Case taking servers the most essential part in the study of Repertory. If case taking be imperfect the data collections will be wrong. Wrong data will produce wrong results i.e. remedy. So we must be well conversant with the different aphorisms where Hahnemann has placed the hints about case taking in his renowned book ‘The Organon of Medicine.’ About case taking through mainly detailed in $72-104 but is scattered in different aphorisms in the whole of the Practical part in this book.
In Organon of Medicine $ 71, Hahnemann says, “The operation of curing is compared in three points”, of which first is case taking. In Organon of Medicine, he has detailed it as follows:
“How the physician is to ascertain what is necessary to be known in order to cure the disease?”
The whole case taking has been detailed by Hahnemann in his Organon of Medicine from $72- $104, dividing it mainly into 2 divisions.
1. Knowledge of disease ($72-82).
2. Case taking proper ($83- 104).
Without the knowledge of the disease, the Case taking will be imperfect. So classified and explained the different kinds of diseases first. This may be Schematised as follows:
Knowledge of the diseases (Sec. 74-82)
Acute Disease ($$72-73) Chronic Disease ($$ 74-82)
Individual Sporadic Epidemic Artificial Pseudo True Conclusion
($ 72) ($ 73) ($ 73) ($ 74- 760 ($ 77) ($ 78-81) ($ 82)
Metric Telluric Recurrent Non- Rec Psors Syphilis Sycosis
(80-81) (79) (79)
Curable Non- Cur.
The Scheme of Case taking proper may be sketched as follows:
Case Taking Proper
General directions Chronic Cases Acute Cases Next duty of Physician
($ 83-93) ($ 94- 98) ($ 99- 102) ($ 103-104)
The general direction is schematised
Patient coming directly ($ 83-90) Patient from physician ($ 91-93)
Patient coming directly has been discussed in 8 aphorisms ( 1st Part)
1. Physician’s special qualifications ($ 83).
2. Expression of patient and its important parts recordings ($ 84).
3. Fresh line- Separately arranged ($ 85).
4. More precised information ($ 86).
5. No Suggestive questions ($ 87).
6. Questions of parts not detailed and of Mental Symptoms ($ 88).
7. More special questions ($ 89).
8. Observations and assertions ($ 90).
Patient from other Physician has been discussed in 3 aphorisms as the 2nd Part.
1. If it is a slow case ($ 91).
2. If it be of rapid course ($ 92).
3. If be by some obvious cause ($ 93).
Special direction for taking up the Chronic Cases ($94- 98)
Coming directly ($ 94-97) Reported by others ($98)
Circumstantially and General Hypochondriac Indolent Patient
Lesser accessory symptoms directions ($ 94) patients ($ 96) ($97)
Direction for taking up the Acute Cases may thus be Schematised (99-102)
Individual ($ 99) Sporadic and Epidemic ( $ 100- 102)
Consideration as on Unknown Characteristic portrait Abstracts ascertained from several
One ( $ 100) be obtained ($101) patients ($ 102)
Next duty of Physician is schematised as follows
Psora must be investigated ($ 103) 1. Picture of the disease
2. Recording ( $104)
In acute cases: ($ 82)
1. The Chief symptoms strike us.
2. It becomes evident to the senses more quickly.
3. Much less time is required for tracing the picture of the disease.
4. Much fewer questions are required to be asked.
5. Almost everything is self-evident.
In chronic diseases:
1. It is gradually progressing for several years.
2. Symptoms are much more difficult to be ascertained.
The demands of the physician or the extra qualification of the physician should as follows: ($ 83)
1. Freedom from prejudice.
2. Sound senses.
3. Attention in observing.
4. Fidelity in tracing the picture of the disease.
5. What is applicable in each individual case of disease?
The process of writing down symptom during case taking will be as follows.
1. The Symptoms should be written in 3 steps ($ 84-85).
a) Patient’s detainments.
b) Attendant’s reports.
c) Physicians Observations.
2. Very expression of the patient and his friends should be written down accurately.
3. The Physician keeps himself silent and must not interfere during their detainments unless they wander off to other matters.
4. The Physician advices him to speak slowly.
5. The Physician should take down only the important parts of what the speakers say.
6. The Physician should begin a fresh line with every new circumstance mentioned by the patients and his attendants, one below the other, and later subsequently when more explicitly explained, be added up.
For having more precise information in case taking the Physician reads over the symptoms as they were related to him, one by one, and about each of them he enquires for further particulars as follows ($86).
1. Location, 2. Sensation, 3. Complaints, 4. Modalities,
5 Concomitants, 6. Duration, 7. Causation, 8. Extensions,
9. Time of occurrences.
The Physician must not frame his questions to suggest the answer to the patient. ($87).
If the Physician asks suggestive questions, the answer will be in most cases “Yes” or “No”. These will ($ 87).
1. Mislead to answer in affirmative or negative.
2. These will be something untrue.
3. These will be half-true.
4. These many not be strictly correct.
5. This sort of answer may take place due to the indolence of the patient.
6. This sort of answer may be made to please the interrogator.
7. This sort of answer will produce a false picture of the disease, and an unsuitable mode of treatment then must result.
Then we will have to collect the symptoms of the parts not detailed before or we will have to enquire in to the state of disposition of mind.
In doing this, the Physician only makes use of general expressions, in order that his informants may be obliged to enter into special details concerning them. ($ 88).
If the physician feels he has not yet gained all the information he needs, he is at liberty and obliged to ask more precise and more special questions ($ 89).
Hahnemann in his Case taking chapters has also advice for any manual or mechanical or laboratory examinations and diagnosis and prognosis by the following sentence.
“He then makes a note of what he himself observes in the patient and ascertain how much of that was peculiar to the patient in his healthy state”.
The discussions may be made in two steps ($ 90).
1. Observation of the Patient- includes mechanical manual and laboratory examinations. Mechanical examination, includes- Examination by instruments e.g., Stethoscope, hammer, needle probe, auroscope, E.N.T- Set etc.
Manual examination includes- palpation, percussions, and inspections.
Laboratory examination includes examinations chemical, microscopically and others of stool, urine, blood, sputum, X- Ray etc.
2. Assertions- may be divided into Diagnosis and Prognosis.
The Diagnosis may be by the modern conception of the disease- the names of different diseases as per their Pathological States etc. Typhoid, Pneumonia, Malaria, Diarrhoea, Cholera etc. or by Homoeopathic nosology e.g. Acute diseases, Chronic diseases, and their individual types e.g. Epidemic, Sporadic, Pseudo chronic, artificial, True etc, to intermittent, Mental Loyal etc.
The Prognosis also may be done in both ways.
By modern way- for the next coming diseases or the effects.
By Homoeopathic thinking- curable or incurable, the processes of developments to take place after the application of medicine.
One more important point to be thought of in the language of the above quoted lines- “How much of that was peculiar to the patient in his healthy state “the word peculiar carries a great weight in Homoeopathy. Homoeopaths deal with the peculiar and uncommon symptoms, which help the Physician to select the correct medicine for the patient. Homoeopathy says “Treat the patient and not the diseases,” confirms the above statement “peculiar to the patient in his healthy state”, i.e. that peculiarity of the symptoms should be composed. So in the patient that in his healthy state also, he will produce the very symptom, and hence will be considered as patient own symptoms.
Next Hahnemann explains about the procedures. To explain nicely the patient coming from other physician- he classified them first and then detailed the method in the following ways.
When the patients coming from other physicians’ hands can be classified in the following 3 ways.
1. If it be slow case. ($ 91)
2. If it be of rapid course. ($ 92)
3. If it be by some obvious causes. ($ 93)
1. If it be a slow case- The symptoms and feelings of the patient during previous course during of medicine do not furnish the pure picture of the disease. The physician requires uncontaminated symptoms i.e. the physician requires:
a) Symptoms and ailments, which he suffered from before the use of the medicines.
b) Symptoms and ailments after they have been discontinued the medicines for several days.
So when such a slow or chronic case comes from other physicians’ hands he must judge the above two points. If the patient comes after taking the medicines whose actions are still going on, he will take the following measures:
a) The physician leaves him some days quite without medicine.
b) The physician administers something of an unmedicinal nature and defer to a subsequent period.
c) After the subsequent period, he takes up the case as per direction set up in the case taking of the chronic cases with the general directions.
2. If it be of a Rapid Course- The physician must not follow the above advice, because.
a) The serious character admits of no delay.
b) The physician cannot ascertain what symptoms were present before the employment of medicine.
c) The complete picture of the disease will then be the conjoint malady formed by medicinal and original diseases and hence is more serious and dangerous.
Here the patient demands prompt and efficient relief. So the patient should
i) Trace out the complete picture of the disease, i.e., conjoint malady formed by medicinal and original disease.
ii) Amply apply a suitable Homoeopathic remedy by the conjoint totality.
Thus the patient shall not fall a sacrifice to the injurious drugs he has swallowed.
3. If it be by some obvious cause- In either acute or chronic cases, the patient or his friends are questioned privately, then,
a) Either they will mention it spontaneously.
b) They will tell everything when carefully interrogated.
Then Hahnemann has grouped the patients for taking up the case, when the disease is a chronic one.
He has grouped the chronic cases, mainly into for proper cases taking ($ 94- 97).
1. When the patient appears himself.
2. When the patient does not appear and is reported by others.
Hahnemann has first of all given a general direction for taking up the case when the patient appearing himself followed by another aphorism about the patients’ with “Lessees Accessory Symptoms”.
He also has subdivided the patients of special types into two:
1. Hypochondriac patients.
2. Indolent patients.
Lastly Hahnemann details some special direction for taking up a chronic case as follows.
The physician considers and scrutinises the particular circumstances of the patient with regard to ($ 94).
1. His occupation.
2. His usual mode of living.
3. His diet.