There are three types of cases. The first is the very acute type. The second is the chronic type with acute flare up and the third that comes in between the two. I consider the last type different from the first two as it seldom manifests as an acute crisis. Neither it can be termed as chronic. This would be clarified later on. My experience with out-patient cases at the medical college hospital where I teach and with my private cases has given me enough opportunity to deal with each one of these cases with satisfactory results. I would like to share such experiences with you and discuss the approach that I follow to manage these cases.

CATEGORY 1 : ACUTE CASES

"In acute disease, the chief symptoms strike us and become evident to the senses more quickly and hence much less time is requisite for tracing the picture of the disease and much fewer questions are required to be asked, as almost everything is self-evident"

- Samuel Hahnemann, Organon, 82

Case 1: A two year old child with recurrent bouts of cough and fever leading to acute breathlessness was brought to the out patient department. He was acutely breathless. The most striking thing that was immediately noticed was the way he was screaming and holding on to his father. He was terrified. It was an intense feeling of fright and he wanted to escape from the room. Another thing that was noticed was the discomfort the bout of cough itself had caused in the child. Every time he coughed, the state of anxiety was further accentuated. The rubrics taken were:

Fear, Physician, he seems to terrify him (Synth.Rep.Vol.1, p.517)
Escape, attempts to with shrieking (Synth.Rep.Vol.1, p.442)
Clinging, to persons or furniture etc. (Synth.Rep.Vol.1, p.142)
Anxiety, coughing from (Synth.Rep.Vol.1, p.71)

A single dose of Stramonium 1M was administered and the patient was asked to wait. Half an hour after the dose, he was remarkably better. His false impression of acute danger was less. Even the physical signs on auscultation of his chest were undoubtedly better. This child continued to do well on placebo with infrequent doses of Stramonium when the case demanded it. It was obvious that the state of Stramonium existed in this child even before this acute episode. This was confirmed by some other symptoms. But this acute state brought up the picture of his similimum to the surface quite clearly. It became obvious that the more acute and urgent a case, the faster will be the relief that must follow after the indicated drug.

Case 2: A few weeks later, there was another child who was brought to the out patient department. He seemed to have a similar sort of anxiety with his cough and his father was finding it very difficult to manage him. Stramonium was prescribed but it had no effect at all. The child seemed even more distressed.

On more careful scrutiny, it was observed that the child had to be lifted during bouts of cough. Not only that, but the father had to walk at a fast pace with the child. As soon as he stopped, the child would cry and cough again. The cough had a very hoarse and dry sound too. Bromium 200, 2 doses at hourly intervals gave quick relief. The rubrics taken were :

Carried, desires to be, fast. (Synthetic Rep.1, p.125)
Carried, desires to be, croup in (Synthetic Rep.1, p.124)

Once the child was better, the remedy was further confirmed as the parents said that there was a marked relief in his general health while he was near the seashore. This is one of the grandgenerals of Bromium. Here I learnt an important lesson. The failure to give relief in an emergency is not the failure of Homoeopathy. It is generally our failure to note what is characteristic. Also we tend to put patients into slots due to the success of a so-called similar case by a particular remedy. For example, in this case, Stramonium was given out of a past experience of a similar case and it failed miserably. It has to fail.

CATERGORY 2 : CHRONIC CASES

Chronic cases from the bulk of our practice. The final outcome of such cases is very satisfying as one can appreciate the total rehabilitation taking place in the patient. But these cases are trying too, and they demand total freedom from prejudice and accuracy in observation. Let me share a case with you:

A young man of forty years, was referred to me by a colleague for a big non-healing ulcer on the dorsum of his left foot. He was a chronic smoker. The ulcer was eating away into his toes and also spreading upwards. The pulsation of his tibial and femoral vessels being absent, the non-healing ulcer and the chronic history of smoking suggested a diagnosis of Raynauds Disease presenting in the form of a non-healing ulcer. He had been warned by doctors from two different hospitals that the pathology may spread upwards and he must urgently undergo amputation just above the left knee.

On seeing him at our hospital out- patient-department and taking the preliminary history it was very evident that he did not have much faith in Homoeopathy. It was only the hope of salvaging his limb that had persuaded him to come to us. He was admitted in our Wards. The presenting complaints were agonizing pain during which he would get very desperate and ask for his limb to be cut off as he could not breathe pain. As there was a danger of the wound getting further infected he had been advised to let the limb to be bandaged upto the knee. For four consecutive nights the pattern of his symptoms would be similar. As night would approach his pains would gradually start increasing. At the peak of pain, he would get very violent, complain of acute burning pain and want the bandage immediately removed. He would start swearing at the hospital staff and threaten to walk away as we were not offering him any relief in his pain. The ulcer would discharge a greenish pussy discharge and was very offensive.

The rest of the history provided by his wife and the colleague who referred the case to me was as follows. He was a head sweeper of a company. He was an extremely violent man. There was repeated history of physical abuse on his wife and young children. When he was asked to wait outside while his wife was being interviewed, she at once pleaded to us not to make him wait outside too long. She said he was extremely suspicious and did not trust her speaking to any male alone. Even a casual talk made him extremely suspicious and then he would land up beating her. There was an incident when his young child had interrupted his get-together with his friends at home. He had flung the child so hard that he was thrown and hit his head against the wall. He had no family life. There were other immoral habits like frequent visits to prostitutes and taking liquor and cheap forms of addictive drugs. When he had come to me he had lost a lot of his hair and looked much beyond his age.

For the first twenty-four hours, he was put only on placebo. I was trying to put his case together and also wanted to see what were the acute physical symptoms. The violent pains, the expressions during the pains, the building-up of the pains by nights were pointing to a syphilitic remedy. But I was not yet sure which one .The next day when I went to see him, he was very upset that he could not sleep all night. He demanded that we remove the bandages at once as he could not bear the burning. We conceded to that request. While he was complaining of the violent burning of the limb, it was extemely cold to touch. That is when this peculiar symptom pointed towards the remedy - Secale Cor.

He was given two doses of Secale cor. 200 daily for four days. Right away the intensity of the pain started getting less each day. Though he did not admit it openly for the first few days, one could see that the violence associated with the pain was already much less. Now he was only complaining. The wound started sloughing and the layer beneath started showing signs of healthy granulation. The entire wound healed up except the tips of toes still remained cold and dark in colour. The Orthopedic surgeon attached to our Hospital who was also following the case, felt that now there may not be any further healing as a line of demarcation had come up between the wound area and the toes. Finally an amputation was done of the toes as our fear was that the gangrene may again spread upwards. The surgery was performed after which he was given special shoes so that he could walk with a limp. I knew for myself that he was rehabilitated in the true sense when he walked into my Out Patient department after two months of discharge to show me his foot. He was leaning against his young son who was assisting his father into the room. It was a great sight to see him hold his son affectionately.

The rubrics that helped to understand this wonderful remedy were:

Extremties, gangrene, foot, cold, with burning, tearing pains.
Forsakes relations fight, wants to Rage, tries to kill people

Suspicious

CATEGORY 3 : CASE WITH A DIAGNOSTIC LABEL

This category is the most challenging to a homoeopath. It is true that every case is a challenge but these cases even more so, as the allopathic physician is critically observing it too. These are the cases with a diagnosis given to them. Moreover, they can be confirmed through pathological tests. Diseases like Typhoid, Pneumonia, Rheumatic fever etc., would fall into this category.

I believe that a good Homeopath who has been treating a patient with the right constitutional medicine would not allow his patient to develop any one of these diseases. If it does happen, he should realise that the patient might not have been getting the right constitutional medicine.

But let us suppose that the patient does develop such an illness. It could also be a new case which comes primarily to us for treatment of such an illness. These cases have to be managed and cured in a specific period of time. There is no time to be lax or wrong in our prescription.

The anxious relatives and the sceptical allopathic physicians make it even more challenging. What does really help in the management of such cases is a sound knowledge of the prognosis ad outcome of such a case. There is a need to have an excellent rapport with the patient, his relatives ad preferably the allopathic physician too.

Finding the similimum is just half the job. The follow-up is equally important. It is common to find one single remedy being the indicated drug all through the course of the illness, but in some cases, a second or even a third remedy may be indicated, but never at the same time. It is our own anxiety and irresolution that makes us do this. We later justify it as "modern" Homoeopathy. In such cases it would also be important to establish a diagnosis through pathological investigations. A good record of the progress of the case must be kept. Finally, the reports indicate in clear terms the cure of the illness. A more important task is to note down the total time that was taken for the cure, otherwise our allopathic friends may dismiss it as a natural course of remission of the disease. Let me illustrate it further with a case:

Case: A Two year old child was brought to me with fever of four days duration. The past history indicated that the child had a very poor immunity due to which there was failure to thrive. He had been treated for severe rickets, recurrent respiratory infections with high fever and finally typhoid, just a week before he was brought to me.

For the treatment of typhoid he had been put on allopathic drugs, but when, after a period of seven days, he developed fever again, the parents thought they had enough. The child appeared very toxic. he had a thick coating on the tongue, relative bradycardia and a palpable spleen. Suspecting relapse again, some investigations were asked for. In this case there was not much resistance from the attending paediatrician. Not only did he happen to be my father, but over the years, he is one of the few physicians in the city who has seen how potent the homoeopathic system of medicine is. He gladly consented to the parents desire to switch over to Homoeopathy. In fact he was very co-operative. So he was closely monitoring the case too. The investigations did show that the child had paratyphoid. Needless to say that none of this helped me in selecting the remedy, but you would agree by now that it was equally valuable in its own limited way.

The history that I got was as follows. The child had become very aggressive during the last ten months. He could not be left alone even for a few seconds. He seemed extremely apprehensive while I was examining him.

The mother said that this was observed ever, when he would play with other children. The fear would get accentuated in the presence of animals, especially dogs, Besides the other common findings in a child with fever of four days duration, the only other characteristic observation that I noticed was a severe repulsion to the torch light being directed at him during the examination. In order to confirm this, I repeated my action which produced a similar response from the child. I decided to probe into the mothers state of health during her pregnancy with this child. I find this an extremely valuable aid in deriving at the remedy of a child, especially as he is not able to express himself through symptoms and this has been confirmed by some of my like-minded colleagues.

What the mother related was very fascinating. She has always had a bad relationship with her mother-in-law. During the pregnancy, she had felt that her mother-in-law, who stayed with her then, was extremely unfair to her and she had been very upset due to this. She said that she had to face her "meanness" daily and it would get her into such a violent rage that she either wanted to terminate the pregnancy in a fit of rage or would end up beating the pillow in her bedroom with such violence that her knuckles would become red. She recollected that, soon after this rage, she would feel extremely bad about her behaviour and thoughts. She also had a terrible feeling that her child would be deformed and no assurance from her gynaecologist would help to allay her anxiety.

According to my observations, the mothers state during pregnancy and the present state of the child corresponded to the medicine Lyssin. Rubrics taken for the child, were :

Shining objects agg. (Synth.Rep.Vol.1, p.910)
* Fear bitten, of being (Synth.Rep.Vol.1, p.482)
Fear alone, of being (Synth.Rep.Vol.1, p.477)
Fear, dogs, of (Synth.Rep.Vol.1, p.495)
* (Apprehension whilst being examined and during interaction with children).

Rubrics taken for the mothers state, during her pregnancy:

* Fear, pregnancy during (Synth.Rep.Vol.1, p.518)
Delusion tormented, thinks he is (Synth.Rep.Vol.1, p.369)
Delusion, wrong, has Suffered (Synth.Rep.Vol.1, p.387)
Rage, reprentance, followed by (Synth.Rep.Vol.1, p.820)
* (of her child born deformed).

After a dose of Lyssin 1M given to the child, the first thing that was observed was that he was less fearful when brought to the clinic. He also showed some inclination to eat a little. Then he became cheerful and wanted to play. Please note that the fever continued, but spike was not as high as it was prior to the medicine being given. We definitely observed that the toxic look of the child was not there. The fever lasted for a total of four days from the time the homoeopathic medicine was started. During this duration, the medicine was repeated in the same potency as and when the child seemed listless, aggressive, irritable, or when the spike of fever would show a definite rise. Investigations done after the treatment showed an absence of the bacterial organism.

CONCLUSION:

The above cases have been presented in order to convey something very basic. These cases do not show any personal style of prescribing. In fact they only adhere to old guidelines mentioned by our Masters. It has possible to do it not only in private practice but also at the out patient department, where the turnover of the patients seen is much larger.

The answer lies on finding what is most peculiar and characteristic in the case, be it mental or physical and find the best and shortest way to derive it. To give it up and look for the so called short-cuts in the name of modernised Homoeopathy only reveals our own misconceptions about our wonderful science and an inability to realise its scope today and for generations to come.