Keywords
Observation, Case Taking, Refining, Regulating, Perception, True Healer
Abstract
Observation is the act of watching somebody/something carefully for a period of time, especially to learn something. [1] Master Hahnemann in his essay ‘Medical Observer’ writes, “True it is that the careful observer alone can become a true healer of disease”. The duty of the observer is only to take notice of the phenomenon and courses of the disease. His attention should be such that, nothing which is present, would escape his notice. Attention is required in observing so that what he observes is understood exactly as it is. It must be chiefly acquired by practice, by refining and regulating perception of senses. Hence it is true that only a careful observer can be a true healer. [3]
Introduction
Firstly, what is case taking? Master Hahnemann defines it as an individualizing examination of a case of disease. Case taking is a unique art of receiving information from a patient as well as from bystanders to define the patient as a person and diagnose the disease. [3]
Depending on the circumstances and the patient’s condition, sometimes the observations made by the physician or the narration by the patient or information provided by the attendants alone may be sufficient to define the problem of the patient. And hence observation plays a significant role for a homeopath in successful case taking. [3]
Observation and Homeopathy
Master Hahnemann realised that the medicine practiced at that time did much harm and instead of giving relief it increased the suffering of patients. So he gave up on his practice and started the work of translation. Around 1784, he made his living chiefly as a writer and translator. While translating William Cullen’s ‘A Treatise on the Materia Medica’, he encountered a paragraph which stated the curative power of ‘Cinchona’, the Peruvian bark in treating malaria because of its ‘astringency’ (bitterness). He believed that other astringent substances are not effective against malaria and began to research cinchona’s effect on the human body by self-application. And as a result it produced malaria-like symptoms in him. He concluded that cinchona cured malaria in the sick because it can also produce the malaria-like symptoms in a healthy person. Thus he gave the principle of ‘Similia Similibus Curenter’.
This was only possible because of inquisitive observation of Master Hahnemann. Thus it is understandable that from the beginning of homeopathic science, how much significant role observation plays in homeopathy itself.
Master Hahnemann’s View On Observer:-
In his lesser writings of “The Medical Observer” he has stated that- “In order to be able to observe well, the medical practitioner requires to possess, what is not to be met with among ordinary physicians even in a moderate degree, the capacity and habit of noticing carefully and correctly the phenomena that take place in natural diseases, as well as those that occur in the morbid states artificially excited by medicines, when they are tested upon the healthy body, and the ability to describe them in the most appropriate and natural expressions”.[2]
In Organon of medicine he has also stated aphorism about how an observer must be unprejudiced- Aphorism 6 – Unprejudiced observer [4]
Observation is regulated perception of events under conditions presented by Nature. It is perception with a definite purpose. Observation is finding a fact. But if we want to be true seekers of truth we must develop strict “intellectual morality” of recording all facts that come to our notice, instead of reading into things our preconceived notions. Our observation is apt to be vitiated by two factors, non-observation and mal-observation. [4]
In non-observation we do not observe something and in mal-observation we observe a thing wrongly.[4] For example if there is a patient who has fair skin and fatty, flabby body so there will be a prejudice that the patient must be Calcarea Carbonica only and will try to form a picture of Calcarea Carbonica even if is not.
So an observer must be free from all bias, preconceived notions and ready to accept facts and truths induced from them, even if these truths are radically opposite to those purposefully held. [4]
Hahnemann holds fast to observation of phenomena, which if correctly and completely recorded, minimises the chances of error. [4]
In order to form the true and only conceivable portrait of disease, the physician should be able to collect all perceptible signs and symptoms of a disease through his sound senses. [3]
A physician should be able to focus his full attention on observing the facts and the phenomenon of disease. A true observation cannot be done without proper attention. [4]
He gave a few points in favour of observation:
-The medical practitioner requires possessing the capacity and habit of noticing carefully and correctly.
-He should direct all his thoughts upon the matter in hand and should come out of himself.
-Great patience supported by the power of will, should sustain him.
-The best opportunity for exercising and perfecting our observing faculty is afforded by instituting experiments with medicines upon us.
-He must restrain himself from poetic fancy, fantastic wit, speculation, overstrained reasoning, and forced interpretation and from a tendency to explain things. [3]
A physician should be able to translate his observation into words by using the most appropriate expressions. Intensity, circumstances, association and other details of all expressions must find a place in the record without changing its meaning. Notation should be candid and in the patient’s own words as far as possible. [3]
In Aphorism 90 Hahnemann stated that: “The physician observes and makes note of the patient’s behaviour, facial expression, dullness, way of answering and other detailed findings during physical observation. He should contrast these with those that existed during his healthy state to differentiate whether the findings are a part of the disease or a part of his constitution. This also helps to understand true concomitants of disease.” [3]
Other Views
According to George Vithoulkas– In ‘closed’ patients who provide very few symptoms, objective observations take on added importance. The physician must note down every gesture, every nervous action, etc. – restlessness of fingers, restlessness of body or feet, excessive irritability, loquacity, the time taken to answer questions, difficulty in finding right words, easy blushing of face, facial expression, swellings around eyes, colour of skin, falling of hair, biting of nails, timidity of expression, perspiration of palms or body, odours etc. [5]
Objective observations are important guides in infants, unconscious patients, insane, deaf and dumb patients, and patients with a different language.
Here observation again plays a crucial role. As for example:
1. Great anguish and restlessness; changes place continually. –Arsenicum album
2. Fears death but believes that he will soon die; predicts the day. –Aconitum napellus
3. Fears touch, or the approach of anyone. –Arnica Montana
4. Takes cold at every change of weather. –Calcarea carbonica
5. Quincy suppurating tonsils from every cold –Baryta carbonica
6. Agonizing cutting pain in abdomen causing patient to bend over double –Colocynthis
7. Cannot bear anything tight anywhere. –Lachesis mutans
8. Consolation aggravates. –Natrum muriaticum
9. Weeps easily. –Pulsatilla pratensis
10. Motion always “limbers up” the Rhus patient, and hence he feels better for a time from a change of position. –Rhus toxicodendron
11. Sinking feeling in stomach at about 11 a.m. –Sulphur
[6]
Dr. Farokh J. Master has written in one of his articles and editorials in 2006 on “Random Notes on Pediatric Case-Taking” about non-verbal symptoms or observation of the child that- How does the child sit; how does the child stand; how does he walk; what clothes he wears; whether he wants a cap or he wants a coat; he wears a shoe or he does not wear a shoe; his behavior; his gestures; his body language; the color of the hair; the color of the eyes; the discoloration of the tongue; the shape of the abdomen; and also discharges which are coming from the various parts of the body like stool, urine, perspiration etc. [8]
Boger’s view– As patients present themselves, it is the physician’s first duty of the physician to observe them closely, noting the facial expression, manner, mode of actions, habits and all external manifestations. This often gives the key to the whole case without asking a single question. [3]
According to Dr. J. T. KENT– After the physician has written down all the information in accordance with the directions of § 85 for the taking of the case he then commences to observe as much as he can concerning the disorder, but more particularly those things which the patient would conceal, or cannot relate, or does not know. Many patients do not know that they are awkward, that they do peculiar and strange things in the doctor’s office-things that they would not do in health, and these are evidence of change of state. [7]
The physician also notes what he sees, notes odors, the sounds of organs, chest sounds, intensity of fever, by his hand or by a thermo- meter, etc., and when he has gone over this entire image, including everything that can represent the disease, he has secured all that is of real value to him. [7]
The things that you can see, i.e., the changes in the tissues, are of the least importance, but what you perceive in the patient himself, how he moves and acts, his functions and sensations, are manifestations of what is going on in the internal. [7]
Conclusion
A physician must be a keen observer like Master Hahnemann. Elizabeth Wright writes, ‘A well taken case is half cured’. [3] This shows the importance of strong case taking and thus we can conclude that how much significance, observation holds in case taking and how it can lead a path towards similimum. Hence it is true that the careful observer alone can become a true healer of disease.
References
1. Oxford Dictionary.
2. Dudgeon RE, Marcy EE.LESSER WRITINGS BY SAMEUL HAHNEMANN. New York: William Radde, 322 Broadway; 1852.
3. Tiwari Shashi Kant. ESSENTIALS OF REPERTORIZATION. #Fifth edition. New Delhi: B. Jain Publishers; 2012.
4. Sarkar BK. ORGANON OF MEDICINE. #Tenth edition. Delhi: Birla Publications; 2005-2006.
5. Vithoulkas George, Tiller William A. The Science of Homeopathy. New Delhi: B. Jain Publishers; 1998.
6. Boericke William. Pocket Manual of Homoeopathic Materia Medica. #Ninth edition. New Delhi: Indian Books and Periodicals Publishers; 2010.
7. Kent James Tyler. Lectures on homoeopathic philosophy. Noida: B. Jain publishers; 2002.
8. Dr Farokh Master Homoeopathic Health Center. Editorials for the month of October-November. Dr Farokh Master; 2006. https://drfarokhmaster.com/wp-content/uploads/2017/09/2006-1011-EDITORIAL-FOR-THE-MONTH-OF-OCTOBER-NOVEMBER-2006.pdf
