Understanding The Clinical Utility Of Objective Symptoms Using Murphy Repertory

6.

BRIEF RESUME OF INTENDED WORK

|6.1

NEED FOR THE STUDY

 In today’s homeopathic practice, there is a common tendency to give importance to subjective symptoms over observation and objective ones during case taking and also in final selection of medicine. However it’s very important to recognize the significance of objective symptom, as they are very clear and unchangeable base for the selection of appropriate medicine

 Many a time we homeopath face the problems like language barrier with the patient who talks in regional native language, patients like infants – children, individual with mental retardation, unconscious patient and many a time patient failed to describe exact feeling and sensation as well as physician failed to understand it and utilize it perfectly.

 Patient can deceive physician by playing with words, and may physician get directed by patient – by trusting everything patient says, but objective symptoms what physician perceive by observation or patient unconsciously do, for ex. Gestures, some type of expressions, some type of physical changes, pathological changes etc.. can never. So, it can make big difference in practice by giving importance to objective symptoms.

 Now, in selection of repertory for analysis of case using objective symptom we need to select repertory which is rich in source of objective symptoms.

 Murphy repertory is an extended work of Kent’s repertory with added clinical experience and rearrangement of chapters as well as some added chapters which are well described.

 The philosophy of murphy’s repertory is from clinical to classical concept.

 Dr. R Murphy’s concept is, individualization of any person can be done by considering his characteristics, may be of clinical condition, nosology, pathological changes, objective symptoms etc.

Ex. Of some extraordinary chapters : Emergency, Blood, Toxicity, Constitution, Disease, Children etc

 So, murphy repertory can fulfill our demand of rich data of objective symptoms.

6.2

REVIEW OF LITERATURE:

 Objective symptoms

 The expression of disease in sensation and function of that side of organism exposed to the senses of physician and bystanders.

 According to aphorism no 6 the changes in health of the body and of the mind (morbid phenomena, accidents, symptoms) which can be perceived externally by means of senses; that is to say, he notices only the deviation from the former healthy state of now diseased individual, which are felt by the patient himself, remark by those around him and observed by the physician. All these perceptible signs represent the disease in whole extent, that is, together they form the true and only conceivable portrait of the disease.

 C.M Boger felt that subjective symptoms, though they have importance in selection of the remedy are liable to altered by the provers, patient as well as by the physician while interpreting. whereas the objective symptoms are the fact and hence, more reliable and concrete. He says “objective phenomena, being exempt from self-interpretation and allowing the largest scope to the acumen of the examiner are the least deceptive and should receive our first and best attention” He further reminds the physician not to neglect those while taking the case. In his words he puts it as, “As patient present themselves, it is the first duty of the physician to observe them closely, noting the facial expression, manner, mode of action, habit and all external manifestation without asking a single question.”

 According to aphorism no 83 “This individualizing examination of case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of disease”.

 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. While taking a case, he should concentrate on observing the patient alone.

 As a matter of fact, many psychologists have expressed their opinion that one cannot attend to more than one work at a time. If two things are attended together, one goes unattended. For a physician it is imperative that he attends to only one at a time that is, observation of patient.

 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. Master Hahnemann in his essay ’Medical Observer’ writes, ‘True it is, that the careful observer alone can become a true healer of disease.’ He delineates 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 his self.

 A physician should be faithful and loyal in noticing and recording the deviation from health with firm adherence to the principles of a medical profession, especially homoeopathy. He should have exactitude in reproduction of the case. In other words, 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.

 According to Dr. Stuart close the technique of an examination for the purpose of diagnosing the disease is quite different from that of the examination for making the homoeopathic prescription. The examiner should be constantly on the alert and observing while making an oral examination. The patient may be unconscious or delirious; or an infant, unable to talk; or insane. He may be malingering or trying to deceive as to the real nature or cause of his disease. Knowledge of the natural history and phenomena of disease will aid in forming a true picture of the disease.

 As a prescriber the homeopathic physician is always seeking that in the case which is peculiar, uncommon, characteristic, individual. That may be noticed in some casual expression of the patient as he talks, revealing his mood or state of mind, or the origin of his trouble; it may be found in the colour, form, or expression of his countenance; or in his attitude, gait, or physical demeanour.

 If the patient is confined to bed, the examiner will observe his position in bed, his manner of moving or turning, his respiration, the state of his skin, colour or odour of perspiration, odour of exhalations from mouth or body, physical appearance of excretions, relation of the patient’s sensations to atmosphere and temperature is shown in amount of covering, ventilation of room, ice bags, hot water bottle, etc..– all these, and many other little points, noticeable by the alert examiner, perhaps without asking a question, will be valuable guides in the choice of the remedy.

 They should be recorded as such. The mental state, conscious and subconscious, is revealed by the general behaviour, the conversation, the expression of the countenance, the desires and aversions and the manner of sleeping, as well as by the voluntary verbal expressions. Mental symptoms are of the highest importance.

 Expertness in observing and analysing these features of disease should be cultivated because right conclusions and effective treatment often depend more upon the physician’s own observations and directions, than upon anything that others or even the patient are able to tell him. In the matter of mood or temper of the mind, for instance, he will be able to judge from the patient’s manner of relating or expressing his sufferings and his behaviour toward his attendants, whether he is sad or cheerful; calm or anxious, confident or afraid, indifferent, morose, censorious, malicious, irritable, suspicious, or jealous. As to the intellect, he can observe for himself whether the patient is dull, stupid, unconscious, excited, delirious, distracted, confused, etc. All the points are covered by the rubrics in any good repertory and they must be covered by the remedy selected.

Murphy repertory

Use of repertory in homeopathy practice is a necessity if one has to do careful prescription because which advance of modern technology and number of drugs in homeopathy any physician can’t do prescription directly with the help of Materia medica knowledge.

 Every repertory has its own philosophical background on which formation of rubrics and arrangement of chapters are done. Objective symptoms are given in murphy repertory is exceptionally well because it is an extended and improved work from kent’s repertory, different chapters is given with objective symptoms that too are clinically verified.

 About homeopathic medical repertory 3rd  revised edition:

Homeopathic medical repertory by Robin Murphy is very significant to use in today’s time because of its vast numbers of rubrics and clinical verifications.

Number of chapters total 74 chapters arranged and compiled from the original 36 chapters of Kent’s repertory

 Gradation of medicine :-

BOLD CAPITAL UNDERLINE – 4 MARKS

BOLD CAPITAL – 3 MARKS

Bold italics – 2 mark

Roman small – 1 mark

 Arrangement of rubrics main rubrics alphabetically and time modalities causation and other sensations alphabetically as sub rubrics which is easy to use and refer it includes many medicine which are very well proven and that were not present in one or other repertory under same symptom or rubric.

6.3

OBJECTIVE OF STUDY:

OBJECTIVE:

·       To understand the clinical usefulness of objective symptoms in homoeopathic prescription.

·      Studying the objective symptoms, which may help in individualization and finding the most similar remedy using murphy repertory.