c. The Previous History of the patient bears
largely on the etiology, or causation, of his illness, and deals
with any illnesses the patient may have had. Note in chronological
order all ailments from which the patient has suffered prior to
the present one, with the dates of their occurrence and their
duration: e.g., contagious diseases of childhood; and especially
previous operations or serious illnesses. If the illnesses have
been at all obscure, it is desirable to add a few of the leading
symptoms to prove the nature of the alleged attacks, and in such
instances inverted commas should be freely used. For instance
“rheumatism” is vague terms which may mean any disease
attended by pains in the limbs, such as are due to alcoholism,
syphilis, tabes dorsalis or neurasthenia. The subject of syphilis
should always be approached with delicacy in the case of women.
Indirect information may often be gained by enquiring for prolonged
sore throat, followed by loss of hair, enlarged glands, skin rashes
, etc. In married women, a series of stillbirths, or children
born with eruptions or snuffles, may have the same significance.

Questionnaire

• Have you had any serious illness in the past?
• How did it affect you?
• Any operation or bad injuries?
• Any stillbirth, miscarriage or problem in pregnancy?
• Have you ever been to hospital?
• Have you missed time from work because of illness?
• Have you ever visited doctor before?
• Have you ever had (here list illness possibly relevant
to present complaint)

d. The Personal History must be enquired into
such as:

i. Present and previous occupations;
ii. Previous residence abroad;
iii. The home conditions;
iv. Habits as to alcohol and tobacco and whether alcohol (e.g.,
wine, beer or spirits) is taken between or with meals, because
more harm is done by alcohol before meals (especially cocktails)
than many times the same quantity taken with meals;
v. The appetite;
vi. The state of the digestion and the bowels;
vii. The weight, and whether this is constant, being gained or
lost;
viii. The general state of the nervous system, e.g., depression,
excitability, nervousness;
ix. The orientation of the patient to his (or her) work and to
home life, and whether there are any special anxieties attached
to these;
x. The amount and quality of sleep;
xi. In women, the previous state of the catamenia, and the number
of pregnancies, miscarriages or stillbirths, should be noted.

e. The Family History may, like the previous
history, have a casual relationship to the patient’s illness.
The age and state of health if living, age and cause of death
if dead, of near relations, should always be noted: i.e., father
and mother, brothers and sisters, sons and daughters, also of
husband or wife. Enquiry should also be made as to whether any
members of the family (parents, grandparents, brothers, sisters,
uncles, aunts or cousins) have suffered from tuberculosis, cancer,
acute rheumatism, gout, nervous disease, asthma, heart disease,
apoplexy, and especially those diseases to which the patient himself
seems liable.

Questionnaire

• Are you married?
• Is your wife/husband well?
• Do you have children? (record age & sex)
• Have they ever been seriously ill (record details)
• Have you lost any children? (record age & cause of
death)
• Do you have brothers & sisters (record age & sex)

• Have they ever been seriously ill? (record details)
• Have you lost any brothers or sisters? (record age &
cause of death)
• Are both of your parents living? (if not, give age &
cause of death)
• Have they ever been seriously ill? (record details)
• Do you know of any one in the family with symptoms like
yours?
• Do you know of any disease affecting more than one member
of your family?

f. Social History, question asked under this
heading are designed to uncover anything in the patient’s
personal life, relevant to either the cause or management of his
ill health. We need therefore, to know about his work, hobbies,
habits, environment at home, visits abroad, domestic and marital
life any potential source of mental illness.

Questionnaire

• Are you working?
• What exactly do you do? (record hours, physical activity,
potential hazards, traveling)
• How long you have done this job?
• What jobs have you done before, starting when you left
school? (record as above)
• What do you do in your spare time? (hobbies, sports etc.)

• Are your mealtimes regulars?
• When is your main meal?
• Do you or did you smoke? (record duration, number of cigarettes/cigars/pipes
per day)
• Do you or did you take alcohol? (record type & amount)

• Do you or did you take drugs of any kind? (record type
& amount)
• Have you been abroad? (record where & when)
• Tell me about your home? (rooms, stairs, toilet facilities,
state of repair)
• Who is living in the same house?
• Have any been ill recently?
• Do you have animals at home?
• Have you had any recent worries or stresses?

B. Physical Examination:

1. Here, again, having learned by interrogation
our patient’s chief complaint, we should ask ourselves, is there
any striking or predominant sign or appearance? The importance
of inspecting our patient cannot be overestimated. In these days
of scientific instruments we are too likely to forget to use our
own faculties. By simply using our eyes many important data may
be learned besides the color of the skin, the condition of the
teeth and gums, the general nutrition, the attitude or decubitus,
and the facial expression. For instance, the manner in which a
patient answers questions is often the first clue to anxiety,
and a peculiar mode of speech is one of the pathognomonic signs
of general paralysis of the insane, disseminated sclerosis and
other diseases. Moreover, with experience we can by this means
form a conclusion as to the kind of patient we have to deal with.
Again, never be in a hurry; only by taking time can we fully appreciate
all the points presented to us. This habit of “observing”
the patient is only developed by long practice; it will never
be developed if the young physician allows himself to be infected
by the hurry of modern times.

2. It is important always to commence examination
with that ORGAN TO WHICH THE SYMPTOMS ARE MAINLY REFERABLE. Some
teachers direct their pupils, to examine and report on the physiological
systems always in the same order (first the heart, then the lungs,
then the digestive system and so forth), whatever, may be the
illness.

But such a course has three objections:

i. The student goes about his work in a mechanical
fashion;
ii. If the patient suffers from some serious
disorder, such as peritonitis, he may be exhausted by a complete
investigation of the chest and other parts during the acute illness;
and
iii. Often it is a waste of time to examine all
the organs with equal thoroughness. The same educational advantages
and experience can be obtained by the other method, and in th
at way we come to the most important facts first.

3. In all cases EVERY ORGAN IN THE BODY SHOULD
BE CAREFULLY EXAMINED; for although we may find in one physiological
system sufficient mischief to account for the patient’s
symptoms, the other organs may reveal changes, which considerably
modify treatment, prognosis & even diagnosis. Whatever order
is adapted; the student should not wander from organ to organ,
but examine each physiological system thoroughly before proceeding
to the next.

It is best to get in to the habit of adopting some such order
of physical examination as the following: first, note the general
conditions; second, examine the organ chiefly affected; third
, other organs in the following order: Thorax (heart and lungs),
Abdomen (alimentary canal, liver, spleen and genito-urinary system),
Head and Limbs (nervous and motor systems).

The examination should always be carried out gently and without
undue exposure. In serious cases, especially when the heart or
lungs are involved, it is often well to postpone a thorough examination
of some organs, so as not to risk harming the patient by exposing
or fatiguing him. On the other hand, the young physician should
never allow modesty to prevent his making a through decision.
This rule is more necessary in sensitive patients, but a little
firmness, tact, and a courteous demeanor will generally enable
him to perform what is a duty both to his patient and to himself.

After completing the above schedule, we have to individualize
remedies and patient. The concept of individualization as reflected
in the totality of the symptoms furnishes the only sound basis
for selection of remedy in Homoeopathy practice. Individualization
is another name for a process of synthesis done after the analysis
of an accurate and complete data recorded after observation and
examination of the patient.

As individuality of each man is unique, his reactions to environment
and other factors also vary from man to man. In homoeopathic language
such a concept of a whole and an individual man that is ill, is
expressed through “totality of symptoms” which is
indicative of the deviation from the total state of health.

In homoeopathy the entire examination of a patient is conducted
with a view to discovering not only the general or common features
of the case by which it is classified diagnostically and pathologically,
but also the special and particular symptoms which differentiate
the case from others of the same general class. It recognizes
the fact that no two cases or patients, even with the same disease
are exactly alike. In actual practice the “differences”
are very often the deciding factor in the choice of the remedy.

Homeopathically each symptom of the patient’s sickness
has to be modified by the following factors before going for Repertorisation
/ Simllimum:

• Laterality or sides
• Time-hour
• Modifications-conditions, circumstances
• Extension
• Location
• Character or kind of sensation

In Organon para 83-104, Hahnemann provides the complete instructions
for “Case taking”. ACCORDING TO THE MASTERS, MOST
HOMOEOPATHIC DOCTORS MAKE THE THREE MISTAKES IN CASE TAKING

• Interruption
• Yes or No answers
• Confirming the remedy you want (Pet remedy)

Hahnemann writes

“…..he then makes a note of what he himself observes
in the patient and ascertains how much of that peculiar to the
patient in his healthy state” (para 90 of Organon).

How to Diagnose?

It is always important that how the data elicited may be utilized
in order to arrive at Diagnosis. An attempt is made to find a
single diagnosis which will account for most or all the facts
of the case. If some facts do not fit the pattern appropriate
to diagnoses, their accuracy must be checked and the original
diagnosis reviewed before two or more separate diagnosis are postulated.
A complete diagnosis would describe the patient’s illness
in terms of the site (Anatomy: where?), nature (Patho-physiology:
what?) and cause (Etiology: why?) of the disease process. In most
instances, however, the physician has to satisfied with a differential
diagnosis which admits to more that a single possible answer to
one or more of these questions. The alternative diagnosis should
be listed in order of probability and reasons given in support
of the one which is preferred.

When considering the differential diagnosis, priority must always
be given to the problems for which the patient sort medical advise.

C. Special Investigations:

Having arrived at a tentative diagnosis, it is always advisable
to confirm (where ever applicable) this by the use of X-rays,
pathological tests, and other special methods of investigations
. These should only be used in confirmation of a clinical diagnosis
and should never replace the interrogation and physical examination
of the patient in the search for a diagnosis.

References

• Organon of Medicine 6th Edition
• Savill’s System of Clinical Medicine
• Chamberlain’s Symptoms and Si gns in Clinical Medicine