DIFFERENT AUTHORS VIEW ON CASE TAKING

MODERATOR:
Dr K.SURESH KUMAR REDDY.MD[HOM]
ASST. PROF.DEPT OF SURGERY.
P.G GUIDE.
JSPS GHMC RAMANTHAPUR.

PRESENTER.
Dr K.HARSHA
21THBATCH P.G.
DEPT OF REPERTORY
JSPS GHMC RAMANTHAPUR.

DATE OF PRESENTATION. SIGNATURE OF MODERATOR

Dr K Harsha 21th Batch PG Dept of Repertory page 1

 Case taking is essentially a social interaction between a physician and a patient under
certain pre-determined conditions. A well taken case is half cured. The Homoeopath should
know his patient’s spiritually, emotionally, mentally, physically, and socially.

The primary object of case taking is the collection of data for a prescription on the basis of
Homoeopathic philosophy.The purposes of case taking are:
 To get the knowledge of disease
 To perceive the true dynamic state of the i.e., whether he is seriously ill or not.
 To find out the totality of symptoms for the selection of a Homoeopathic remedy.
 To find out the nature of disease whether it is acute or chronic, curable or incurable.
 To find the causation of the disease.
 To find the mode of development of the symptoms.
 To analyse and evaluate the symptoms i.e.,Mental, Physical Generals, Peculiar, Strange,
Key notes etc.
 To collect all important symptoms for Repertorisation.We repertories the symptoms to
find out Homoeopathic remedy and which remedy scores the highest marks and can be
similimum.
 To cure the curable and to palliate the incurable patients by selecting medicine according
to the law of similars.
 To keep a systematic record of the case for guidance, treatment and future reference and
defence.
 To diagnose the case.
 To give prognosis.

KENT’S INSTRUCTIONS ABOUT CASE TAKING:

Dr. J. T. Kent, in his famous book “Lectures on Homoeopathic Philosophy” has given a
lucid description and useful guidelines about the examination of the patient. The summary of the
instructions is as follows:

1. All the information obtained from the patient should be recorded in the patient's own
words.
2. The case record should be constituted in such a way that the physician can record
symptoms even while talking to the patient.
3. Bystanders, if anxious, do not give correct information.
4. The physician should not put words into the patient's mouth. He should frame collateral
questions and not direct ones.
5. The physician must be able to collect symptoms with regard to pathology, diagnosis,
prognosis and material medica. Symptoms with respect to material medica are the key to
the prescriptions.
6. The physician should set his mind to work instantly to ascertain the condition of the
patient and what relation they maintain to material medica

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 7. The physician should know that anything that affects a change in the symptom like taking
drugs, drugging, too much wine, drinking toddy will mask the case. In such cases, he
should wait a while and then order will begin to emerge and that remedy which was
indicated prior to the drugging will act. He should get the original form of the malady.
8. The circumstances of life and habit must be studied with a view to going into the
slightest particulars.
9. What seem to the patient as 'little' and 'not related' symptoms, are very often
characteristic of the disease, and necessary for the choice of a remedy. Hence a physician
should make note of these symptoms in all cases.
10. When a patient consults a physician, the question of modesty should be laid aside
11. Exaggerators and too lazy patients do not present the true picture of sickness.
12. A physician should never prescribe for an acute and chronic trouble together. He should
select the worse one, and let the other one alone, entirely ignoring it for the time being.
13. Sequelae of acute diseases are psoric disorders and must be treated as psora
14. It is a great mistake for anyone to fit remedies based only on the complaints stated by the
patient.
15. It is a fatal error on the part of the physician to go to the bedside of a patient with the
feeling in his mind that he has had cases similar to the present one. We ought to regard
the pure image of each prevailing disease as a thing that is new and unknown
16. There is order, perfect order, in every sickness that presents it and it rests with the
physician to find that order. The homoeopathic physician need never be taken unawares.

M.L. DHAWALE’S INSTRUCTIONS:

Case taking essentially is a social intercourse between a physician and a patient under certain
pre-determined conditions.
During the course of a successful clinical interview a happy relationship develops between the
two. This has been technically termed as ‘rapport’.
.
Homoeopathic Physician should undertake the training in the following areas-

1.Accurate, unprejudiced observation.

2.Cross-Section Study of the patient.
3.Longitudinal-Section Study of the patient.
4.Diagnosis of the Disease.
5.Diagnosis of the Patient:
6.Diagnosis of the Homoeopathic Remedy:

The requisites of a physician to reach the inner core of the patient and establish rapport are:
 An unfailing love of mankind
 A sincere desire to help his fellow-beings out of their sufferings.
 Performing duty without any expecting any fruits of labour.
 A desire and ability to put in one's best for the patients.
 An unfailing faith in God.

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Obstacles in case taking:
(i) A predominantly materialistic mind is unable to grasp the important role played by
the emotions in the genesis of ill-health.
(ii) The physician who holds fast to the various pathological theories and concepts,
develops his own system of relevance - irrelevance in relation to the story narrated by
the patient.
(iii) Sudden interruption.
(iv) Some physicians just 'can't warm themselves up' for work. They are those 'born tired'
with 'constitutional aversion to work'.
(v) 'Pathological Prescribers'.
(vi) Multi-lingual community
(vii) Over-modesty.
(viii) Attempts at pushing the patient along and frequent glance at the watch will throw
additional cold water and force the patient to withdraw in his shell.
(ix) A highly jovial manner, on the other hand, might be interpreted as flippant and give
wrong notion to the patient.
(x) An inordinately long session is a sure method of boring the patient.
(xi) Precipitate action on the part of the physician may lead to flight on the part of the
patient who may regard the physician as dangerous.
(xii) A condescending manner on the part of the physician can prove very irritating; so
also the use of pedantic words which the patient has some difficulty in following.
(xiii) He should avoid the temptation of pursuing the point when the patient is not
emotionally prepared to face the issue honestly.
(xiv) Interpretation of highly charged emotional material like dreams is at best a risky job;
the physician without adequate specialized training should not enter into this
potentially dangerous field.

Some More Instructions:

Rarely is it possible or advisable to complete the interview in one session, especially when the
emotional side is predominant in the case.

In some instances valuable data are obtained from the relatives and friends of the patient.
Considerable tact is required to obtain this without antagonizing the patient.

The patient should be allowed to come out with his story in full. That will help to establish the
confidence which is essential before any reassurance could have the desired effect.
Questions which indicate to the patient the answer or which require him to answer either 'Yes' or
'No',Questions which are worded in an ambiguous manner. Questions which are too complex for
the meaning to be grasped readily by the patient. Questions on 'Remedy lines', Questions which
interrupt the chain of thought in the patient will prevent him from coming out with a coherent

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account.Insinuating type of questions or the accusing types evoke resentment in the patient.The
same question put twice will indicate to the patient the inattentive physician.

All these will have to be carefully avoided by the physician interested in obtaining an undistorted
image of the patient in his illness.

How to do it:
Skilled Listening.
Skilled Interrogation.
Assessment.

BOGER’S INSTRUCTIONS :

 If every symptom is a little picture reflected from the central disturbance, a composite
picture will most nearly depict the whole. This is what we mean when we speak of the
symptom complex or the totality of the symptoms.
 The individualistic way in which the patient reacts affords the best point of departure for
inquiry into the more obscure yet highly essential details for successful prescription.
 Every patient will show some symptoms from all three (mental, dynamic and physical)
spheres if careful search is made for them, but the symptoms shown will be more
prominently marked in any one of the spheres.
 In taking your case and hunting through your repertories and material medica don’t make
mistake of getting a remedy too firmly fixed in your mind or you count disease.
 As patients present themselves it is the first duty of the physician to observe them closely,
noting the facial expression, manner, mode of action, habits and all external
manifestations. This often gives the key to the whole case without asking a single
question.
 If physician can get at the patient's mode of thinking, his voluntary ideas, he can build up
a picture of his mental process.
 An exciting cause uncovers the underlying strata, often lying dormant for years and is an
important part of the symptom picture. The patient expresses disease, as a unit and not by
scattered symptoms here and there.
 The spirit of the clinical symptom picture is best obtained by asking the patient to tell his
own story, whenever this is possible. This account is then amplified and is accurately
defined by the questioner, who should, first try to elicit the evident cause and the course
of the sickness down to the latest symptom, to which he will especially add all the things
which now seem to interfere with the patient's comfort.

Hierarchy of symptoms to be considered:

I. First- the natural modifiers of sickness- the Modalities- should be very definitely
ascertained. The following are the most vitally important of such influences, Time,

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 Temperature, Open Air, Posture, Being Alone, Motion, Sleep, Eating and Drinking,
Touch, Pressure, Discharges, etc.

II. Second- The mental state comes next in order of importance. Here the presence of
Irritability, Sadness or Fear is the ruling factor.

III. Third- It deals with the patient's own description of his sensations. This is very vital point
and in order not to be misled it is always well to ascertain whether any of the following
primary sensations are present. Burning, Cramping, Cutting, Brushing, Soreness,
Throbbing etc. There may be many others, but the presence of anyone of these often
overshadows them, especially those which may be due to the play of the imagination;
The primary sensation is in itself often of more importance than the particular thing
imagined.
IV. Fourth- Next in order comes the entire objective aspect or expression of the sickness.
This should especially include the Facial Expression, Demeanor, Nervous Excitability,
Sensibility, Restlessness, or Torpor, State of the Secretions and any abnormal coloring
that may be present.

V. Fifth- Lastly the part affected must be determined; which also brings the investigation in
touch with diagnosis.

Particular symptoms which are peculiar, strange or bizarremay appear in any sphere
whatsoever. We need not look especially to Location, Sensation, Modalities, and Concomitants
etc. but rather to the features which make them prominent as individual morbid expressions

ROBERT’S INSTRUCTIONS:

Herbert A. Roberts has given very useful instructions about taking the case in his book, 'The
Principles and the Art of Cure by Homoeopathy'. The summary of his instructions are as follows:

1. The first requisite in taking the case is that the physician must have a case record
2. The attitude of the physician should be one of absolute rest and poise with no
preconceived ideas or prejudices.
3. The physician must not fail to get a picture of the type of ailments from which the
members of his family have suffered. Consanguinity plays an important part in hereditary
tendencies as well as in making a prescription.
4. Special care is to be taken while recording the past history of a patient to inquire about
his recover from each illness.
5. While inquiring into complaints, the physician should continue interested listening until
the patient has exhausted his story. He should take care of the following points:
(a) Avoid all leading questions.
(b) Never ask direct questions.
(c) Never ask alternating questions.

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 (d) Avoid questioning along the line of a remedy.
(e) While dealing with one symptom confine yourself to that symptom alone.
6. The physician must complete, as far as possible, every symptom that has been presented,
and for this, careful questioning is necessary.
7. The source of information must always be scanned with a great deal of circumspection
and he must weigh the integrity of the source as being worthy of consideration.
8. While dealing with an acute condition, the physician should inquire into the acute state
alone, and should not attempt to dip into a chronic state at the same time.
9. There is no time in the history of the case when one sees the picture of the chronic
underlying conditions so plainly as the end of an acute attack.
10. It is eminently necessary that homoeopathic physicians should be task masters with the
art of cross-examination. The observance of every movement and expression of the
patient should be a matter of record.
11. In a chronic case it is necessary to take into consideration the general symptoms-physical
and mental.
12. The physician should not interrupt his patient while he is telling all he has known of his
case, except in case of wandering from the main stream. The physician's questioning
comes afterwards, and it is here that we must complete the picture of the case.

STUART CLOSE’S INSTRUCTIONS:

Stuart Close late professor of homoeopathic philosophy, New York Homoeopathic Medical
College and Flower Hospital, author of ‘The Genius Qf Homoeopathy’ has given very useful
guidelines for examination of the patient in his book. The summary is as follows:

1. The physician should keep in mind that our method of examining a patient varies
according to the particular end in view i.e. homoeopathic prescription.
2. The selection of the homoeopathic remedy is based very largely and sometimes almost
entirely upon the phenomena or deductions drawn from the phenomena of subjective,
conscious experience, perceived only by the patient and stated by him to the examiner,
his friends or the physician himself.
3. The physician must first gain the patient's confidence and relieve him, as far as possible,
from a sense of restraint and embarrassment
4. The physician should try to put the patient at ease by adapting himself to his personality
and mood
5. The physicians attitude should be calm, dignified, but at the same time quiet and
sympathetic; a demeanor confident but not pompous; simple and direct, but not
aggressive; cheerful, but not flippant; serious, but not grave or funeral
6. The physician should not hurry a patient in his narration. He may quietly keep him to the
point and prevent him from rambling inconsequential statements.
7. It is well to keep in mind always during the examination of a case, some working
classification of symptoms –as general, particular and common.

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 8. Laziness, selfishness and ‘easy conscience’ are responsible for more homoeopathic sins
and shortcomings than anything else. A physician should get rid of these.
9. Having all the facts in mind, he should determine what features of the case are medical,
what are surgical, what are psychological, what are hygienic, what are sanitary, etc.

10. The purpose of homoeopathic examination is to bring out the symptoms of the patient in
such a way as to permit their comparison with the symptoms of the materiamedica for the
purpose of selecting the similar or homoeopathic remedy
11. The physician's senses must be on alert, mind clear, logical faculties acute, sympathies
and prejudices held in abeyance.
12. Attention should be directed to the use and importance of logical analysis in the
symptomatic examination of a patient.
13. To discover and bring out the facts of a case and give them form and individuality as a
whole is an art.

FURTHERGUIDELINES ABOUT RECORDING CASE HISTORIES:

Recording a good clinical history is one of the most important parts of case taking. The
following instructions should be followed:

(i) The complete list of patient's previous diseases, in chronological order, their nature,
symptoms, duration, severity and sequelae should be recorded. The kind of treatment
the patient had must be inquired.
(ii) In women and girls, the physician should inquire about the details of menses, the time
and influence of marriage and pregnancies.
(iii) Personal history like vaccination, treatment history, accidents or any mental shock
should be inquired into. The occupation and habits of the patient, diet, exercise, sleep,
use of tea, coffee, tobacco, etc. should be noted.
(iv) It is important to ascertain the family history. A brief history of diseases, causes of
death, predisposition and tendencies to diseases and individual peculiarities not only
of the patient's brothers and sisters but of his father, mother, uncles and aunts and his
grand parents, if possible.
(v) Such thorough examination gives the patient a confidence in the physician's
professional ability and skill.
(vi) A properly and systematically structured case record will facilitate the process of
good history and case taking.
(vii) 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 as
shown in amount of covering. ventilation of room, ice bags, hot water bottles, etc. -
all these, many other little points, noticeable by the alert examiner, perhaps, without

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 asking a question, will be valuable guides in the choice of remedy. They should be
noted.
(viii) The mental state, conscious and subconscious, is revealed by the general behaviour,
the conversation, the expression of the countenance, the desires and aversions and the
manner of sleeping, as well as by the voluntary verbal expressions. Mental symptoms
are of the highest importance.

BIDWELL’S INSTRUCTIONS:

1.It is not simply a matter of recording symptoms found in patient but knowing the value
of symptoms.
2.It is not the disease we want to make record of, it is the individualised diseased patient.
3. The whole aim of the physician is to secure the language of nature.
4. It is necessary to know disease not from pathology not from physical diagnosis,no
matter how important these branches are, but the symptoms, the language of nature.
5. The physician must not only be attentive to what the patient tells and to what the nurse
or family may impart but he/she must observe closely the appearance of the patient himself: the
way the patient lies,sits,walks,talks,conducts himself generally. The appearance of discharges,
the color of eyes,hair,tongue,skin etc all have their place and are of greatest importance in our
record
6.The physician should be aware of the three mistakes made in examining the case
interruption of patient, asking direct questions and making answers confirm to some remedy they
may have in mind.
7.Physicians must allow the patient to tell his symptoms in his own language.
8. In obscure cases the symptoms of which have been masked by drugging, homeopathic
and otherwise operations etc so that these present with only few common symptoms, the
simillimum must be found after thorough study of materiamedica.
9.Symptoms that existed in childhood before any pathology existed are very important to
know the progress of the sickness.
10.The physician should know about the origin, the duration and the progress of the
sickeness.
11.The physician should know three injunctions to cure promptly,mildly and
permanently.
12.The physician should master miasms and theory of vital force to understand the
expression of the disease and health.
13.The physician should not be in a hurry to prescribe on few symptoms without having
understood the full picture.

BOENNINGHAUSEN’S INSTRUCTIONS:

While giving instructions to the distant patient about writing the case history he has
emphasised the following.

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 1. He should get a general image of the patient by stating the age, the sex, the
constitution, mode of living, occupation and especially the disposition when the person was well.
In many cases it is also of importance to know other peculiarities, such as, eg., the complexion,
the color of the hair, leanness or corpulence, whether slender or thickset, etc and this should be
added.
2.Then a brief mention should be made of former sickness passed through, together with
their course and cure, with a remark as to any sequels they may have left. The it is very desirable
to know the kind of treatment used and the medicines that were prescribed.
3.Then the present disease should be described, first in its general outlines, emphasizing
the most prominent or the most troublesome symptoms; then should be given exactly and
circumstantially according to the whole extent of all the symptoms, describing in every case just
how the patient himself, feels, or how those around him observe the matter, abstaining from the
use of technical terms and learned names as far as possible, as there are general in their nature,
while homoeopathy must individualize most strenuously.
4.Then let patient give a complete register of all the morbid symptoms ie and
enumeration of all the sensations and phenomena with the patient which are not seen in a healthy
person. To avoid all unnecessary prolixity and countless repetitions, every symptoms should be
given clearly and completely. with respect to clearness the usually conversational language in
which the internal sensations of the patient may be expressed is at all times the best, and we need
only to take care that all indefinite and therefore inexpressive words, such as pain and ache, be
omitted and instead of them the kind of pain be described in the best known and most
unequivocal expression.

W.M. BOERICKE’S INSTRUCTIONS:

1. Be patient in getting at the symptoms especially in chronic diseases. There is a great

difference between patients some cannot others will not give much aid in analysing their case;
some are morbidly desirous of imparting symptoms and will perhaps, unconsciously, wrap their
statement by exaggeration.
2. Do not interrupt the patient in his first recital too much; lead him on, if he wanders off.
when he has finished, cross examine him, by careful questioning, to supply and deficiencies.
3.Avoid asking leading questions, as far as possible, and not so that the patient must
answer yes or no.
4.Accept no diagnostic suggestions, or pathological theories or former opinions of other
physicians as these can be no guide of the selection of a curative remedy.
5. Be sure and get the modalities, especially the influence of the times of day, weather
season, position of body, exercise, sleep etc.
6. Pay special attention to the mental state of the patient and his intellectual functions.
7.In chronic diseases, especially investigation should be extended to the family history of
the patient; heredity is a potent factor in determining disease.
8.the history of the patients previous diseases, particularly eruption of any kind that may
have been treated with strong local remedies and so suppressed; also as to all forms of local

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treatment generally, and the patient’s medical habits, the use of patent medicines, purgatives,
mineral waters etc.
9. Notice any alternation of groups of symptoms such as gastric and rheumatic
symptoms, rheumatic and catarrhal, bronchial and skin affections etc.
10.Remember that certain bodily conditions have certain mental states- depression and
constipation, anxiety and heart affections, hopefulness and consumption etc.
11. Remember that when a certain train of symptoms are present in some one organ or
apparatus of the body, there are almost sure to be present certain other symptoms, objective and
subjective, in other organs often, anatomically, quite remote and of which the patient probably is
hardly aware until his attention is called to them by the physician. For instance, certain pains in
the head co exist with certain uterine affections, or anomalies of vision, etc.
12. Write down the record of the symptoms , beginning a new line with every symptom.
This will greatly facilitate study and reference to allied remedies.
13. Write down the record of the symptoms, beginning a new line with every symptom.
This will greatly facilitate study and reference to allied remedies.

GARTH BOERICKE’S INSTRUCTIONS:

The history should be taken in the regular manger and then expanded to meet the needs of
our specialized therapeutics. Thus, following the history of the present illness before the physical
examination the patients subjective complaints are listed under four heads in regard to the four
systems of the body. Interrogation under these give the indication for a pretty good homeopathic
remedy as the chart indicates.
Nervous system: alterations or complaints relating to the special senses. General
reaction[hypersensitive, restless and torpid, etc] pain and particular sensations[ causal factor if
known,location,sensation,modality] sleep[type and dreams of marked] vasomotor
phenomena[flushes,chill,sweating,either general or local]
Cardio-respiratory system:pain [location,sensation,modality and concomitants]
pulse[irregular, thready,soft,full etc] sensations other than pain felt in thorax. Dyspnoea[type and
aggravation] cough[modalities and type] expectoration[type and taste]
Gastro intestinal system: tongue[dry,coated,shape] taste, recent cravings or aversions.pain
or sensations[location,sensation,modality and concomitants] eructations[type and whether relief
or not] Thirst. Abdominal pain [same as under pain above] back. Constipation [type of stool].
Gastro urinary system:pains[as above]relation to micturition. Discharges[types,
modalities ,concomitants] menstrual cycle[other body complaints felt at this time also type and
flow]

ELIZABETH WRIGHT’S INSTRUCTIONS:

1. The homeopath must know his patient spiritually emotionally, mentally, physically and
sociologically.
2.The physician must be receptive, must clear his mind of other pre occupations, and
must be tranquil and cordial.

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 3. The physician must allow the patient to tell his own story in his own way without any
interruption.
4. The personality of the patient, his state of mind, physical status, traits of character
should be noted.
5. It is safer for the beginner to list all the symptoms narrated by the patient and observed
by him as they come and sort them out later in the working out of the case.
6. If the patient is loquacious, time may necessitate the prevention of irrelevance and
utmost tact is needed to keep him on the main tract. If the patient is reticent or gives only brief
and objective data, the physican should adopt active questioning.
7. The physician should encourage the patient while he is narrating his story.
8. If the case has not been completed in one sitting, the physician might give the patient a
subsequent appointment. Physical examination and necessary laboratory tests must be done.
9. The physician must run through the list and see which of the possible mentals,
generals, particulars and modalities have not been mentioned and question the patient about each
of these.
10.All the questions the physician asks must be so put that the patient cannot reply with
simple yes or no but must think before answering.
11. The physician must make sure that he has questioned the patient on every system and
function. Otherwise some imported detail will be missed out.
12. The mental symptoms and characteristics of the patient should usually be elicited last
when the patient’s confidence has been more fully gained.
13.The patient must get an impression that the physician is interested in his case.

Bibliography:

1. DHAWALE. M. L. – Principles & Practice of Homoeopathy, 3rd edition 2000, Institute

of Clinical Research, Parekh Street, Bombay. (pages:64-76)
2. HARINADHAM. K. – The Principles and Practice of Repertorisation, 1st Reprint
edition October 2004, IBPP, New Delhi. (page: 17)
3. KENT. J. T. – Lectures on Homeopathic Philosophy, Reprint edition 2002, B. Jain
Publishers (P.) Ltd, New Delhi. (pages:158-178)
4. ROBERTS. H. A. – The Principles and Art of Cure by Homoeopathy, Reprint edition
Sep. 2004, IBPP, New Delhi. (pages: 75-82)
5. STUART CLOSE – The Genius of Homoeopathy, Reprint edition July 2004, IBPP,
New Delhi. (pages:167-182)
6. TIWARI. S. K. - Essentials of Repertorization, 4th edition, Reprint edition 2006, B.
Jain Publishers (P.) Ltd, New Delhi. (pages: 79-90)
7. RAMANLAL P.PATEL – The Art Case taking Of and Practical Repertorisation in
Homoeopathy, 5th edition, published by Dr. J.R.Patel ,Kerala, India.(page:10)

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