DEPARTMENT OF PRACTICAL CASE MANAGEMENT


A medical student recently asked if we were not afraid of a starvation acidosis in cases such as the one reported. So far we have had no such untoward result. However, in chronic conditions where an individual is extremely fleshly and overweight it is dangerous to order too rigid a fast as the body toxins may be dissolved out so rapidly as to overwhelm the constitution.


CASE REPORT.

Female, aet. 59, single, living with older unmarried sister. Occupation: Selling.

History of the usual diseases of childhood. Constipated for many years. Always a hearty eater and fond of rich and concentrated foods. High blood pressure, the systolic ranging from 180 to 220 with a general upward trend. Urine of low density showing trace of albumin, average of 3 to 5 pus cells per microscopic field. Occasional hyaline casts. Indican considerable. Uric acid and calcium oxalate crystals present in some of the specimens.

During past year has complained of attacks of vertigo which have been increasing in frequency and severity. On two or three occasions has fallen without apparent cause.

Around Christmas, 1938, a severe fall resulted in fracture of the left radius. The shock was considerable and reaction slow and unsatisfactory; unable to work for several weeks.

One night in February handbag containing seventy-five dollars and a briefcase containing valuable papers were snatched from her on a dark street. The theft reacted most unfavorably upon the constitution. she was furiously angry, terribly frightened, and as the anger wore off the fear increased, so much that she would not walk out alone after dark.

On March 6 contracted a heavy cold which developed into influenza and confined her to bed. Fever rose to 104.4, cough became hard and unproductive. Complained of severe frontal and occipital headache > by pressure as she insisted on having a towel bound tightly around the head, < on the least motion and severely < on coughing. Extreme thirst > by taking half a glass of water at frequent intervals. Distinctly worse during evening than at any other time. Bryonia 200 was prescribed. This loosened the cough, > the headache and for two days it seemed that a prompt and uneventful recovery would ensue.

The fever persisted, however, and for ten days fluctuated between 101 and 104. Because increasingly nervous and restless with twitching of arms and legs < on the left side. Began to complain of sensitiveness along spine. Later developed cramping pain in left leg and foot.

Patient was observed to be always lying on the back, both she and her sister stating that it was also her usual position in sleep. Mild delirium developed, thought continually reverting to the purse snatcher, the incident evidently having produced a profound effect through the mind upon the constitution.

One evening the sister called on the phone and said: “Come right away. If there is such a thing as having a convulsion in the foot I wouldnt know any other way to describe it.” Before leaving to see the patient we looked up Convulsions of the Extremities in Kents Repertory and, sure enough, on page 969 of the Fourth Edition the rubric Convulsion of the foot was found with thirteen remedies listed which were noted down as the symptom was so strange, rare and peculiar that it must be a strong characteristic for purposes of remedy selection.

We found the patient lying on the back and quiet except for incessant movement of the feet. Upon inquiry found that restlessness of the feet had become increasingly marked during the previous twenty-four hours. Considering the history of the fall which may easily have caused mild concussion of both the brain and cord, the effects of anger, shock and fright resulting from the theft, the exhaustion and nerve fag from a particularly strenuous years work, the complaint of severe occipital headache, the evidence of spinal hyperesthesia, the convulsive tendency and the fidgety feet, we prescribed Zincum 200. This was given about midnight.

The balance of the night was very distressing, but patient was distinctly better in the morning. After midnight there were several slight convulsions involving the entire left side, worse in the lower extremity. Recovery since then has been prompt and uneventful.

Realizing that the supine position must have caused considerable venous and capillary stasis along the spinal centres we advised the prone position and also suggested that the patient lie on each side at intervals.

The diet for two weeks consisted of:.

1. Water.

2. Cracked ice.

3. Lemon juice.

4. Lime juice.

5. Scraped apple.

Daily enemas of plain warm water were prescribed with amazing results during the entire two-week period, the patients sister remarking that she could not possibly understand how so much material could be eliminated while on such a diet. The explanation, of course, is obvious – retention of the residue of digestion for weeks or perhaps months. (The shock from the fall and the theft together may have almost paralyzed the bowels.).

Overfeeding is one of the major causes of death in acute conditions. After the fever and most of the other symptoms have subsided wait until the appetite returns in no uncertain manner, then proceed with caution. It should require about two weeks to return to a full or regular diet.

Dietary supervision is important also in prophylaxis against attacks of both acute and chronic sickness and it is not only safer but more effective than any serum or vaccine prophylaxis on the market.

The high caloric feeding used in pneumonia is, in our opinion, exceedingly dangerous and the cause of many deaths.

A medical student recently asked if we were not afraid of a starvation acidosis in cases such as the one reported. So far we have had no such untoward result. However, in chronic conditions where an individual is extremely fleshly and overweight it is dangerous to order too rigid a fast as the body toxins may be dissolved out so rapidly as to overwhelm the constitution. Serious consequences have been observed in chronic, obese patients on too radical a dietary regimen. Extremely thin and apparently emaciated individuals can usually fast much longer and with less danger than those who are very much overweight. Mahatma Gandhi is the perfect type for a long fast. In the case reported cerebral haemorrhage may perhaps have been averted because of the cleansing effect of the acute condition. With careful prescribing and dietetic supervision and the avoidance of overfatigue, together with proper amounts of rest and outdoor exercise, there may yet be years of reasonably good health in store for the patient.

QUESTION AND ANSWER DEPARTMENT.

Question: IS IT ADVANTAGEOUS TO EMPLOY ENDOCRINE THERAPY IN CONNECTION WITH THE HOMOEOPATHIC REMEDY?.

Answer: In the March, 1939, number of the Pennsylvania Medical Journal, on page 639, we read:.

Endocrine substances should not be used promiscuously. The indication for endocrine therapy depends upon a correct diagnosis, a thorough knowledge of the fundamental cause and a definite knowledge of the existence of glandular disturbance or deficiency. Endocrinology is practically a new field, yet the literature on this subject is so voluminous that it is almost impossible for physicians to keep abreast of the progress being made.

Evidently nobody as yet really knows what it is all about. It would seem far safer and wiser for the homoeopathic physician to confine his therapeutic endeavors to the realm of straight homoeopathy. Until the endocrine products are thoroughly proven as Hahnemann proved the polychrests we can have no scientific basis for their employment. The remedy which is homoeopathic and suited to the entire constitutional state of the patient will often correct glandular imbalance to a surprising degree.

Question: SOME AUTHORITIES CLAIM THAT THE HUMAN AND ANIMAL ORGANISMS CAN ASSIMILATE ONLY ORGANIC MINERAL SALTS AS BUILT UP THROUGH PLANT PROGRESS. HOW, THEN, CAN THOSE HOMOEOPATHIC REMEDIES WHICH ARE DERIVED FROM AN INORGANIC MINERAL SOURCE PROVE EFFECTIVE?.

Answer: The process of potentization renders a medicinal substance highly active while eliminating the risk of tissue irritation which might result were the crude substances prescribed. It is amazing, sometimes, to observe the result upon deformed finger nails of a single dose of Silica, Calcarea, or other indicated remedy from an inorganic mineral source. The potentized homoeopathic remedy induces a change in the body chemistry which enables the organisms to assimilate the organic mineral substances in the food which previously could not be utilized.

Question: WHY SHOULD HOMOEOPATHS NEGLECT TYPING THEIR PNEUMONIA CASES AND EMPLOYING SERUM THERAPY WHEN INDICATED?.

Answer: If there were no better way of treating pneumonia we might possibly say, Go ahead and use serum therapy; but serum treatment as compared to homoeopathy is about as efficient as the old kerosene lamp as compared with the modern electric light. The time will doubtless come when all forms of serum therapy will be regarded as an amazing crudity typifying the medical chaos and commercialism of the twentieth century.

Eugene Underhill