Illustrated by a Clinical Case.
As I have already explained in the first part of my discussion. the taking of the history, especially a homoeopathic history, involves great forethought and tact. I shall re emphasize the necessity of allowing the patient to tell all he or she can, and ask questions indirectly only as suggested by the patient. Do not allow the patient to sway you in any direction and interrupt his story only when he begins to ramble and gets off the subject.
In order to put your patient at ease, one should always begin by asking some general questions as to age; note the sex, occupation and address. Having elicited these, allow your patient to tell his story. If during the recitation of his case, he should cease, one may always ask some question as, what else? and thus keep up the trend of the patients story.
History.-Age, 55. Sex, male. Occupation, tailor. Date, December 16, 1922.
Patients Story.- I have been a diabetic for the past five years (Here the patient stopped and I was forced to ask, “Why did you come here?”) My entire body itches all over and I have pain in the left chest. My feet and hands also pain me and I find it impossible to sleep. I have itching of my eye, ear, back and sides. This comes on especially in the afternoon like the sting of a mosquito. Also when sitting, I get electrical shocks (Here I asked if he noticed whether anything made it better or worse?) This is better from pressure.
He usually gets up in the middle of the night and micturates two to three times.
I always feel better during the summer and worse during the winter and cold weather. Always catches cold easily, and is subject to wry neck. Always gets dizzy spells when excited. This dizziness appears before the eyes. He prefers the open air.
He also has itching about the eyes. Complains of coated tongue. Has burning sensation in the stomach and gets relief from the use of soda. Fruits do not agree, causing a burning sensation.
He also has right-sided pains worse from pressure. Also complains of piles.
Nervous and weak, though not easily excited and expressed himself as craving sympathy from those at home but does not get it. Has a great thirst (polydipsia), 6-8 glasses of water, drinks tea and coffee.
Also states that he had a sore on the penis either gonococcal or luetic in origin. Complaints of a suppressed spermatorrhea. Had orchitis.
When hands are pendent they begin to pain.
This patient was rather singular for he gave an excellent expression of most of the reactions he observed and so enabled us to more accurately prescribe for him. One not versed in homoeopathic history-taking would consider this a hodge-podge of symptomatology, but to the homoeopath it is an individualistic expression of this mans reactions. The old school would simply call it a case of diabetes and treat it per se. We treat the individual and not the diabetes.
We shall now proceed to the next step with out patient. As I have mentioned, a physical examinations should be conducted. I have examined this patient and can state that nothing abnormal was found except the aortic second sound was markedly accentuated. As in all chronic cases of such character, physical examination reveals very little and cannot help to any extent in the treatment of the patients. However, I must insist that it shall always be conducted, for occasionally we do find pathology. Secondly, a physical examination always, makes the patients feel that a great deal is being done for them. A proper frame of mind on the part of the patient is essential to every treatment.
We shall now consider laboratory data in the case.
Color and appearance Light straw color.
Specific gravity I. 019.
Glucose 0.59 percent.
Blood sugar report Not returned.
Clinical diagnosis Diabetes Mellitus
So far, all our work has led to a history and a final clinical diagnosis. The homoeopathic diagnosis of the similar remedy is now the problem.
In this case the problem of choosing the individualistic symptoms, heretofore referred to, is very difficult. The difficulty arises from the fact that we know that our patient is diabetic and consequently we know that some of his symptoms are distinctly due to the disease as such, and therefore are the general symptoms which any diabetic patient may present and are not individualistic to our patient.
Symptoms such as polydipsia, polyphagia, nocturia and pruritus are common characteristics of any diabetic. We cannot utilize them unless properly modified. Here, we were greatly helped, for the patient accurately described his own reactions to such symptomatology, where he could, and in that event these general symptoms really become very individualistic. A careful perusal of our history and we note the abundance of individualistic symptoms the patient presents.
Itching pain in the evening which is stinging in character, itching like the sting of a mosquito electrical shocks which are better from pressure, Better in the summer and worse in the winter and cold weather, prefers the open air, burning in the stomach, worse from fruits, etc. Veritably we have a wealth of individualistic symptoms from which we can choose rubrics to search our repertory. The following were chosen as rubrics and the list of remedies under each is given. Many rubrics were chosen because of the wealth of characteristic symptoms. Itching pain in the evening.
Plus stinging in character.
Apis Mur acid.
Arnica Nat. mur I.
Bar-c Pul 2.
BRYONIA Rhus tox.
Kali carb Urt-u.
Merc 2 Vio-t
Worse from fried fat things.
Arsen. Mer. 3.
Bryonia 2 Nat mur 2.
Carbo veg PET.
Colch PULSA 3.
Desires the open air.
Ars Nat mur 3.
Aur Pulsa 4.
Better in summer.
Bry 3 Lach.
Carb-veg Nux vo 2.
Aggra. when limbs are hanging down.
Cim-c. Puls 6.
The four remedies which now predominate in our search are: Pulsatilla, which has appeared six times, and.
Mercury } each of which has.
and Bryonia } appeared three times.
After tallying all the remedies obtained from the repertory, four remedies stood out preeminently, namely Pulsatilla, Nat. mur., Mercury and Bryonia.
Now comes a really very important task-the use of the Materia Medica. Clarkes “Materia Medica” was obtained and a careful perusal of each of the drugs was made. As previously stated, the mental symptoms are very important and should be very carefully considered and read. Mental symptoms are always individualistic. The remedy which reads best mentally of those being considered is usually the correct one. In choosing the drug, always, however, consider the totality of the case presented.
Another caution which I must add in reading the mental symptoms in the “Materia Medica” is that one must not merely see the words as printed, but there must come to him a revelation of the personality expressed by that symptom group. During the perusal of remedies it is well to generally individualize your patient. Watch him very carefully and especially watch him from a mental point of view.
Before the final selection of the remedy in this case was made it was interesting to consider some of the clinical remedies so often used for diabetics, and see how well they compare with the four remedies which come out in the repertory and with the one finally selected.
Some remedies most often used in diabetics are Arg. nit., Kali. brom., Phos. acid, and Uran, nitrate. A careful reading of these remedies was made and I must state that none of these touched the case in any way. Phos, acid had some few of the symptoms, This well illustrates the futility of prescribing offhand for chronic cases. Chronic cases must be treated individually and even the homoeopath who attempts to prescribe for a disease didactically can only get, at most, palliative results.
After reading the four remedies which stood out preeminently from our repertory search, Pulsatilla was chosen for our case.
Pulsatilla was given for many reasons. It was most conspicuous form the repertory point of view, fitted our case most precisely form a reading in the “Materia Medica.” It was more particularly given because mental symptoms were in perfect accord, since our patients was nervous, desired sympathy and because his general make up as I watched him when reading the “Materia Medica” all aimed toward Pulsatilla.
Pulsatilla also has itching in the eyes, ears, back and sides, is worse from fats,
dimness of vision,
dizzy spells in front of eyes,
better in the open air,
disordered stomach from fats,
pressure in rectum,
which is painful,
urging to urinate with frequent urination,
nocturnal emissions which fail to appear.
coldness of hands and when pendent are painful,
burning and itching and stinging here and there,
itching in the evening,
always worse in the evenings.
Thus we see that our remedy fits the case from every homoeopathic viewpoint. I gave the patient one powder of the 200th, of Pulsatilla, and sufficient placebo to take I tablet t.i.d.
Two weeks later, I again saw the patient. He appeared much brighter, was spirited in character, and greeted me appreciatively. I inquired as to how he was, and he told me that at first he felt very poorly, but soon noted remarkable improvement. His dimness of vision, the dizzy spells, his urgency to urinate, all had disappeared. He, however, still complained of the itching sensation, but said that this was not as bad as previously.
Such rapid improvement is remarkable, and I had certain misgivings. Drugs which act rapidly in a chronic case of this character are often palliative and not the true similars. In some cases rapid cures mean only subsequent return of symptoms and at times indicate the incurable definitely pathologic case.
One could easily note objectively that the man seemed markedly improved. I gave him more placebos and asked him to return again in two weeks. He subsequently appeared. I again inquired as to his condition, and he stated that he cannot recall when he felt better. The itching had now practically ceased. He, however, did complain of waterbrash as a result of indulgence in fats.
This case, we can readily see, is due for an ultimate alleviation of symptoms, and, in spite of his diabetic condition, can live a normal life.
The question which next arises is how to give our remedy. I gave the patient one powder of the 200th of Pulsatilla. I did not repeat the drug. Repetition of remedies I deem inutile and often will mix our case. A similar remedy acting dynamically upon the uncanny human system, and once having stimulated that organization to activity in the proper direction for ultimate cure, needs no further giving. Repeated stimulation means fatigue results in symptomatology. Thus, one may say that as long as a remedy is acting, do not repeat your dose. It is well always to bear in mind that repetition is never essential, and need never be hurried in the chronic case.
With this first dose of the 200th, I gave the patient sufficient placebos until the next office visit. Placebos are given merely as a psychologic means of not alone making the patient believe we are giving him medicine, but a constant watchfulness is placed, on the part of the patient, upon himself and enables him to more accurately describe the changes he has noted in his condition.