Tag Archives: Case taking

By Clemens Franz Maria von Boenninghausen

    “The invisible, morbid mutation in man’s internal and the change in condition perceptible to our senses in the external (the complex of symptoms), form before the eyes of creative Omnipotence what we call disease; but only the totality of the symptoms is the side of the disease, which is turned to the disciple of healing; only this is perceptible and is the main thing which he can know about the disease, and what he needs to know for the purpose of cure:” –Sam. Hahnemann, Organon of Healing. §6, Fourth Ed.

“The invisible morbid change within and the complex of the symptoms perceptible from without and belonging to the disease are as necessarily conditioned the one by the other and constitute the disease in such a unity, that the latter stand and fall with the former, that they must exist together and disappear together, etc...“-Ibid. §11.

“The physician who would investigate the hidden relations in the internal of the organs, may daily make his mistakes; but the homeopath, if he with proper care seizes upon the true image of the complete group of symptoms, has a sure director, and if he succeeds in removing the entire group of symptoms, then he will have surely removed the hidden cause of the disease.“-Royal Councilor Rau, “The homeopathic Method of Healing,” Heidelberg. 1824, p.103.

From the words quoted, which contain an important part of the principles of Homoeopathic Practice, we not only see what the physician must know about the patient, in order that he may be able to make a sure selection among the known remedies, but also why he must know it. One single symptom may it be ever so complete and plainly pronounced can never be the complex of all the signs of a disease, which are externally perceptible (i.e., the whole complex of symptoms), nor enable us to guess the rest. Still less is possible if our aid is asked against quite a general name of a disease, which is not otherwise defined (e.g., headache, eyeache, toothache or bellyache), or against an ailment which includes quite a variety of diseases (as, e.g., convulsions, fever, gout, eruptions or against some troubles like lack of appetite weakness, aptness to take cold, insomnia, etc.), which belong to the common symptoms of disease, which are therefore seldom characteristic.

Homoeopathy can only promise a gentle, sure and permanent cure where it is enabled to oppose to disease that remedy which corresponds with the greatest similitude to all its perceptible symptoms, thus where the physician is completely informed of everything with the patient, which is other than should occur with a patient who is in complete health and is of his age and sex. Of course there are cases where the physician is able after a few questions and answers to determine with certainty the selection of the remedy. But in such a case these must refer to the characteristic points of the remedy, which to the experienced Homoeopath not infrequently are so plainly pronounced that he cannot be in doubt. But only the physician who is familiar with the pure virtues of the remedies and the peculiar sphere of action of each one can judge of this, as in one case a symptom else hardly considered may be characteristic, while in another case it may not have any particular value, and will deserve less consideration.

If, therefore, a patient wishes to report his illness to a physician living at a distance, and enable him to select the suitable remedy, he has to act in the following manner:

1. He should give a general image of the patient by stating the age, the sex, the constitution, modeof 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, e.g., the complexion, the colour of the hair, leanness or corpulence, whether slender or thickset, enc…., and this should be added.
2. Then a brief mention should be made of former sicknesses passed through, together with their course and cure, with a remark as to any sequelai they may have left. Then it is very desirable to know the kind of treatment used and the medicines that were prescribed, and if this can be shown by enclosing the prescriptions used thisshould be given briefly but plainly and clearly.
3. Then the present disease should be described, first in its general outlines, emphasizingthe most prominent or the most troublesome symptoms; then should be given exactly and circumstantially according to the whole extent 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 these are general in their nature, while homeopathy must individualize most strenuously.
4. Then let him give a complete register of all the morbid symptoms, i.e., an 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. Withrespect to clearness the usual conversational language in which the internal sensations of the patient may be expressed is at all times the best, and we need only 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.

With respect to completeness in every case the exact location of the pain in the body (e.g., on the head: the forehead, the temples, the sides of the head, the vertex, the occupied; then also whether on the right or the left side, in the half of the whole of the head); so also the time and circumstances should be enumerated, which have an influence on the aggravation of amelioration of the pains. As to the time the exact times of the day (whether morning, forenoon, afternoon, evening, night, before midnight, after midnight) should be enumerated. So also the periodical aggravation or amelioration as to hours, days, or seasons should be exactly reported. Among the circumstances it should always be stated what influence is exerted by rest or by motion, and by particular, modes of the same (e.g., lying, sitting, standing, walking, running, riding on horseback or in a vehicle, etc.), so also the influence exerted by warmth or cold, the open air and the room, by various enjoyments, by touch, by baring the body, by overheating, by eating and drinking in general, by emotions, by dry or wet weather, by thunderstorms, by daylight or candlelight, etc., as to the aggravation or amelioration of the symptoms.

In order that there may be a natural sequence in the symptoms and that nothing may be omitted, the subjoined rubric of the condition of the patient should be followed, and in every case it should be noted what there is of morbid; in those cases, where there is nothing morbid, we pass it over, but that which is especially marked, should be underscored. Every new symptom begins a new line. The reporter must consider that every special symptom belongs always to one and the same disease, and that the homeopathic physician must view and weigh every group of symptoms even in epidemic diseases, as if it never before existed in the world, and now appeared for the first time.

The subjects to be considered and the order in which they are to be given are the following:

VERTIGO.

• According to its nature(whirling around, falling forward, to the side, backward, in a circle, etc.).
• According to the time of the day(morning, forenoon, afternoon, evening, night, before midnight after midnight).
• According to position and circumstances.
• Aggravated.
• Improved (e.g., on rising from bed or from a seat, on raising oneself up, while moving, while at rest, when stooping, on awaking, before, during or after eating, while riding, during the chill, during the heat, in the open air, in the room,. while walking, riding, ascending, while lying on the back, on the side, while looking upward, during warmth, during cold, during or after stool, after drinking alcoholic beverages, etc.).
• Attendant troubles (e.g., it becomes black before the eyes, nausea and vomiting, yawning, flushes of heat, various pains in the head or the body, bleeding in the nose, weariness and swooning, trembling, etc.).

OBSCURATION.

• According to the sensations(e.g., numbness, unconsciousness, stupidity and dizziness, dullness of the head, staggering, drunkenness, chaos in the head, etc.).
• According to the time of day.
• According to the position and circumstances.
• Aggravated.
• Relieved.

III. IMPAIRMENT OF THE UNDERSTANDING.

• According to its nature(e.g., exhausted by mental work, nervousness, difficulty in comprehending, inability to think, stupidity, delirium, fixed ideas, lack of thoughts, weakness of thoughts, excited fantasy, fanciful illusions, delusions of the senses, inability to remember distraction, insanity, etc.).
• As to the time of the day.
• According to the position and circumstances, aggravated or relieved.

LOSS OF MEMORY.

• As to its nature: diminutionin the memory, weakness, loss, forgetfulness.

INTERNAL HEADACHE.

• According to the sensations(rush of blood, boring, burning, pressure inwards or outwards, pulsation, heat, cold, sensation of looseness, crawling, pressing together, pressing apart, tearing, lancinating, with tension, numbness, digging, as if bruised, drawing, twitching, etc.-every time stating with exactness whether the pain occupies the whole head, or is in the forehead, the temples, the sides, the vertex, the occiput, predominantly on the right side or on the left).
• With respect to the time of the day.
• With respect to position and circumstances.
• Aggravated.
• Relieved.
• Accompanying ailments.

OUTER HEAD.

• As to sensations(e.g., dandruff on the scalp, eruptions of various kinds, burning, painful sensitiveness of the skin, swelling, falling out of the hair, painfulness of the hair, sensation of pulling on the hairs, and on the scalp, heat, coldness, twitching, knots and bumps, pain of various kinds in the bones, shuddering, perspiration, tension, lancination, drawing, twitching, contraction, etc.).
• With respect to the time of the day.
• As to position and circumstances, worse or better.

VII. AILMENTS OF THE EYES.

• As to the sensations.
• On the pupil and on the eye in general.
• In the eyebrows.
• In the cavity of the eyes.
• On the eyelids.
• In the corners of the eyes (everywhere not only with exactness the kind of sensation, as in the preceding, but also exactly the locality, e.g., on the upper and lower eyelids, in the inner or outer corner of the eye, etc.).
• As to the time of the day.
• As to the position and circumstances.
• Improved.
• Aggravated.

VIII. SIGHT, VISION.

• Asto the sensations (dazzling of the eyes, blindness, flickering before the eyes, delusion of the sight as to colors, or as to objects which are not at all present, spots, sparks, mist,. fog, etc., shortsightedness, farsightedness, photophobia, weakness of the eyes, amaurosis, or cataract, dimness of vision, blackness before the eyes, etc.).
• Asto the time of the day.
• Asto the position and circumstances.
• Aggravated.
• Improved.

EARS AND HEARING.

• As to sensations.
• in the ears, various issues from the ear, boring, burning, pressure in and on the ears, changes and sensations inthe glands of the ears, heat, cold, itching, pinching, crawling, tearing, lancinating, tension, drawing, clawing, consistence of the ear-wax, etc.
• In the hearing (e.g., sensitiveness to noise, delusions of the hearing, buzzing, ringing, tingling, hissing, singing, detonations, etc.-diminution in the hearing, hardness of hearing, deafness, etc.).
• Asto the time of the day.
• Asto position and circumstances.

NOSE AND SMELLING.

• As to sensations.
• On the nose (e.g., bleeding of the nose, bleeding when blowing the nose, eruption in or on the nose, various issues from the nose, ulceration, burning, swelling, redness, itching, of the nose, crawling sensation, tension, warts or other excrescences, etc.).
• With respect to smelling (e.g., dulness or total lack of the sense of smelling, sensitiveness of the smell, various delusions as to smelling, etc.).
• As to the time of the day.
• As to position and circumstances.

FACE.

• As to color andexternal appearance (e.g., paleness, redness, various spots, freckles, blue rings around the eyes, yellowness of the face, etc.).
• As to the sensations.
• In the face in general (e.g., eruptions of various kinds, swelling, burning, heat, coldness, perspiration, itching, tearing, lancination, drawing, etc.).
• On the lips (e.g., peeling off, cracking open, bleeding, eruptions, ulcers, burning, itching, spots, swelling, knots, tension, lancination, tearing, etc.).
• On the lower jaw (e.g., convulsive pain, lockjaw, crackling or getting out of joint, various sensations in the glands of the lower jaw, swelling of the bones, tearing, lancination, etc.).
• On the chin (e.g., tearing, lancinations, eruptions of various kinds, itching, burning, etc.).
• Asto the time of the day.
• Asto position and circumstances, worse or better.

XII. TEETH AND GUMS.

• As to sensations.
• On the teeth (e.g., boring, burning, pressure, painful sensitiveness, breaking off and becoming rotten, becoming hollow, yellow or black; itching, cold, heat, pulsation, becoming too long, looseness, gnawing and fretting, crawling, tearing, lancinations, twitches and blows, dullness of the teeth, soreness, drawing, jerking etc.-stating in every case what teeth are implicated).
• On the gums (e.g., bleeding, swelling, ulceration, redness, paleness, itching, drawing, tearing, etc.).
• As to the time of the day.
• As to position and circumstances.
• Aggravated.
• Improved.
• As to the ailments connected therewith, and into what parts, if any, the pain extends.

XIII. MOUTH.

• As to the sensations.(After what has been given so far, further specifications will be unnecessary.)
• In the buccal cavity.
• On the hard or the soft palate.
• In the fauces
• With regard to the saliva. .
• On the tongue.
• With regard to language.
• According to the time of the day.
• According to position and circumstances, worse or better

XIV. APPETITE.

• As to sensations(e.g., aversion to certain kinds of food or drinks, or special fondness therefore, voracity, quick satiety, some kinds of food or of beverages disagree, troubles appearing, after eating, etc.).
• As to the times of the day.
• THIRST.
• As to sensations and circumstances (e.g., during chill, heat or perspiration, thirstlessness, etc.).
• b. As to the times of the day.

XVI. TASTE.

• As to the sensations (various tastes in the mouth, as well during eating as also at other times, and strange taste of some things).
• As to the time of the day.
• According to circumstances, aggravated or relieved.

XVII. BELCHING UP.

• As to sensations (among these things, belching up of food, of water, etc.-with, or without, any special taste, gathering of water in the mouth, heart burn, rising up in the throat, etc).
• As to the time of the day.
• As to position and circumstances.

XVIII. HICCOUGH.

• As to sensations.
• As to the times of the day.
• c. As to the position and circumstances, worse or better.

XIX. NAUSEA.

• As to sensations (vomituria, retching, vomiting of various taste, flabbiness, nausea with a statement as to the part where this is particularly situated, etc.).
• As to the time of the day.
• As to position and circumstances.
• Aggravated.
• Relieved.
• STOMACH AND CARDIAC REGION.
• As to the sensations.
• In the stomach.
• In the pit of the stomach (also here in every case should be accurately stated the sensations, with an avoidance of all indefinite expressions).
• As to the time of the day.
• As to position and circumstances, worse or better.

XXI. ABDOMEN.

• As to the sensations.
• In the epigastrium.
• In the umbilical region.
• In the side of the abdomen and the hypochondria.
• In the region of the hips and loins.
• In the hypogastrium.
• In the whole of the abdomen.
• As to the time of the day.
• As to position and circumstances, worse or better.

XXII. THE OUTER ABDOMEN (the abdominal walls).

• As to the sensations.

XXIII. LAP AND ABDOMINAL RING.

• a. As to the sensations (among these are also ruptures).

XXIV. FLATULENCE.

• As to the sensations, flatulence, its accumulation, incarceration and discharge, with various smells, noise in the stomach, colic.
• Asto the times of the day.
• As to position and circumstances, worse or better.

XXV. STOOL.

• As to quality(diarrhea, constipation, hard, soft, bloody, knotty, sharp, of especial color or smell, mucous, watery, etc.).
• Asto the accompanying troubles.
• Before the stool.
• During the stool.
• After the stool.

XXVI. ANUS AND RECTUM.

• As to the sensations(nature of the piles and the sensations in them, as in general on the inner and outer parts of the anus).

XXVII. PERINIUM

• As to the sensations.

XXVIII. URINE.

• As to its quality.
• As to the sediment.
• As to the discharge (differencein the tenesmus and the micturition).
• As to the accompanying ailments.
• Before the micturition.
• In the beginning of micturition.
• During micturition.
• When concluding micturition.
• After micturition.

XXIX. URINARY ORGANS.

• In the bladder.
• In the urethra.

XXX. SEXUAL ORGANS.

• As to the sensations.
• On the sexual organs in general.
• On the glans.
• On the prepuce.
• On the penis.
• On the testicles.
• On the scrotum.
• On the spermatic cords.
• On the female sexual organs.

XXXI. SEXUAL INSTINCT.

• As to the sensations(excitation of the sexual instinct, lack of it, impotence and weakness of the potency, seminal emissions, emission of the prostatic fluid, abuse, etc.).
• As to the concomitant troubles.
• During and after coition.
• After pollutions.

XXXII. MENSTRUATION.

• As to its quality(returning too early, too late, too weak, too copious, too brief, too long lasting, blood is discharged outside of the period, suppressed menses, quality of the blood discharged, leucorrhea of various kinds, etc.).
• As to the accompanying troubles.
• Before the menses.
• When the menses appear.
• During the menses.
• When the menses are concluded.
• Troubles connected with the leucorrhea.

XXXIII. CATARRH.

• As to the sensations (running coryza, stuffed coryza, quality of the mucus, sneezing, dryness of the nose, nose stuffed up without a cold, etc.).
• As to the times of the day, worse or better.
• As to the accompanying troubles.

XXXIV. RESPIRATION.

• As to the sensations(nature of the respiration as to the smell or sound during respiration, retention of the breath, shortness of breath, with deep respiration, dyspnea, angina, etc.).
• As to the prevention of the respiration.
• As to the time of the day.
• As to position and circumstances, better or worse.

XXXV. COUGH.

• As to quality(with or without expectoration, husky, deep, hollow, convulsive, a small dry cough, whooping cough, tickling cough, etc.).
• As to the expectoration (withrespect to consistence, color, taste, smell and abundance).
• As to the time of the day.
• As to the excitation(as well with respect to the part where the irritation is located as the external circumstances which call forth the cough)
• As to the accompanying troubles.

XXXVI. LARYNX AND TRACHEA.

• As to the sensations.
• As to the time of the day.

XXXVII. OUTER THROAT AND NECK.

• As to the sensation in it, with an accurate description of the parts affected (the skin, glands, muscles, bones, etc.).

XXXVIII. CHEST.

• As to the sensations.
• On the inner chest.
• In the outer chest.
• In the axillary glands.
• In the glands and nipples of the breast.
• In the heart and the cardiac region.
• As to the time of the day.
• As to position and circumstances, worse or better.

XXXIX. BACK.

• As to the sensations.
• On the shoulder-blades.
• In the back proper.
• In the small of the back and the coccyx.
• As to the time of the day.
• As to position and circumstances, worse or better.

UPPER LIMBS (arms).

• As to the sensations(in this case we must not only distinguish the exact spot, the shoulder, upper arm, lower arm, hand, finger, the joints of the shoulder, the elbow, the wrist, and the joints of the fingers, but also distinguish whether the sensation is more in the skin, the muscles or in the bones.)
• As to the time of the day.
• As to position and circumstances, worse or better.

XLI. LOWER LIMBS.

• As to the sensations(here should be observed what was said above as to the upper arm).
• As to the time of the day.
• As to position and circumstances, worse or better.

XLII. GENERAL AILMENTS.

• As to the sensations, here may be enumerated what would not find a suitable place elsewhere, so, also, a general description of the kind of pains or other morbid phenomena (e.g., emaciation, bodily exhaustion, varices, trembling and quivering, attacks of epilepsy, or other illness, lack of sensibility, or supersensitiveness, convulsions, paralysis, swoons, restlessness in- the body, tendency to colds, twitches, ere.), state this with the necessary clearness definiteness and completeness.
• As to the time of the day,keeping in view more the general state of health.
• As to position and circumstances, worse or better; under which heading would fittingly be given a recapitulation of all that belongs here, having an influence on the wholeas well as on the parts.

XLIII. DISEASES OF THE BONES.

• As to the sensations, in so far as they have not before been enumerated, in which case it is sufficient to refer to that.

XLIV. GLANDULAR DISEASES.

• As to sensations, withremarks as given in the preceding rubric.

XLV. CUTANEOUS DISEASES.

• As to the sensations, especially in those cases where the ailment ‘extends over several parts, with an exact description of the kind of cutaneous disease, the eruptions, itching, burning, ulcers, tumors, blisters, spots, herpes, erysipelas, excrescences ., and their progression according to the time and external circumstances. It is of especial importance to know in ulcers, herpes and itching what change occurs after touching, scratching or rubbing of the same and also the nature of the pus in the ulcers.

XLVI. DISTURBED SLEEP.

• As to sensations, time, position and circumstances(stretching and yawning, late in falling asleep, waking up at night, insomnia with its well known causes, sleepiness at various times during the day, morbid sleep, troubles during sleep, somnolence, etc.).
• As to the quality of the dreams with respect to their number, time and subject.

XLVII. STATES OF FEVER.

• Circulation of the blood, as to its nature, time, and the circumstances influencing the same,
• Chill, as to its quality, time of day, circumstances and accompanying troubles.
• Heat in the same way.
• Shuddering, in the same way.
• Sweat, in the same way, but especially with respect to the quality of the sweat, as to its color, consistence and smell.
• Composite fevers, as to their whole characteristic, not only as to the sequence of chill, heat and sweat, but also as to the time of the day, duration, accompanying troubles, and such as precede and follow the attack.

XLVIII. MENTAL DISPOSITION.

• As to its peculiarity (cheerfulness, changeableness, imaginary state of disease, impatience and hastiness, indifference and insensibility, suspicion and misanthropy, lack of determination, irresolution, anxiety and desperation, timidity and fearfulness, dejection and melancholy, sadness and weeping mood, vexation and obstinacy, excitement and irritability, quarrelsomeness, and passionateness, insanity, fury, etc.); for a sure selection of the right remedy, the most plain and definite information is necessary and it should always be particularly mentioned what was the patient’s disposition when well, and how changed through his disease.
• As to the time of day.
• As to position and circumstances, worse or better.

The more complete and faithful the image of the disease is composed in this way, the more safely can the selection of the most suitable medicine for the present group of symptoms be made, and the more surely we may expect help for the same. Only in cases where diseases have been treated with large quantities of allopathic or domestic remedies, there will generally be added to the disease the effects of the medicines, disturbing the image, and in such a case it is absolutely necessary, as stated above, to also inform the homeopathic physician by communicating to him the prescriptions or telling him about them.

In conclusion, I would remark that every time after the completion of the full action of a medicine a new image, of the disease should be taken. It happens at times, though not often, that the symptoms throughout remain unchanged. In such a case at the first presentation one thing or another has been overlooked, and the image had not been presented quite correctly, and the remedy which accordingly was incorrectly selected remained without effect. In such a case it will therefore be necessary to go over the whole image of the disease, one point after the other, and to supplement the presentation by the necessary corrections or explanations.

Most frequently it will be found that in chronic cases which are inveterate, the chief ailing has only been diminished, but still continues, nevertheless when the medicine has completed its action, the concomitant symptoms have suffered such a change that the former remedy will not appear at all applicable any more. In such a case the homeopathic physician can only make a sure selection after having been informed of these changes by a new complete image of the disease. For it is not only taught by experience, but it lies in the nature of all chronic diseases which have in consequence been interwoven with the whole organism, that rarely or never one remedy will cover the whole complex of symptoms; so that it will be necessary in order to destroy the whole malady fundamentally to let several medicines, selected after each report, operate, until nothing morbid may be left.