Thank you for the summary.

1. CASE TAKING ACCORDING
TO BOGER
DR MARIA SHAJU
PART 2 MD REPERTORY
UGO: DR ANUSUYA M A

4. CASE TAKING
Unique art of getting into conversation,
observation and collecting information.

5. PURPOSE OF CASE TAKING
Correct prescribing is the art of Carefully
fitting pathogenetic to clinical symptoms.

6. REQUISITES
Grasping the essential points of
symptom image.
Mastering working knowledge of our
materia medica.
Skilful usage of many books of
reference.

7. .
SPIRIT OF
CLINICAL
SYMPTOM
PICTURE IS
BEST
OBTAINED BY
ASKING TE
PATIENT TO
TELL HIS OWN
STORY
WHENEVER IT
IS POSSIBLE.

8. • CAUSE AND COURSE OF THE
SICKNESS
• MODALITIES
1ST STEP
• MENTAL STATE
2ND STEP
• SENSATIONS
3RD STEP
• ENTIRE OBJECTIVE ASPECT OR
EXPRESSION OF THE SICKNESS
4TH STEP
• PARTS AFFECTED
5TH STEP

9. CAUSE AND COURSE OF THE
SICKNESS
 It should include all the things which now
seems to interfere with the sufferers
comfort.
 Especially should the natural modifiers of
sickness- the modalities- be very
definitely ascertained.
 Most vitally important of such influence:
Time, temperature, open air, posture, being
alone, motion, sleep, eating and drinking,
touch, pressure, discharges, etc.

10. MENTAL STATE
fear
sadness
irritability

11. PATIENTS OWN DESCRIPTION
OF HIS SENSATIONS
 Always ascertain whether any of the following
primary sensations are present:
Burning
Cramping
Cutting
Bursting
Soreness
Throbbing
Thirst
 There may be many others, but the presence
of any one of these often overshadows them.

12. 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.

13. PARTS AFFECTED
 It brings investigation in touch with
diagnosis.
o Organs
o Right
o Left

14. CASE TAKING
 Power of observation.
 Proficiency in details.
 Physical diagnosis and Therapeutics are mutually
inter-dependent.
 One helping to interpret and define the other.
 Diagnosis should be as accurate as the fitting of the
remedy.
 We must not only diagnose sickness in its larger
sense but the comprehension of its picture will
most certainly limit our grasp of the remedies
from which a choice is to be made. This is
especially true of localized affections

15. 1. THE LOCATION
2. THE ORIGIN
3. THE MODALTY
4. THE MIND
5. THE CONCOMITANTS
6. THE PECULIARITIES
7. THE TIME

16. LOCATION
Different drugs affect
different parts, tissues and functions
of the organism The study of regions
implies a discovery of the seat of the
disease and remedies related thereto
 Drugs which affect the same or similar tissues
bear a certain relation to each other and are
differentiated through mental sphere and the
modalities

17. THE ORIGIN
 Things in themselves apparently very trivial may become of
the greatest import when related to the beginning of disease
 Sickness arises from extrinsic as well as intrinsic or
autogenic causes
 The extrinsic causes are more accessible and therefore
more accurately defined
 They embrace the susceptibility to certain external
influences which pervert the vital principle,
 Injuries, the state of weather, heat, cold, dampness,
physical exertion etc.

18.  Autogenic causes often have mental states as their
starting point : The effects of grief, worry or fright are
good examples
 Emotional states may be the beginning of a long train of
untoward manifestations for which the simillimum cannot
be perceived unless they are given a proper place in the
pedigree of the disease and as the mind does not always
readily disclose such things they may be difficult to discover
 Whether the causes come from without or arise from within,
the homoeopathic simillimum cannot be chosen with safety
without taking them fully into the account
 The great miasms belong to this class.

19. THE MODALITY
 Closely related to the cause, are the circumstances under
which disease, and the conditions which modify it, makes its
appearance
 These are commonly known as the modalities.
 They individualize and define every sickness as well as
every drug
 Hence the most suitable medicine cannot be chosen
while they remain unknown
 They include such modifying agents as the effect of posture,
the different kinds of motion, the various forms of heat and
cold, the effects of the weather, or bathing, washing, getting
wet or any modifying agent whatsoever

20.  Many odd or strange modifying influences also occur,
they belong to few remedies.
 Eg clemattis – eczema
Increasing moon and waning moon
 Conditions which modify or excite mental symptoms
are not exceeded in importance by any others
To these belong the influence of the emotion, fright,
grief, solitude or company, thinking of the disease,
consolation, vexation etc. on the mind
 “Pain which excites to anger” is an excellent
example

21. THE MIND
 Mind is subjective as well as objective
index; it reveals the bias which rules the
whole case
 Mental exaltation or depression coupled
with physical state is a rare occurrence
but if it is observed then it remarkably
indicates the remedy
 Study of mind includes gross objective
changes noted by attendants and also
close observation and interpretation of
speech, action and countenance by
physician.

22.  Mind reflects itself with accuracy in
different modes and manners of
physical expression
 Voice intonation sometimes explains
the source and meaning of particular
symptom.
 Changes in ordinary moods are points
of departure whose value depends
upon their variation from normal to
everyday condition.

23. THE CONCOMITANTS
 Anomalous and peculiar symptom
 So distinctive suggest remedy name
 Sometimes affected organ seems to b
overwhelmed by the impact of disease and
vital powers express through concomitants
only
 Value of concomitants is fixed by its age,
acute or more recent ones are most guiding
 These will guide capable of correcting
irregular expenditure of energy temporarily –
for acute conditions not capable enough to
remove fundamental dyscrasia- needs
antipsorics.

24. THE PECULIARITIES
 Similar picture: location, origin,
modality and mental condition
concomitants, peculiarities and time
 Objective symptoms – free from self
interpretations
 Facial expression, posture,
temperature both localized and
general alterations of color or
consistence, odor

25.  Subjective symptoms – many subjective
symptoms have sn indefinite character or are
common to many disorders, there fore
deserving little attention. It is ony when an
ordinary symptom appears in an
extraordinary place or way that it becomes of
much value
 It expressed according to mentality of
subject and it varies from simple idefiniteness
of childhood to hysterical loquacity.
 Hence factors like time manner and
circumstances under which symptom occurs
gives great deal of information

26. THE TIME
 A few remedies have such a remarkably
exact periodicity as to distinguish them
from others
 Certain remedies exhibit their action
during a more or less definite time of
the day
 The action of some medicines coincides with
the time periods of the sun, moon or seasons
or tides thus affords peculiar differentiation

27. SUMMARY FROM ESSENTIALS
 Given in the article “ SOME THOUGHTS ON
PRESCRIBING”
 Every patient will show some symptoms from
all three (mental, dynamic and physical)
spheres if a careful search is made for them,
but the symptoms shown will be more
prominently marked in some one particular
sphere.
 While taking a case and hunting through the
repertories and materia medica, don’t make the
mistake of getting a remedy too firmly fixed in
your mind or it could lead you to a disaster.

28.  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 the physician can get at the patient’s
mode of thinking, his voluntary ideas,
he can build a picture of his mental
process

29.  An exciting cause uncovers the
underlying strata, often lying dormant
for years, and is an important part of
the symptom picture. Remember that
a patient expresses disease as a unit
and not by scattered symptoms here
and there.

30.  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 accurately defined by the
questioner, who should, first try to elicit the evident
cause and 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
sufferer’s comfort. Especially should the natural
modifiers of sickness – the modalities – be very
definitely ascertained. The following are the most
vitally important of such influences – time,
temperature, open air, posture, being alone,
motion, sleep, eating and drinking, touch,
pressure, discharges, etc.

31.  A consideration of the mental state comes next in
order of importance. Here the presence of
irritability, sadness or fear is the ruling factor.
 The third step concerns the estimate to be put
upon the patient’s own description of his
sensations. This is a 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, soreness,
throbbing and thirst. There may be many others,
but the presence of any one of these often over
shadows them, especially such as may be due to
the play of imagination; which feature is in itself
often of more importance than the particular thing
imagined.

32.  Next in order comes the entire
objective aspect or expression of the
sickness. This should especially
include facial expression, demeanour,
nervous excitability, sensibility,
restlessness, or torpor, state of the
secretions and any abnormal
colouring that may be present.
 Lastly, the part affected must be
determined; which also brings the
investigation in touch with diagnosis.

33.  Particular symptoms which are
peculiar, strange or bizarre may
appear in any sphere whatsoever. We
need not look especially upon
location, sensation, modalities,
concomitants, mind, etc for them, but
on features which make them
prominent as individual morbid
expressions.