THE SKILLFUL RECORDING OF THE ANAMNESIS AS PREREQUISITE FOR FINDING THE SIMILIE
What is demanded of one who wishes to become a good homœopath?
Strict obedience of the Rules.
HAHNEMANN wanted us to “follow him, follow him exactly” if we would like to have good results; so, strict obedience.
He must have a genuine and intense wish to become a good homœopath.
He should have studied the Materia Medica and must be studying daily for hours,
Must have mastery over repertorization,
And he should also have the ability to make out a good Anamnesis.
The first – Mat.Med. - requires much study and a good memory, both of which should be cultivated,
The second: ingenuity,
The third: devotion.
In §5 HAHNEMANN clearly says that in respect of Chronic Disease we should draw an Anamnesis.
We should allow the patient to tell his ailments.
We should make ourselves internally clear and without any prejudice, like a blank paper, and take his condition as narrated.
We should keep out our personal opinions while taking note of the picture depicted by the patient, be fully attentive, observant, and note. We should keep out clinical ideas during the case taking and simply note whatever the patient said in his own words.
The Materia Medica can be learnt mechanically by repeated study,
The repertorization also by repeated exercise, but the drawing of the Anamnesis requires the employment of our whole person.
It is an art, which although the most difficult of all, h a s to be indeed learnt.
How are these three tools available with us for use, applied?
A homœopath who imagines himself to be simply emulating HAHNEMANN thinking that he is a master will find out to his disappointment that these three operations are extra-ordinarily difficult indeed.
Many of the new Materia Medicas are very thin, hastily collected from the old Materia Medica and written, reducing the bulk; most of them to suit the taste of those ‘clinical’- thinking of so-called ‘scientific’- thinking doctors.
The repertorization is explained as a simple rigmarole – of course by people who have never learnt it - and the art of interrogation as being insignificant. If a homœopath works with improper tools he would only be bungling about.
How to correctly learn his work tools? Let us go through the journals and see what have been written about repertorization or the art of drawing the Anamnesis. Of course much good has been written but the old HAHNEMANN is almost never mentioned. Naturally we have his “Organon”, his other works, but much will have to be again h a m m e r e d in.
HAHNEMANN is the master and his directions are authoritative for us. We would have his views and not interpretations of his views – interpretations and explanations according to the natural sciences; this view of life has no place in true Homœopathy. We should accept the concept of Vital Force, Dynamis, spirit-like action, etc., conceived by HAHNEMANN.
For those who think critically the question that naturally arises: is : Is HAHNEMANN really sufficiently modern, are not his teachings, his assertions outdated? Is not all these already antiquated?
Entirely opposite is the case. We can say that the life sciences are moving in the direction which HAHNEMANN intuitively indicated about 200 years ago. Many who tried to be one-up over HAHNEMANN have failed.
Let us now look up what HAHNEMANN has to say about the homœopathic individual examination.
He writes about this in Organon (VI edn.) in amazingly as many as 23 Aphorisms. Aphorism 104 says: “When the totality of symptoms which particularly define and distinguish the case of any disease or in other words the picture of any kind of disease is accurately drawn, then the most difficult task is already accomplished….”. Mark the words: not just the ‘symptoms’, but “symptoms that principally determine and distinguish the disease case”.
In the annotation to Aphorism 148, HAHNEMANN further says: “But this laborious, sometimes very laborious, pursuit of the remedy most suitable homœopathically in all respects to any given disease condition, is a business which demands study of the sources themselves as well as a greater amount of circumspection and serious reflection… .
“How should these laborious, careful work which enables the only best way of curing diseases, please the gentleman of the new mongrel sect who boast the honorable title of homœopathists…., and who when incorrect medicine does not immediately help, throw blame therefore not on their unpardonable laziness and carelessness in making short work of this important and gravest of all human concerns, but upon Homœopathy which they reproach of imperfection”.
Instructions and informations as to how a good Anamnesis is to be recorded are, as already stated, available in our journals, rather scantily. It may be so, may be because most homœopaths already have a wonderful grasp of it. That, unfortunately, does not seem to be the case. Rather, one has the misgiving that the art of investigation – which HAHNEMANN has called a laborious business – has been given much less value, the importance of it is undervalued and many colleagues have, generally speaking, not at all learnt to draw a correct Anamnesis as KENT once said that only one out of 100 homœopaths could draw a correct Anamnesis. It is not much different in these days. We are talking of the ‘leaders’ or the ‘teachers’. None need feel offended.
The result? One either does complex Homœopathy or stays put with Organopathy, or Polypharmacy. We need not reiterate that with Organopathy and complex medicines different results obtain. Almost every homœopath comes to these stages, but some pass on discarding this and go to the genuine methodology. Rarely one jumps to the homœopathic single remedy, the Similie, direct. The only danger is that one remains in this stage and we would like to ask what is this Homœopathy which is nothing more than just a complementary, rather a caricature to the mainstream medicine?
The question asked is: Where does one have the time to make the Anamnesis during the busy practice, for the totality of the symptoms, to classify the symptoms, to look for the characteristics, etc.?
That is a problem that we all face actually. But does it least alter the principle? N e v e r.
One should not therefore mix medicines or peddle polyprescription, adopt Organopathy; it must be clear that in this way one cannot go further on with Homœopathy and does not learn to make proper Anamnesis and so can achieve nothing more than mediocre success.
He is far removed from the high school of Homœopathy and many remain so, far till the end.
What have we learnt from a failure?
We have learnt how we should not do.
Perhaps we have not got the right symptoms, have not made correct classification. It is seldom that in an acute case no leading symptoms are found. Only we have
not found it.
We treat for example 10 such cases by wrong remedies; for all that, let us say that a few dozen cases have been treated by wrong medicines and then there comes once, a winning shot. Slowly we get the feeling that symptoms which only we considered as good ones and out on top are not really good symptoms for the prescription.
We realize that we do not yet have the feeling for the essential symptoms in the homœopathic sense. We have not learnt to distinguish the important – for a homœopathic prescription – from the unimportant.
We have also not observed since a long time perhaps the true, faultless action of a remedy, meditated over the case again, thought over as to which proved to be as this or that key symptom, read it in the Materia Medica, etc. When we succeed truly in a case we should study that curative remedy in a complete Materia Medica; and more so when we fail in a case. Faith comes only from your own experience. Homœopathy is not ‘faith’ Medicine. It is Practical Therapeutics.
When we slowly begin to learn Anamnesis our attempts in a case which is sub-acute or chronic becomes a flop. Let us not forget that we are making an Anamnesis in accordance with HAHNEMANN and not the other customary one under pressure of time, a transitory, sketchy hotch-potch Anamnesis. The artistic taking of a sub-acute or chronic disease case history demands systematic exercise for months.
I draw your attention to the complete instructions in my booklet ‘Art of Anamnesis and Repertorisation’.
A striking result obtained with a well chosen medicine given in high potency is an experience for us. The action of the remedy, especially a high potency, is not any more our imagination but we are convinced of it. Every further experience – after eliminating critically everything else, evidently – gives us new stimulus, fresh joy to go ahead. We do not any more feel sorry about our failures since we now know that it depends only upon us whether we have success or not and not due to any deficiency with the homœopathic principles.
With further development we observe that we become penetrative, that we make pointed questions, and not long-winded, laborious questions. We also observe that we think less and less, on clinical lines.
We perceive the difference between a spontaneous and clear reply to a question and a vague answer.
We learn from the successes and failures whether for example the cause of the disease, an important symptom, has been evaluated as too high or too low in a case or how while a time modality was decisive in one case, in another it was the thermic modality, and so on.
We can proceed slowly, and during the consultation hours work properly with an acute case. By and by we can venture into sub-acute and chronic cases. We get more satisfaction in having cured a sub-acute or chronic case. We then get similar success further, more frequently and soon i t b e c o m e s r o u t i n e! . We can then celebrate each day.
This Homœopathy can be learnt, everyone of us can learn it and to that end we must follow the right path and this right path has been shown to us by HAHNEMANN and his students.
Of the small number of instructions as to how to make a classical Anamnesis the best, are the instructions of PIERRE SCHMIDT. It is completely according to HAHNEMANN. It seems that only KENT, SCHMIDT and few others have understood HAHNEMANN correctly and above all have grasped and employed the concept of Vital Force, the Dynamis. Only then it is possible to throw overboard the junk of clinical line of thinking, and pursue correct Homœopathy.
It is not the intention of this paper to draw a complete picture of the Art of Interrogation. However, a brief sketch of some important points can be drawn. PIERRE SCHMIDT’s and KENT’s “Lectures” and certainlyOrganon are recommended.
Fundamentally whoever the patient with whatever complaints may come to us must be allowed to narrate and we must listen. There are many nervous homœopaths. To keep oneself silent and let the patient tell his story is not at all so easy. It requires experience to keep the patient talk of his ailments. As a first commandment: we must learn to listen, not to interfere with the line of thought of the patient by intervening frequently.
Often we may get one or two interesting symptoms from this spontaneous narration. During his spontaneous narration by the patient we register, alongside and unobtrusively, the expression, the look, the play of the features, the total behavior of the patient. As already said one or two important symptoms could come up from the spontaneous narration.
However, a caution: We do not straight-away rush to classify these one or two symptoms because it is possible that more valuable symptoms would come up when we cross examine the patient.
After the patient has finished his narration – whether long or short – we go through it carefully and enquire for modalities etc. not already given. Answers to these must come freely.
We must ask with great circumspection, ask generally, not put questions suggesting alternative answers which would be answered with yes or no. We ask, what difference does anger make to his stomach pains – always with reference to the spontaneous report already made by him.
We do not ask: does excitement or anger makes you better or worse?
If a reply is half-hearted and hesitant we should know that that symptom is useless. P.SCHMIDT says that when the patient jumps up from his chair to an appropriate question and says: “indeed, anger makes me totally ill, that is the cause of my stomach troubles”, then it is a good symptom.
We may not experience this springing from the chair so frequently, but not unusually we come across expressions strongly speak; in any case the answers should in every case come promptly and with firmness. When the patient reflects over the question about something being agreeable or otherwise it means that symptom is not worthwhile.
There is always the danger that the unclear or banal indications and symptoms – local ailments, common symptoms, mental symptoms – are elevated by us as valuable particularly if we could obtain from the patient only few symptoms. It is more often the case that if we do not take a total anamnesis and are satisfied with “half-baked” symptoms. This is not a good way, and at best the medicine selected on these only palliates. If we experience that a patient takes medicines for months and many medicines and the medicine benefits only as long as he takes it, it is only a palliative action and nothing else.
.This does not however contradict the fact that HAHNEMANN says in his ‘Chronic Disease’: a medicine may have to be given for 1-2 years. Our experience corroborates it. If a suitable medicine is given then it unfolds its action relatively sooner and brings about successive improvement.
It is self-evident that it is a question of the nature and intensity of the disease. In a case of chronic joint rheumatism if we actually find the remedy, or 2 or 3 were given one after the other, we cannot expect a substantial action within a few weeks. At best the subjective symptoms will become better soon but the swellings, the sediments go only slowly – steadily, of course.
With the technique of the LM potencies the healing is much more speeded up; that was the reason why HAHNEMANN gave it at the end of his life. A 1000, a 10,000 etc. acts, presumably, - when given as a single dose – more intensively. But the vital point is undoubtedly the finding of the Similie or Simillimum; the potency question is, ultimately, secondary; only that the high potency acts more profoundly, deeply and elegantly.
If an amelioration is only of a passing nature or a reversal recurs often, it is not due to potency being insufficiently high but we have found only the nearer remedy but not the curative.
Now: how do we go about the recording of the Anamnesis?
After noting down the spontaneous report of the patient and making it more precise by interrogation, we ask, what else? Anything more to say? Have you said everything abut you; your ailments in the past howsoever insignificant it may be?
We note whatever the patient says; if he says nothing at all then we proceed to enquire thoroughly, non-specific questions for example, have you any problem with your head, with your ears, with the tonsils, the pharynx, throat, eyes, etc. Were there anything peculiar with these features earlier? We should allow the patient to talk. It is important here how the patient talks and what uncommon peculiarities and modalities are to be recorded. If for example he says about his throat: Yes, I have had my tonsils removed six years ago, and says it spontaneously – or only after careful enquiries about the origin -that he has constant throat inflammations with fever after drinking cold drinks, it is then a noteworthy modality.
We then go over to chest, lungs, heart, stomach, upper and lower abdomen, kidneys, genitals, limbs, skin. And in regard to these also we proceed to inquire and allow the patient to depict the condition. Often very good symptoms come up.
When the patient has told everything, we pursue. We ask: You said earlier about your tonsils. They were always inflamed after cold drinks. Was it only after cold drinks or also from feet getting cold, after a thorough wetting, after perspiration, from over-all cooling?
If the patient affirms: “no, it was only after cold drinking, I myself have wondered at it, other things cold do not at all affect my tonsils”, then this symptom becomes very much more interesting and it can tip the scale towards the medicine choice, whatever be the disease.
Let us realize that we note how the patient qualifies the modalities, the terms he uses, the words he stresses upon – etc. We have to bear in mind that we are concerned with the “feelings and functions” of the patient. What are his feelings? How has his functions been affected?. If we have unusual, individual symptoms and modalities to be worked out the small rubrics in “KENT” are often the most important.
The local symptoms and signs also in so far as they are unique or strange, could influence the medicine choice. All unique, unusual symptoms in the history of the patient even if they have faded away since long, belong to the pathobiography of the patient and are as valuable as those of recent period. They belong to the patient exactly so as the sub-acute or other chronic sickness for which the patient consults us; they indicate to us the individual nature of reaction of the patient in the view point of his organism over a period of time.
After the spontaneous narration and then after other local ailments referred to directly we put our questions with reference to the ‘general’ symptoms and the ‘mental’ symptoms – often over those already mentioned in the spontaneous narration. If a patient tells: Since my rheumatism began I constantly weep because of it, or says that some other suffering went away after this rheumatism came on. We then have a very good symptom to help our selection of medicine. Remember that we should know how to and what questions should be put. Wrong questions will bring wrong answers. A good knowledge of Materia Medica will help put the right questions.
The general and mental symptoms must also be of high rank and should also be given high ranking if they are, by virtue of their note-worthy modalities, individual to the patient. When a woman feels hot during flushes of heat it is only a common symptom; if she says that she felt worse from warmth it is of course a general symptom but still a common one.
In the spontaneous narration everything which is peculiar to him, be it mental or physical range, will be told. He comes to the physician because of these. Hence listen to and note down carefully and thoroughly the spontaneous narration. In acute cases these would be enough. In sub-acute or chronic cases what he himself does not consider worth mentioning must be extracted as much as possible and noted.
We search, of course, for rare, unusual symptoms (§ 153). As much longer we practice classical Anamnesis so much often would we find them. We find them out because we have learnt to ferret them out, not to miss them and not to put them off as nonsense. We will, moreover, be astounded to find how relatively often they are available when correctly interrogated and carefully listened to. Mostly these symptoms do not make any specific complaint. They are not easy to be elicited since the patient does not all find them pleasant, perhaps because they are strange that he did not think of telling them. We may therefore ask the patient: have you experienced anything peculiar, singular, whether connected with the mental or physical levels which may perhaps not be of any significance to your ailments but are there or were there earlier. We will find such special symptoms in the repertory and also of course in the older (complete) Materia Medica but not any more in the new ones which unfortunately are in condensed form.
As much unusual the symptoms are, as much “ridiculous” they are, so much more useful. Naturally they must have their counterpart. We must, right from our early practice, follow this method to take serious note of such symptoms and signs. In the beginning we may overlook them and consider them as silly stuff and don’t know what to do with them. We should also have mastery of the Repertory to know that it is there and also where to find it when required. The clinical line of thought will leave us only in the lurch and be a hindrance.
We should always keep in view that it is not the jumble of symptoms that should interest us. These jumble of symptoms, be they small or large in number, must be sorted out, to find in some corner the grain of gold. It is, however, essential that we must have the whole jumble, namely the totality of the symptoms of the whole patient.
The signs and symptoms classified from the raw material must be clear and unmistakable and dramatic. Dramatic not in the clinical sense but in the sense of the individuality of the patient. Aphorism 153 is clear about it.
We may spare ourselves much work with the anamnesis if we investigate exactly like a detective, the true cause – in the homœopathic sense – for the ailment, if such a reason is available. This cause must be ‘cut clear’. If a clear cause – be it acute, sub-acute or chronic – is evident, not a common or vaguely probable one, only then this cause becomes the key symptom and the case may be worked out from it.
We have to bear in mind the phenomenon of suppression. It is in agreement with HAHNEMANN’s observation of consequences of expulsion of skin eruptions and such others. The difference is only that now the modus of suppression has changed, the principle however remains the same.
Another difference is that the modern therapy in most cases is however a suppressive therapy. Many endure it, some don’t. These “some” is getting to be more.
Such cases do not come in the usual way even if we take the Anamnesis so skillfully; but if available it is useful.
What subsequently happens in the organism from a suppression are symptoms which have developed as it were artificially. We cannot do much with certainty with the individual reaction to suppressives. They are not symptoms which appeared primarily, which have developed sui genesis, they are strong manifestations of suppressions.
For these symptoms therefore we do not have an antitype, no similar image, in our textbooks in the sense of Similie.
We can only say that the suppression of a mostly acute as also sub-acute or chronic disease picture by the above mentioned medicaments produced symptoms in human organism. The organism could not live out the disease.