DEPARTMENT OF PRACTICAL CASE MANAGEMENT


Seeing and observing the patient is somewhat different from reading over the record. We noted and unusual restlessness and many erratic motions (see Gestures, page 50 of the Repertory). It almost seemed as if the diagnosis of chorea was still a possibility.


NOTES ON CASE 1 REPORTED INĀ LAST MONTHS Recorder.

Through an unfortunate oversight a few important symptoms elicited at subsequent interviews were not included in the report. Some of these had considerable weight in the final choice of the remedy.

History of chorea which began at twelve years of age, became severe at thirteen and fourteen and was apparently outgrown at the age of sixteen.

Recently becoming increasingly nervous and has spells lasting an hour or so when it seems impossible to sit still. This is relieved by motion and especially by walking in the open air.

Becoming increasingly clumsy and makes many erratic motions.

The following rubrics were employed, using Kents Repertory, fourth edition:.

Page.

Ailments from anger 2

Sensitive to music 78

Fear of insanity 45

Fear of impending disease 44

Aversion to company 12

Restlessness 73

Restless in sleep 1247

Sudden weakness 1419

Emaciation 1357

Ravenous appetite 478

Appetite wanting 479

Desires highly seasoned food 485

Desires salt 486

Desires cold drinks 484

Lack of vital heat 1366

Amelioration in open air 1344

Menses protracted 728

Aggravation after menses 1374

Lochia suppressed 724

Breast milk suppressed 838

Constipation 606

Difficult stool 607

Straining at stool (tenesmus) 630

Diarrhoea 609

Boils (see Skin, eruptions, boils) 1309

Chorea 1347.

Anyone who may have worked out this case with the rubrics available no doubt has selected Phosphorus as the remedy in spite of the fact that rubrics Lochia suppressed and Breast milk suppressed appear to rule it out. It can be argued that as the apparent determining cause of the trouble was a fit of anger these suppressions may be considered in the light of a result. Anyway, it is the essential correspondence between remedy and patient that we are hoping to find.

Allens Boenninghausen, fifth American edition, and Bogers Synoptic Key, fourth edition, will not bring us anywhere near a choice of remedies. Most cases can be worked out satisfactorily with Boenninghausen but this one can not.

In light of the additional symptoms of chorea, etc., reported above, the view of this case must be somewhat modified. Tarentula Hispanica, or the Spanish spider, has followed through to a surprising extent, but not as completely as Phosphorus.

Tarentula will not be found under Amelioration in the open air, but is present under Desire for open air. The materia medica stresses the amelioration and therefore its absence under this rubric in the repertory must be an omission. The same is true of the symptom Aggravation after menses (see also Bogers Synoptic Key, fourth edition, page 257). The particular fear of tuberculosis (consumption) while relatively unimportant on account of the family history calling the patients attention to it, nevertheless points again to Tarentula (Kents Repertory, page 43). The rubric Appetite increased alternating with loss of appetite, page 477, again rules out Tarentula while Phosphorus is present, and yet Tarentula has both ravenous appetite and appetite wanting and it also has the element of periodicity in its nature.

Seeing and observing the patient is somewhat different from reading over the record. We noted and unusual restlessness and many erratic motions (see Gestures, page 50 of the Repertory). It almost seemed as if the diagnosis of chorea was still a possibility.

Tarentula 200 was prescribed and produced a distinct aggravation. The patient reported that she had never felt so fidgety as she did the first day or so after starting the medicine. After that she felt stronger and had much less fear ad apprehension of mind. The weak spells became less frequent and less severe and by December 13, 1938, at the time of the last visit, they had disappeared altogether, the patient reporting that she had never felt better as long as she could remember. Weight 132 pounds, menses regular, normal and are lasting four to five days. No trouble in sleeping except taking coffee at the evening meal which is very unusual. The prescriptions in this case were as follows:.

March 23, 1936 — Tarentula 200.

June 1, 1936 — Tarentula 200.

October 8, 1936 — Tarentula 1000.

March 15, 1937 — Tarentula 1000.

April 18, 1938 — Tarentula 10M.

All these prescriptions, with one exception, were made in what may be considered the spring of the year, pointing suggestively to an annual periodicity in the case. See page 1391 in the Repertory. Springtime aggravation is common among all the ophidia and many other venoms.

An occurrence of interest during the progress of the case was noted beginning May 11, 1936, not so very long after the first prescription. “Been having several small boils and now abscess is forming in right axilla.” Advised no local treatment. May 18: “Abscess receded of its own accord; no more boils, feel just fine.” June 1, 1936: “Abscess forming again in right axilla; been feeling badly all week. Last menses began May 24, lasted six days, thinks she is getting worse again.” This determined the second prescription of Tarentula 200. June 8, 1936: “Abscess pointing in axilla; advised patient to allow it to open spontaneously. Feeling better in every way.” June 11: “Abscess ruptured yesterday and has been discharging freely– reddish brown pus streaked with yellow, some blood. Odor not offensive”.

From this time on recovery was uneventful as far as any eventful developments were concerned and it appears that the results obtained by the use of Tarentula have been all that could possibly be desired, and we therefore conclude that it was the true similimum for this patient.

QUESTION AND ANSWER DEPARTMENT

[ Note: Send questions to Dr. Eugene Underhill, Jr., 2010 Chestnut Street, Philadelphia, Penna.].

Question: WHAT ANTIDOTES HAVE BEEN SUCCESSFULLY USED AGAINST INSULIN EFFECTS? –Royal E. S. Hayes, M.D.

Answer: The insulin in potency has been my best antidote.– A. H. Grimmer, M. D.

I have used Carbo veg., Antimonium tart. and Lycopodium in some of these cases of insulin shock, with good results. I suppose any of the so-called collapse remedies might be indicated. Incidentally, Carbo veg. has served me very well in aspirin collapse.– H. A. Roberts, M.D.

I have never seen any protracted bad results from the use of insulin, that is, to recognize them. One case only in which our best diabetes men were really baffled and a man who, it is quite evident, cannot take the new Protamine zinc insulin, was having steadily increasing doses up to 190 units in twenty-four hours. He has been on Lycopodium 200 and has got his insulin down to 116 units a day. The pancreas is evidently improved by having to function rather than by being allowed to remain inactive.–K. A. McLaren, M. D.

Question: THERE ARE THREE RECOGNIZES MEANS OF CONFERRING PASSIVE IMMUNITY AGAINST MEASLES: (1) WHOLE ADULT BLOOD, (2) CONVALESCENT SERUM, AND (3) HUMAN PLACENTAL EXTRACT OR IMMUNE GLOBULIN. WHICH OF THESE WOULD YOU CONSIDER BEST IN THE LIGHT OF HOMOEOPATHY?.

Answer: We would welcome an attack of measles if it would confer lasting immunity against a shot in the arm. The prophylaxis is worse potentially than the disease.

After known or suspected exposure to measles some homoeopathic physicians modify and often prevent an attack by prescribing either Ferrum phos, or Pulsatilla t.i.d. in the 30th potency for two or three days. Even this might not always be advisable in deeply psoric constitutions owing to suppression of susceptibility.

Eugene Underhill