DEPARTMENT OF PRACTICAL CASE MANAGEMENT


Unrefreshing sleep is generally an indication of an increasing toxemia and plenty of “good nourishing food” is often the cause of the trouble. Many cases will clear up after dietary correction and an increased amount of outdoor activity. Remove the obstacles to recovery and then prescribe the indicated remedy. The idea of letting the remedy do it all is unscientific and in the long run disappointing.


PROBLEMS IN DAILY PRACTICE.

Sleepiness after eating is generally an indication of slow, imperfect digestion and a sluggish liver function. If the condition is worse in the afternoon advise suitable modification of the midday meal-either a very light lunch, a raw fruit meal or nothing whatever according to he requirements and indications of the particular case. Sometimes a walk in the open air is far better than something to eat.

In other cases the patient may need rest and relaxation more than he needs food. Individualization in case management is just as important as in selecting the remedy. It is well to remember, however, that the vast majority of people are habitually overburdening their digestion by over eating, by frequent snacks between meals and other dietetic errors. These should be corrected before prescribing the indicated remedy. Rubrics for Sleepiness after eating will be found in Kent on page 1250 (4th Ed.).

Unrefreshing sleep is generally an indication of an increasing toxemia and plenty of “good nourishing food” is often the cause of the trouble. Many cases will clear up after dietary correction and an increased amount of outdoor activity. Remove the obstacles to recovery and then prescribe the indicated remedy. The idea of letting the remedy do it all is unscientific and in the long run disappointing.

Pruritus ani and vulvae are often very distressing complaints and simply mean acrid, irritating secretions. Interdict all beverages such as tea, coffee, cocoa and substitutes. Restrict the use of salt, pepper and all other seasonings insofar as possible.

The urine must be examined, of course, but in any event soups, meat broths, sugar and candy are likely to prove irritating factors in the diet.

Drinking too much milk has been a cause of pruritus in some cases. The citrus fruits are especially beneficial in complaints of this kind. Hot sitz baths may be expected to afford temporary relief while the remedy and the dietary correction are taking hold of the case. Baking soda, about a level tablespoonful, may be added to the hot water for the sitz bath. Antipruritic lotions containing carbolic acid, menthol, resorcin, etc., are mentioned only to condemn them.

Acute abdominal complaints unduly alarm many physicians, In the absence of collapse or shock symptoms and if there is no marked tenderness or rigidity just proceed to take the case in the usual way. The general rule is that if nothing very serious has happened it probably will not happen. The patient must be kept in bed and given absolutely nothing to eat and above all no laxative or purgative drugs of any kind. Allow whatever amount of water or cracked ice may be necessary to relieve thirst.

Carefully elicit the history and progress of the case. Note down all the symptoms of the patient. Make a careful physical examination. Select and prescribe the homoeopathic remedy and allow it time to act. As long as conditions become no worse everything is in your favor. If the case clears up like magic the remedy selection was correct and the patient cured. If slow progress is made toward recovery then the remedy was not homoeopathic to the symptoms but the patient recovered nevertheless owing to correct case management. In either event the surgeon would have been a needless and expensive luxury and even surgery has its own mortality statistics.

Chapped Hands : Causes: excessive dryness of skin, frequent washing or rinsing of hands in cold water, irritating factors. Wash or rinse hands only in hot water and then apply a soothing cold cream or hand lotion. Stubborn cases will require constitutional homoeopathic treatment and the chapping of the hands or cracking of the skin is then only one of the symptomatic indications. For a a list of the commonly indicated remedies see the rubrics Chapped Hands on page 95 5 and Cracked skin, hands, etc., on page 970 of Kents Repertory.

Chapping or cracking of the lips is often caused by thoughtlessly moistening the lips with the tongue, especially during cold weather. The same remedial measures are indicated. Sometimes bathing the lips with hot calendula solution is of value. Use ten drops tincture of calendula in a cup of hot water. The habit of moistening the lips must be discontinued. A rubric for Chapped Lips will be found on page 356 in Kents Repertory but do not prescribe for the local condition. Prescribe for the patient and that will include everything.

Pains in the region of the umbilicus if sharp, cutting or griping and if aggravated by standing, lifting, sneezing or coughing may be a symptoms of inguinal hernia. If the trouble recurs form time to time without apparent cause and if the pains are relieved by lying down and drawing up he limbs it is all the more suggestive of rupture.

It is surprising how often a hernia remains undiagnosed because of failure to examine for it. The most frequently indicated remedy for mechanical troubles is some mechanical form of mechanical troubles is some mechanical form of indicated remedy for mechanical troubles is some mechanical form of treatment, in this case surgery or a properly fitted truss.

If the patient is not too old and his tissue tone reasonably good we prefer operation but each case is an individual problem to be thoughtfully considered from all angles. The potentized drug is apt to prove disappointing except in cases of incipient hernia and the patient should be careful to avoid lifting, pulling, stretching or overreaching and he should flex thigh of the affected side against the abdomen when coughing or sneezing. Only by mechanical prophylaxis in connection with the homoeopathic remedy can there be much hope of success in such cases. (See rubric Hernia in Kent, page 552).

Eugene Underhill