, pg no. 73.
2. HAHNEMANN SAMUEL, THE LESSER WRITINGS, the medicine of experience, 12^th impression, B. Jain publishers(P) ltd. , 2015, pg no. 443.
3. KENT J T., LECTURES ON HOMOEOPATHIC PHILOSOPHY, the examination of the patient, new edition, medical book suppliers, 2000, pg no. 158.
4. KENT J T., LESSER WRITINGS, taking of he case in discussion of a paper, 11^th impression, B. Jain publishers(P) ltd., 2014, pg no. 374.
5. BANERJEE P N., CHRONIC DISEASE ITS CAUSE AND CURE, B. Jain publishers(P) ltd., pg no. 133.
6. ROBERTS H A., THE PRINCIPLES AND ART OF CURE BY HOMOEOPATHY, taking the case, low price edition, B. Jain publishers(P) ltd., 2011, pg no. 75.
7. CLARKE J H., THE PRESCRIBERS, case taking, reprint edition, B. Jain publishers(P) ltd., 1998, pg no. 39.
8. CLOSE STUART, THE GENIUS OF HOMOEOPATHY, examination of the patient, low price edition, B. Jain publishers(P) ltd., 2002, pg no. 167.
9. VITHOULKAS G., THE SCIENCE OF HOMOEOPATHY, taking the case, indian edition, , B. Jain publishers(P) ltd., 1998, 2000, pg no. 169.
10. WRIGHT E., A BRIEF STUDY COURSE IN HOMOEOPATHY, know the patient, reprint edition, , B. Jain publishers(P) ltd., 1999, 2001, pg no. 15.
11. GUNWANTE S M., INTRODUCTION TO HOMOEOPATHIC PRESCRIBING, taking the case, reprint edition, , B. Jain publishers(P) ltd., 1996, pg no. 75.
12. DHAWALE M L., PRINCIPLES AND PRACTICE OF HOMOEOPATHY, receiving the case, revised and enlarged edition, , B. Jain publishers(P) ltd., 2014, pg no. 87.

Dr Rajni Gandha
PGT,Father Muller Homeopathic Medical College
Email: drrajni.1990@yahoo.com