Silence

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• Silence
• Words
• .More words
• Observation.
• ..Picture

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• CASE TAKING
• IN HOMOEOPATHIC MEDICINE
• HAHNEMANNS DIRECTIONS 83. - 104.
• This individualizing examination of a case for
  which
• I am giving here only the general directions
  and from
• which the practicing physician should take
  note of
• What is applicable in each case individually
• But what is demanded from him always in each and
  every case is-
• Freedom from prejudice
• Sound senses
• Attention in observation
• Fidelity in tracing the picture of disease. 83.
  

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• Patient tells his problems and complaints.
• Those around him, his relatives and friends, tell
  what
• they have seen and heard the patient
  complaining
• The physician sees, hears and remarks by his
  other
• senses what there is altered and unusual
  character
• about him from his normal state of health.
• Writes down every important information heard by
• him, in the very expression used by them.
• Maintains silence all the while, unless they
  wander off
• to some unimportant issues and subjects,
  since any
• Interruption breaks their train of thought, and
  all they
• would have said at first, does not again
  occur to them
• in precisely the same manner after that.
• Advises them, at the beginning of an interview,
  to
• speak slowly so that he can take down the
  important
• information they pass on to him. 84.

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• The physician begins to write on a fresh line
  every
• new symptom or the circumstance mentioned by
  the
• patient or his friends and relatives
• So that they are arranged separately one below
  the
• other.
• This way he can fill the precise details
  subsequently to
• complete each symptom given in the beginning
  in too
• vague manner but stated afterward more
  clearly
• 85.

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• After the narrators have finished what they have
  to
• say
• The physician then reverts to each symptom and
  now
• elicits more precise information about them,
  if
• required.
• Physician reads over the symptoms as they were
  told
• to him and he enquires for any further
  particulars like
• location, duration, sensation, continuous
  or
• intermittent, periodicity, time of
  occurrence (day or
• night), modalities-time, position, movement,
  
• Temperature, weather, effect of previous
  medication
• etc.
• All recorded in plain words 86.

6

• Physician avoiding direct or leading questions or
  else
• He may get misleading, untrue, half true or not
  strictly
• correct answer from which-
• A false picture of disease and unsuitable mode of
  
• treatment would results.
• This happens because patients are either
  indolent, shy or just
• Wants to please the physician 87.

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• If in these voluntary details nothing has been
• mentioned about
• Several facts or functions of the body or his
• Mental state, or about
• The disposition and mind etc.,
• The physician must ask now, but
• in general manner in order that the patient is
  obliged
• to think about the details before he answers
  them
• 88.

8

• We have to rely on the patient for the
  description of
• his sensations and complaints (except when
  he is
• feigning).
• When the patient has furnished these details
  either
• on his own accord or on questioning him
• We get a fairly complete picture of the disease,
  but
• still If the physician feels that he has not
  got
• The complete data
• It is the time to explore on these incomplete
• areas of inquiry. 89.

9

• After detailed history taking comes
• The physical examination of the patient by the
• physician, wherein he makes a note of what
  he
• himself has observed in the patient
  (including the
• objective symptoms-signs).
• He thereafter analyses the case and
• Evaluate the symptoms to ascertains how much of
• this was
• The deviation from his healthy state 90.

10

• Modified picture of disease, that is
• Symptoms and feelings of the patient during the
  time
• when he was taking the medicine in the past
  does not
• furnishes the true picture of the disease
• As the unmodified picture, that is, his symptoms
  and
• feelings prior to his taking the treatment
  or
• His symptoms several days after discontinuing the
• medicine does
• This unmodified picture of disease is important,
  which
• The physician must take note of.

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• It is always better in a chronically ill patient,
  not to
• prescribe any medicine on the existing
  symptoms but
• Wait for some time to elapse after withdrawal of
  the
• previous medicine, before working out the
  case
• Because by doing so
• We can get correct and an unmodified picture of
  the
• chronic disease 91.

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• In acute and serious conditions when the time at
  our
• disposal is very short,
• One should content himself by prescribing for the
  
• present and modified picture of the
  disease, when we
• know that the patient has taken some
  medicine
• earlier
• At least this way we can apprehend
• The complete picture of the acute disease and
• prescribe suitable homoeopathic medicine
• To avoid complications 92.

13

• The obvious cause for the onset of an acute or a
• chronic disease must always be explored and
  elicited
• from the patient or his friends
• Taking them into confidence 93.

14

• Chronic disease, chronic case-taking, chronic
  prescribing
• Peculiar circumstances of the patient in relation
  to his
• Work,
• Family and
• Society etc. Must be explored and scrutinized
• Whether these play any role in the production or
  maintenance of his disease and
• if their removal promote early recovery 94.

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• Besides these,
• The other associated minor or major deviations
  from
• the earlier healthy state, which to
• The patient appear quite insignificant, because
  of his prolonged condition, and
• Having no bearing on his principal disease, are
• On the other hand quite important.
• On these alone many a times the curative medicine
  may be prescribed.
• The physician should take extra efforts to elicit
  these if
• Cure has to be effected in chronic diseases 95.

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• Besides this,
• Patient themselves differ so much in their
  dispositions
• that
• Some exaggerate while describing their ailments
  96.

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• While other of opposite character
• Refrain from mentioning a number of their
  symptoms
• and minimize their complaints
• Even of serious nature as of no much consequence
• 97.

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• In tracing the picture of chronic disease
• one should have
• Tact,
• Knowledge of human nature,
• Caution in conducting the inquiry and
• Great patience 98.

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• In the investigation of acute diseases
• The physician is also required to note, every
  thing that
• has been said about chronic cases,
• But, since in these cases changes are quite
  recent
• and
• So intense, that
• These are very fresh in the minds of patient and
  his
• friend
• The physician is not required to spend time
• The most part spontaneously described to him 99.

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• Every epidemical disease and
• Even a sporadic disease must be considered as
• Some thing new and unknown and be investigated as
  
• Thoroughly as possible for tracing its picture or
  its
• Totality of symptoms.
• If a physician has to practice earnestly as the
• medicine should be practiced
• He should not substitute actual observations with
  
• conjectures and
• He should always carefully examine every new
• epidemic in all its phases, as he does in
• All new individual diseases.

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• Each epidemic is a phenomenon of unique character
  
• And differs vastly from all previous epidemics
• Exception being epidemic like small pox, measles
  or
• chicken pox etc., 100.

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• It is only by a close observation of several
  cases of every epidemic that
• A physician can become conversant with totality
  of its signs and symptoms.
• However, a carefully observing physician can
  arrive so nearly a characteristic picture of the
  epidemic that on the basis of first few cases
  that
• He can find out a suitable remedy homoeopathic to
  that epidemic (genus epidemics) 101.

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• But by taking down the symptoms of several cases
  of
• the epidemic,
• The picture of the diseases becomes clearer and
  its
• Uniqueness stands out boldly.
• This also help in clearly defining the vague
  general
• symptoms like fever, sleep, headache etc and
  
• Rare symptoms which only few victims manifest in
  the
• entire epidemic.
• Complete picture of the epidemic is only however,
  
• possible
• If the symptoms are noted in several victims of
• different constitutions 102.

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• The misamatic chronic diseases, like fixed
  epidemical
• disease, always remain same in their
  essential
• nature, especially the psora.
• These must also be examined in the same minutest
• details, because in them also one victim
  exhibit one
• set of symptoms,
• While other the another portion of the entire
  picture of
• this misamatic disease
• The whole range of symptomatology of the chronic
• miasmatic disease can only be traced by
• Taking down the symptoms of very many individuals
  
• Of different constitutions.

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• And without this collective picture of the
  disease
• Anti-miasmatic drug can not be found out.
• And if obtained in such manner, it will work for
  number
• of persons affected with chronic affections
• 103.

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• Utility of the detailed written case record
• Noting down in writing, the picture of the
  disease,
• (particularly the chronic diseases), for the
  purpose of
• Curing, and
• In the progress of the treatment for making note
  of
• Remedy response,
• Making the second prescription,
• Ordering auxiliary measures etc. 104.