Organon paragraph 104, “When once the totality of the symptoms which especially characterize and define a case of disease, or in other words the image of any disease has been accurately noted down…then also the hardest work is done.”.
The importance of faithful case taking is thus emphasized by Hahnemann. Paragraphs 84 to 104 in the Organon describe how this should be gone about. With repertory and materia medica study in mind certain points of emphasis may be brought out in reference to such recording.
The writing down of the totality of the symptoms which especially characterize and define a case of disease affords a record for study and reference. As a record it is as essential in true homoeopathic prescribing as an analysis or balance sheet in the field of industry. This application of sound business procedure to the province of medicine is not universal. The jotting down of occasional notes hard to read when cold, or carelessness in permanently filing these pen pictures of the sick individual for future reference or study is seen too frequently in practice.
Some degree of uniformity in case records would enhance our prestige in the medical field. Few patients are unimpressed by the physicians reference to a well kept resume. The value of a complete analysis is only too apparent in the unsuspected legal contingency. Miasmatic study is hopeless without a well taken image of the disease permanently before one for consideration, comparisons, and the nothing of perhaps later modifications.
The integrity of the examination should be above reproach. No amount of repertorial analysis or material medica study can survive a false premise. Time must be taken and care exercised that scrupulous accuracy be observed in every statement in the record. Allowance for exaggerations must be made. Nor must the obscurity due to timid or modest patients be allowed to render a partial or incomplete symptom picture. The patient should not be hurried. The search for an accurate similar remedy picture demands truth in the image created by the totality of the symptoms.
Hence the importance of keeping a free mind as a possible, remedies until all the evidence is in. Questioning with a remedy in mind is one cause of a biased record. To keep the integrity in the picture the examination must be unprejudiced, and the physician should avoid snap judgment during the tasking of the case.
The record should be complete. The relating of troublesome complaints by the patient is by no means sufficient. Symptoms, minor to his mind, perhaps may be characteristic of the disease and hence decisive in regard to the choice of and remedy. There should be minute investigation as to the most minute particulars. States of the mind or mood, especially if there are changes produced by the sickness, are important indeed. Likewise the exact location and character of pain, time, position, circumstances, aggravations, amelioration, and all symptom modifications are characteristic and to be carefully noted.
The physician is seeking an accurate individualization of every single case. To this end the usual habit of life, occupation, domestic relations, diet, nature of discharge, and conditions of sleep must not be overlooked. Some unusual or striking event may have preceded the illness. This circumstance should have careful check and note. In short, no symptoms is without value so long as it be a symptom of the patient or of his parts.
This is equally true in acute cases. Symptoms due to morbid anatomy will not lead not lead to the similar remedy in repertory or materia medica study. The case may be masked or mixed by the previous use of drugs, too frequent repetition, or careless prescribing. In such conditions the examiner should wait until the image of the disease is again definite. A complete record may require several consultations. On the other hand, the characteristic symptoms may be so striking as the quickly suggest the remedy.
When the case has been taken, as previously noted, the use of repertory may be helpful in narrowing the field of remedies to be more closely studied. Here a knowledge of homoeopathic philosophy is essential in evaluation of the symptoms. Briefly put, those pertaining to the whole man, in other words the generals, are first to be considered. There are of supreme importance.
Unless they are to be found in the case record it is difficult to get far, for they serve to individualize and distinguish. Against this list of remedies found by the used f the general and peculiar symptoms, are checked those pertaining to the parts of the patient with all their various modifications. Thus we see the repertory work presupposes a well taken case. Otherwise the labor of repertory may be inaccurate or even mislead. It is never an end in itself. Materia medica study is basic in all good prescriptions.
The image of the sickness as revealed in the case record must have its counterpart in the image of the remedy as found in the provings. Symptoms common to all remedies or all disease are of little discriminative value, and the same may be said for those what come and go merely on occasion. In the materia medica study, as generals, characteristic, symptoms strange, rare, and peculiar and individualizing the search for a similar remedy; again is the necessity the necessity for a permanent, accurate, complete case record absolutely fundamental.
A case of P.P.Wells in which the necessity of a thorough first examination of the patient is shown: A young man came limping in with a cane, he could just step and that was all. He had had what was considered homoeopathic treatment for two years. He had taken Bryonia and Rhus and was no better. There was a suspicion about this young man and so he was asked a plain question and said “yes”. He was given a dose of Thuja 200 and nothing for three months but sugar of milk, and is cured. He had that one dose and nothing more and the secret was in letting that dose alone.
In rheumatism, after suppressed gonorrhoea, Thuja has proved a blessing to many a sufferer, especially articular rheumatism with prostatitis and impotence. The rheumatic symptoms are tearing and biting pains, as if from subcutaneous ulceration. Feeling of coldness and numbness in the parts, like Nux vomica and Pulsatilla.- KENT.