Case Taking

Dr Amrutha R BHMS MD(Hom)

A physician should be able to focus his full attention on observing the facts and the phenomenon of disease. A true observation cannot be done without proper attention. His attention should be that nothing, which is present would escape his notice. Master Hahnemann in his essay “MEDICAL OBSERVER” writes “ True it is, that the careful observer alone can become a true healer of disease.”

                    

  

Medical Observer by Hahnemann

In order to be able to observe well, the medical practitioner requires to possess, what is not to be met with among ordinary physicians even in a moderate degree, the capacity and habit of noticing carefully and correctly the phenomena that take place in natural diseases, as well as those that occur in the morbid states artificially excited by medicines, when they are tested upon the healthy body, and the ability to describe them in the most appropriate and natural expressions.

In order accurately to perceive what is to be observed in patients, we should direct all our thoughts upon the matter we have in hand, come out of ourselves, as it were, and attach ourselves, so to speak, with all our powers of concentration upon it, in order that nothing that is actually present, that has to do with the subject, and that can be ascertained by the senses, may escape us.

This capability of observing accurately is never quite an innate faculty; it must be chiefly acquired by practice, by refining and regulating the perceptions of the senses, that is to say, by exercising a severe criticism in regard to the rapid impressions we obtain of external objects, and at the same time the necessary coolness, calmness and firmness of judgment must be preserved, together with a constant distrust of our own powers of apprehension.

The best opportunity for exercising and perfecting our observing faculty, is afforded by instituting experiments with medicines upon ourselves.

So true it is that the careful observer alone can become a true healer of diseases.

Examination of the patient by Dr Stuart CloseThe technique of an examination for the purpose of diagnosing the disease is quite different from that of the examination for making the homoeopathic prescription.

The examiner should be constantly on the alert and observing while making an oral examination. The patient may be unconscious or delirious; or an infant, unable to talk; or insane. He may be malingering or trying to deceive as to the real nature or cause of his disease. Knowledge of the natural history and phenomena of disease will aid in forming a true picture of the disease.

If the patient is confined to bed, the examiner will observe his position in bed, his manner of moving or turning, his respiration, the state of his skin, color or odor of perspiration, odor of exhalations from mouth or body, physical appearance of excretions, relation of the patient’s sensations to atmosphere and temperature is shown in amount of covering, ventilation of room, ice bags, hot water bottle, etc.,-all these, and many other little points, noticeable by the alert examiner, perhaps without asking a question, will be valuable guides in the choice of the remedy. They should be recorded as such.

In the matter of mood or temper of the mind, for instance, he will be able to judge from the patient’s manner of relating or expressing his sufferings and his behavior toward his attendants, whether he is sad or cheerful; calm or anxious, confident or afraid, indifferent, morose, censorious, malicious, irritable, suspicious, or jealous.

Physical examination should be made thoroughly and systematically findings should be recorded. All these points are covered by rubrics in any good repertory and they must be covered by remedy selected.

EXAMPLES FROM KENT’S REPERTORY

HEAD CHAPTER:

• HEAD – HAIR – gray; becoming
• HEAD – LICE
• HEAD – DANDRUFF – white
• HEAD – DANDRUFF – yellow
• HEAD – HAIR – baldness
• HEAD – HAIR – falling – handfuls, in
• HEAD – HAIR – falling – parturition; after
• HEAD – HAIR – falling – pregnancy, during LACH.
• HEAD – HAIR – falling – spots, in
• HEAD – HAIR – falling – Ears; behind Phos.
• HEAD – HAIR – gray; becoming
• HEAD – HAIR – greasy
• HEAD – HAIR – lusterless
• HEAD – HAIR – plica polonica
• HEAD – HAIR – sticks together
• HEAD – HAIR – tangles easily 

MOUTH CHAPTER: 

• MOUTH – APHTHAE – Tongue
• MOUTH – BLEEDING – Tongue
• MOUTH – CORRUGATED Tongue nat-ar.
• MOUTH – CRACKED – Tongue fissured
• MOUTH – DISCOLORATION – Tongue – black
• MOUTH – DISCOLORATION – Tongue – gray
• MOUTH – DISCOLORATION – Tongue – white
• MOUTH – FLABBY tongue
• MOUTH – INDENTED – Tongue
• MOUTH – LACERATED Tongue
• MOUTH – MAPPED tongue
• MOUTH – PROTRUDING – Tongue
• MOUTH – RINGWORM – Tongue sanic.
• MOUTH – SPEECH – difficult
• MOUTH – VARNISHED; tongue looks as if
• MOUTH – WARTS – Tongue 

TEETH

• TEETH – BREAKING off
• TEETH – CARIES, decayed, hollow
• TEETH – CUPPED – children; in syph.
• TEETH – DIRTY looking
• TEETH – DISCOLORATION – black
• TEETH – DISCOLORATION – yellow
• TEETH – DISCOLORATION – brown
• TEETH – ENAMEL deficient
• TEETH – CRUMBLING
• TEETH – SERRATED 

NAILS:

• EXTREMITIES – NAILS; complaints of – hangnails
• EXTREMITIES – NAILS; complaints of – ingrowing toenails
• EXTREMITIES – DISCOLORATION – Fingers – Nails – black
• EXTREMITIES – DISCOLORATION – Fingers – Nails – blood settles under nails apis
• EXTREMITIES – DISCOLORATION – Fingers – Nails – blueness
• EXTREMITIES – DISCOLORATION – Fingers – Nails – dark
• EXTREMITIES – DISCOLORATION – Fingers – Nails – gray
• EXTREMITIES – DISCOLORATION – Fingers – Nails – livid
• EXTREMITIES – DISCOLORATION – Fingers – Nails – purple
• EXTREMITIES – DISCOLORATION – Fingers – Nails – red
• EXTREMITIES – DISCOLORATION – Fingers – Nails – white – spots
• EXTREMITIES – DISCOLORATION – Fingers – Nails – yellow
• EXTREMITIES – NAILS; complaints of – thick nails
• EXTREMITIES – NAILS; complaints of – thin nails
• EXTREMITIES – NAILS; complaints of – crippled nails
• EXTREMITIES – NAILS; complaints of – curved fingernails Nit-ac.
• EXTREMITIES – NAILS; complaints of – corrugated nails
• EXTREMITIES – NAILS; complaints of – corrugated nails – transversely
• EXTREMITIES – NAILS; complaints of – distorted nails
• EXTREMITIES – KNOBBY – Fingertips Laur. 

FINGERS:

• MOUTH – FINGERS in the mouth, children put
• EXTREMITIES – FELON – panaritium
• EXTREMITIES – EXOSTOSIS – Fingers
• EXTREMITIES – DISCOLORATION – Fingers 

ABDOMEN:

• ABDOMEN – ENLARGED – children
• ABDOMEN – ENLARGED – mothers
• ABDOMEN – HERNIA; ABDOMINAL – Inguinal
• ABDOMEN – HERNIA; ABDOMINAL – Umbilical
• ABDOMEN – HERNIA; ABDOMINAL – Umbilical – children; in – newborns nux-m.
• ABDOMEN – DROPSY – ascites
• ABDOMEN – DISTENSION
• ABDOMEN – BUBO
• ABDOMEN – PENDULOUS abdomen
• ABDOMEN – RETRACTION – Umbilicus

SKIN:

• SKIN – WARTS
• SKIN – DRY
• SKIN – WRINKLED
• SKIN – ULCERS
• SKIN – SORE – becomes sore
• SKIN – MOLES
• SKIN – NEVI
• SKIN – INTERTRIGO
• SKIN – FRECKLES
• SKIN – EXCRESCENCES
• SKIN – ERUPTIONS – chickenpox
• SKIN – ERUPTIONS – herpetic
• SKIN – ERUPTIONS – urticaria
• SKIN – ERUPTIONS – scabies
• SKIN – ERUPTIONS – measles
• SKIN – CICATRICES
• SKIN – CRACKS
• HYPERKERATOSIS – SKIN – THICK – scratching; skin becomes thick after
• TAENIA VERSICOLOR – SKIN – DISCOLORATION – white – spots
• SKIN – DISCOLORATION – yellow
• SKIN – DISCOLORATION – bluish
• SKIN – DISCOLORATION – brown – liver spots
• SKIN – DISCOLORATION – chloasma 

PERSPIRATION:

• HEAD – PERSPIRATION of scalp
• EXTREMITIES – PERSPIRATION – Hand – Palm
• EXTREMITIES – PERSPIRATION – Foot – offensive 

OBESITY:

• GENERALS – OBESITY
• GENERALS – OBESITY – children, in 

EMACIATION:

• GENERALS – EMACIATION – children; in
• GENERALS – EMACIATION – children; in – infants; in
• GENERALS – EMACIATION – Affected parts; of 

EXAMPLES FROM MURPHY’S HOMOEOPATHIC MEDICAL REPERTORY

• Eyes – CATARACT
• Hands – FELON, general
• Perspiration – ODOR, general – aromatic
• Perspiration – ODOR, general – cadaverous
• Perspiration – ODOR, general – fetid
• Perspiration – ODOR, general – honey, like thuj.
• Perspiration – ODOR, general – garlic, like
• Perspiration – ODOR, general – onions, like
• Perspiration – ODOR, general – sour
• Skin – WARTS, general – bleeding
• Skin – WARTS, general – brown Sep. Thuj.
• Skin – WARTS, general – flat
• Skin – WARTS, general – horny
• Skin – WARTS, general – large
• Tongue – BLACK
• Tongue – BLEEDING
• Tongue – BLUE
• Tongue – BROWN
• Tongue – INDENTED
• Teeth – DECAYED, teeth, rotten, hollowed
• Hands – NAILS, fingers, general – brittle, nails
• Hands – NAILS, fingers, general – cracked, nails
• Hands – NAILS, fingers, general – chapped, skin, about the nails NAT-M.
• Hands – NAILS, fingers, general – panaritium, nails