DUNHAM C., How To Case Taking (dh5)
Symptoms and their study
For, gentlemen, in accordance with Hahnemann’s instructions, no less than with the common sense of the matter, we include under the term “symptom” every phenomenon presented by the patient which is a deviation from, or an addition to, his condition when in average health.
whatever we can ourselves observe by careful scrutiny of the patient, bringing to our aid every instrument of observation which the ingenuity of man has contrived; whatever the patient can tell us as the result of his observation of himself or of his sensations; whatever his friends and attendants have noticed concerning his appearance, actions, speech and condition, physical or mental, which differs from his condition and actions when in health-all these phenomena together constitute what we call the symptoms of the patient.
Hahnemann directs us to acquaint ourselves with every deviation from the patient’s normal, healthy condition which we can observe; to gather from the patient’s friends and attendants all of a similar character that they have observed; to listen to the patient’s statement of everything of the kind which he has noticed, and of all unusual sensations and pains which he has experienced, and all unusual phenomena of which he has been conscious, whether of body or mind.
You will perceive that here are two classes of phenomena referred to, viz. : such as may be observed by the physician or attendants and friends, and such as are perceived and can be stated only by the patient himself. The former, which may be the objects of study and observation by the physician, are called objective symptoms. The latter are the subjects of the patient’s own consciousness, and are styled subjective symptoms. We may notice and study the spasmodic twitching of the facial muscles, the alternate flushings and pallor in a case of facial neuralgia, but the patient alone can make us aware of the sensation which he experiences simultaneously with those twitchings and flushes
-but the patient alone can tell us that he suffers from a stitch in the side, where it is, what direction it takes, what provokes and aggravates and what relieves it.
but only the patient could have made known to us the failing strength of body, mind and will, the peculiar headache and the desolate sense of illness which, perhaps many days preceding the commencement of the doctor’s attendance, began to take possession of him.
The patient is before us – the object of our observation and inquiry, just as the healthy human being is before us when we study his constituent tissues and organs and their respective functions in pursuing the sciences of anatomy and physiology. We observe his objective symptoms and learn from him his subjective symptoms.
A fact of prime importance for us to remember at the outset of our inquiry is this : that as in nature there are no accidents, so there can be no symptom which is not directly the result of some immediate cause operating in the organism, so small observations are very important.
BOGER, C.M. 1951?
Taking the case
The proficiency of the physician’s daily work, rather than the flash of genius which makes an occasional brilliant cure, is the final measure of the successful practitioner. His abilities will very largely depend upon the powers of observation and proficiency in details.
The location
Different drugs affect different parts, tissues and functions of the organism, but the final reason why one depresses and another excites, or one either heightens or lowers activity according to dose and circumstances, remains substantially unknown in spite of researches into drug affinity which seemingly push it further and further into obscurity.
The study of regions implies a discovery of the seat of the disease and of the remedies related thereto. A large number of drugs are known principally by their regional effects; many of them are imperfectly proven and crudely applied because their drug image is not well rounded out. They are often prescribed for specific, antipathic, palliative or suppressive effects. This is especially, although not exclusively, true of the use of low potencies or crude drugs.
The origin
In ordinary parlance we speak of the etiology of disease, but for us these old school ideas are far too narrow because the radius from which we draw our information is wide and may include any influence whatsoever. Things, in themselves apparently very trivial may become of the greatest import when related to the beginnings of disease. Sickness arises from extrinsic as well as autogenetic causes. The former are in a general way more accessible and therefore more accurately defined. They embrace the susceptibility to certain external influences which pervert the vital force, injuries, the state of the weather, heat, cold, dampness, physical exertion, etc.
Taking the case
Autogenetic causes often have mental states as their starting point; the effects of grief; worry or fright are good examples. Emotional states may be the beginning of a long train of untoward manifestations for which the similimum cannot be perceived until they are given a proper place in the pedigree of the disease and as the mind does not always readily disclose such things they may be difficult to discover.
Whether the causes come from without or arise from within, the homoeopathic simillimum cannot be chosen with safety without taking them fully into account. The great miasms belong to this class.
The modality
Closely related to the cause, are the circumstances under which disease, and the conditions which modify it, makes its appearance. These are commonly known as the modalities; they individualize, the most suitable medicine cannot be chosen while they remain unknown. They include such modifying agents as the effect of posture, the different kinds of motion, the various forms of heat and cold, the effects of the weather, or bathing, washing, getting wet or any modifying agent whatsoever. Many odd or strange modifying influences also occur; they belong to but few remedies and are not often seen in practice, but possess the highest value. A striking instance of this kind is found under Clematis which has an eczema which is moist during the increasing moon but dries up during the waning moon. We now know that this modality belongs almost exclusively to Clematis and that any symptoms having it will almost certainly belong to this great antisycotic, whether it be a skin eruption or a goitre.
The mind
The mind is a subjective as well as an objective index which reveals the bias which rules the whole case. Rarely do we see a mental exaltation or depression coupled with an opposite physical state, but when we do its remarkableness points the indication. The relative activity of the intellect combined with its moral trend is an invaluable aid and should always if possible be ascertained.
A study of the mental symptoms should include the gross objective changes noted by the attendants as well as a close scrutiny and interpretation of the speech, action and countenance by the physician, for the mind mirrors itself with great accuracy in the different modes and manners of physical expression. An intonation of the voice may sometimes explain the source and meaning of a particular symptom, so intricate are the mental processes. It is to be remembered that changes in the ordinary moods are points of departure whose value depends upon their variation from the normal or everyday condition.
The concomitants
As a group the concomitants contain many anomalous and peculiar symptoms. They are often so distinctive of a remedy as to render the name of the disease under which a peculiar symptom may occur of little moment. Nevertheless the modalities, mental accompaniments and duration of an unusual symptom govern its position.
When these go to make up an harmonious picture it becomes a true characteristic, otherwise it has only a negative value.
Sometimes the affected organ seems overwhelmed by the impact of the disease and the vital powers can find expression through the concomitants only; then they become of supreme importance as the almost sole guide for the selection of the remedy.
The value of a concomitant is often fixed by its age. The acute or more recent ones are of course the most guiding, for within their genesis lies bound up the type of the similimum. Remedies suitable for acute vital disturbances stand in an accessory relation to the constitutional or antipsoric (miasmatic) drugs.
They are capable of correcting the irregular expenditure of energy which may temporarily be imperiling the life of the patient but are mostly impotent to remove the great fundamental dyscrasias which they nevertheless have the power to uncover or arouse into activity.
The peculiarities
In making an examination it is generally best to allow a free statement of the case in the patient’s own way while we take pencil memoranda of the salient points, gradually filling in the deficiencies by such questions as the notes suggest.
As every sickness, whether natural or induced, is the child of a combination of events which never again produces its exact self, it follows that the best indicated remedy is the one holding the closest similitude thereto in location, origin, modality, mental condition, concomitants, peculiarities and time.
Objective phenomena, being exempt from self-interpretation and allowing the largest scope to the acumen of the examiner are withal the least deceptive and should receive our first and best attention. They teach lessons not to be learned elsewhere, and by their great utility have contributed much to the brilliant success of Homoeopathy, particularly in the diseases of children. The facial expression, the involuntary posture, the temperature both localized and general, alterations of colour or consistence, the state of the reflexes including sensibility, the odour of the patient, etc., are but a few of the points to be noted. Nothing should escape the observer, for faulty examinations are the main cause of failure.
Most subjective symptoms have an indefinite character or are common to many disorders, therefore deserving of little attention. It is only when an ordinary symptom appears in an extraordinary place or way that it becomes of much value.
Sensations are expressed according to the mentality of the subject and vary from the simple indefiniteness of those of childhood to the hysterical loquacity which takes on every symptom thought of: it therefore follows that the attributes of the symptoms are of far greater importance than the sensations themselves. In certain cases by paying more attention to the time, manner and circumstances under which a given symptom occurs we succeed in not only diverting the mind of the patient, but in gaining a great deal of very valuable information.
Every sickness possesses a more or less definite individuality which is reflected by those symptoms which in their nature epitomize the various attributes of the whole case, the characteristics. (the GENIUS of the case)
The time
Symptoms which return at stated times become important in proportion as the sickness of which they form a part diverges from the malarial type or is not connected with naturally periodical functions.
A few remedies have such a remarkably exact periodicity as to distinguish them from among all the ordinary anti-periodics, but in spite of this, they have not been found to be even as frequently useful in intermittants as many others having a much less marked periodicity.
There are certain other remedies which exhibit their action during a more or less definite time of the day; among the most prominent are Natrum mur., 10-11 p.m. ; Apis, 3 to 5 p.m. and the well known Lycopodium from 4 to 8 p.m.
The different divisions of the day have a large number of medicines each, from among which a few stand out prominently. We have Pulsatilla in the evening; Rhus tox. and Arsenicum right after midnight and many more.
The action of some medicines coincides with the time periods of the sun, moon or the seasons, and thus affords peculiar differentiations by which we may pick them from among others. That drugs may also exhibit cycles of action corresponding to other planetary influences seems very reasonable but has as yet not received much attention.
Many plants are known to show certain manifestations at particular hours of the day. According to the doctrine of signatures they have a meaning for us if we are only wise enough to see and use them. When we bear in mind that the universe moves forward in obedience to laws which work harmoniously and that every part thereof bears a definite relation to every other part, no fact however insignificant remains without value. Such things are the little hints thrown out to attract our attention, the rest we must do for ourselves.
In conclusion
As the
preservation of health depends largely upon an harmonious mental as well as
physical adjustment to our surroundings we as healers of the sick must perforce
remember that our dealings are with vital processes indissolubly connected with
the expenditure of force gathered and stored by the human economy from food and
from the media in which it moves. That the intake of energy cannot be shown
equal to the outgo need only trouble the materialist, for we do not live by
bread and meat alone (wheat grass and raw foods alone) and the inflow from
the infinite is measured by the capacity to receive.
The common parent to our ills is ignorance, and when the future once reveals a just apprehension of our natural position and we live to fill it, the similimum will be less frequently called into requisition.
Observation on prescribing
The better we know our original materia medica the less will we feel the need of newer and but partially proven drugs
The sum of Hahnemann’s incredible labours is before us and we should not fail to avail ourselves of this great store-house of homoeopathic knowledge, that we may actually cure and not trifle with disease.
Only by means of its masterful materia medica, has homoeopathy been able to meet every emergency and weather every storm without changing its basis of action. This alone stamps the development of the law of cure as one of the world’s greatest achievements, and also as sadly discredits the peculiar shiftiness so characteristic of regular medicine which by the way is the delectation of the punsters as well as the despair of suffering humanity.
Detecting obscure mental twists is a very helpful part of our work, especially because these things permeate and colour the whole fabric of the patient’s being. Be he secretive, prideful, arrogant, cynical, careless, amative or what not, his traits betray his basic predilections and largely motivate his actions, thereby affording one of the surest indications for the most suitable remedy.