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Homeopathic Home » Case Management » How To Take The Case


 

HOW TO TAKE THE CASE AND HOW TO USE OUR REPERTORIES AND MATERIA MEDICAS

A physician came to me with the following statement: "Dr., you have given us your methods of proving drugs for the purpose of securing methods of proving drugs for the purpose of securing symptoms and have also given us your method for grouping and ranking them. Will you not give me a grouping and ranking them. Will you not give me a little them tomorrow to tell me how you take the case, and then what books, and how you use the books for selecting the indicated remedy?"

The next afternoon he had another physician and myself met in the corner of the library and I gave them some of the following; I also promised to put what I gave them into pamphlet or book form, elaborating it by illustrative cases and adding the umber of the pages in the books; also the number and name of the journals mentioned during our conference. The following is the result of that promise: Time is the most important essential for taking the case, especially when the patient is a babe. To the statement, made by my boyhood friend and others who think, talk, and act as he did, viz., that memory and life are too short to study and remember all the provings, let me say that time is a relative term, and that an additional hour spent in taking the case and selecting the remedy may be worth years of comfort and even life to the patient. One of the first and most essential steps in taking the case of office patients is to so arrange your private room that the light from the windows may fall upon the patient's face and your back. This will enable you to note the general complexion, color of the skin, lips, and mucous membrane. The light, if possible, should not be artificial. My office has two large north windows, double- paned, each of the four panes 3x3 ft. 6 inches. The door through which the patient enters is at the south end. My chair is nearly in the center of the room. The patient's chair is in the southwest corner of the room. By this arrangement I can observe the patient as he or she is ushered in by the office girl and takes his or her seat. This first observation (sight), together with the Entrance Complaint, viz., his or her answer to my question, "What can I do for you?" determines the selection of the remedy in many cases.

[Case 1]
Let us take the following case as an illustration : Fannie J., jolly, good-natured ; light complexion; five feet two inches tall; weighing 140 pounds; pale-faced; colorless lips; cold, clammy hands and feet, came into my office with the following Entrance Complaint: "What can you do to cure my cold and lessen my menstrual flow?" In this case it was not necessary for me to go to any repertory or materia medica to find out that she was a Calcarea carb. patient. Nevertheless I then took my notebook and pencil and secured the following symptoms, family and personal histories, for the purpose of having the record for my files. "Mother living, strong, healthy as were all of her people. Father was a short, chunky, light-complexioned man, whom I resemble. He died when I was three years old of an acute attack of pneumonia. He was always subject to colds and catarrh, as was his mother and her people. His mother died of tuberculosis, as did also one of his sisters. I was slow in learning to walk, not being able to do so until I was eighteen months old. I did not have any teeth until I was thirteen months old, and my first teeth decayed very early. I had what they called `capillary bronchitis' at eight years of age and came near dying. I matured at 12. Preceding that, however, I had profuse vaginal discharge for several months. The discharge was thick but did not irritate much. The menses have been coming anywhere from eighteen to twenty-four years of age and came near dying. I matured at 12. Preceding that, however, I had profuse vaginal discharge for several months. The discharge was thick but did not irritate much. The menses have been coming anywhere from eighteen to twenty-four days; the flow quite profuse for six or seven days, and then the discharge I spoke of is more profuse for about a week after the menses cease. My feet and hands are always cold and clammy. I perspire easily and there is a sour, musty odor to the sweat. I crave sour things to eat and drink; often have heartburn; milk disagrees; frequently vomit undigested food, and my bowel movements, which are generally loose, contain particles of undigested food." You see, this is a typical case for Calcarea carb. for this particularly group of that remedy. The Calcarea carb. was given in the 3rd, five grains ten minutes before each meal and at bedtime, till after the next menstrual period. Her diet to be fruit, fish, vegetables, coarse bread-corn or whole wheat-no tea or coffee, but a goo deal of unfermented grape juice. She reported ten days after the next period; "Went twenty-five days and the flow was not so bad, nor did it last as long as usual." Continued the same medicine in the same potency, but only mornings and evenings, and asked her to report in a month, which she did, as followers: "Time just the same-26 days; flow less in both amount and duration; leucorrhoea less; feet and hands warmer; but I have lost seven pounds of flesh the past two months." Remedy discontinued. She continued to improve in every way. Fifteen months after beginning treatment her weight was only 114 pounds, and her statement was that she never had felt so well in her life.

[Case 2]
Let us now take a second case to show that one may be far more difficult than another in many particulars. Case II. Miss Carrie B., aged 26; school teacher; five feet seven inches tall; weight 118; brown hair; skin neither dark nor light, came into the office and dropped into the chair with, "Doctor, I have come in to see if you could give me something to prevent my taking cold on the least provocation. I'm so sensitive to cold. My pupil, Fannie J. (Case I), told me you cured her." When asked what was the result of her taking cold, she remarked, "Oh ! everything." The reply was in an irritated, disgusted, discouraged tone of voice. "Sometimes I have a sore throat with sharp, sticking pains at first, then later a sticky mucus, which is hard to get up or down; this mucus is always worse from three to six A.M., when it often wakes me up; sometimes the cold goes to my liver and my side gets sore and I have sticking, stitching pains over the liver; and my abdomen bloats hard and then constipated and light colored. In either case, the stools are painless. And then again the cold may go to my female organs so that the menses are delayed and accompanied by the same pains that I have in my throat and side, or I may flow like a river. I'm in that condition now. After these cold, I'm weak, good for nothing. An irritable, so much so, that the pupils have complained to the principal." that I have in my throat and side, or I may flow like a river. I'm in that condition now. After these cold, I'm weak, good for nothing. An irritable, so much so, that the pupils have complained to the principal." When asked about her family and personal history, she replied, "I'm just like dad. He is fifty and has been cross and irritable ever since I was old enough to remember. He is always grunting about his `poor liver.' His mother died of cancer of the liver at the age of sixty five; about two years after the cancer was first discovered. Mother and her folks are O.K. She is healthy and her ancestors all lived to be over seventy-five." As no remedy came clearly to mind in this case, I took down Gentry's Concordance, and turning to page 789 of Vol. VI, found the following: "Tendency to take cold easily. Magn-m., Natr-c., Natr-m., Nitr- ac., Nux-v. (Calc.-c., Kali-C., Phos., Sulph., Sil.), also tendency or liability to take cold. Coni., Graph." This gives us a class of remedies and constitutes the first step. The second step was to determine which remedy of this class most closely resembles the patient in make-up and other symptoms. For this purpose I most frequently use, and did for his case, T.F. Allen's Handbook of Materia Medica of J.H. Clarke's Dictionary or both. that I have in my throat and side, or I may flow like a river. I'm in that condition now. After these cold, I'm weak, good for nothing. An irritable, so much so, that the pupils have complained to the principal." When asked about her family and personal history, she replied, "I'm just like dad. He is fifty and has been cross and irritable ever since I was old enough to remember. He is always grunting about his `poor liver.' His mother died of cancer of the liver at the age of sixty five; about two years after the cancer was first discovered. Mother and her folks are O.K. She is healthy and her ancestors all lived to be over seventy-five." As no remedy came clearly to mind in this case, I took down Gentry's Concordance, and turning to page 789 of Vol. VI, found the following: "Tendency to take cold easily. Magn-m., Natr-c., Natr-m., Nitr- ac., Nux-v. (Calc.-c., Kali-C., Phos., Sulph., Sil.), also tendency or liability to take cold. Coni., Graph." This gives us a class of remedies and constitutes the first step. The second step was to determine which remedy of this class most closely resembles the patient in make-up and other symptoms. For this purpose I most frequently use, and did for his case, T.F. Allen's Handbook of Materia Medica of J.H. Clarke's Dictionary or both. We find a excellent description of the first case in Allen's Handbook, page 235, under clinical; also in Clarke's Dictionary, page 388, of Vol. I. Kent gives us a most striking resemblance of the first patient's make-up in his Materia Medica, page 297. Let us now take up the most important part of the first patient's Entrance Complaint, viz., the menstrual and leucorrhoeal flow. For this, see Allen's Handbook, page 241; Clarke's Dictionary, Vol. I, Page 348; Kent's Materia Medica, page 310; Boericke's Materia Medica, page 168. Again, let us now take up in similar manner the Entrance Complaint and make-up of Case II. The condition for which both sought relief was the same viz., menorrhagia caused by taking cold. But the make-up was very different. As stated, I decided on Calcarea for the first case at first sight. Calcarea carb. is a very easy drug to study, while Kali carb. is as difficult as the other is easy. As a result, I was unable to decide on which of the remedies in Gentry the patient most resembled. Recalling that Kent had said something about Kali carb, being a hard remedy to study, I took down his Materia Medica, and on page 586 I read the following: "The Kali carb. patient is a hard patient to study, and the remedy itself is a hard one to study." Then rapidly running my eyes over the twelve pages and taking a few of the symptoms, which were in italics, such as "irascible," "irritable to the very highest degree," "sensitive to every atmospheric change," "Sensitive to cold." "symptoms come on at two, three or five o'clock in the morning; and internal hemorrhages," I decided upon Kali carb. as the remedy for my patient, Case II. This question settled, another arose, viz., potency and repetition of the dose? This question I answered "Yankee" fashion by asking myself another question, viz., What am I expecting to do for the patient? Cure her? Relieve her condition? or simply prolong life? My experience with this case of patients has taught me that to be able to make a complete cure is the exception. My experience with Kali Carb. refreshed by these words in Kent, viz., "Kali carb. fits just these symptoms alone and dose not fit the whole constitution of the patient (page 593)," made me decide that the remedy would only be palliative; that it would act best in a low potency, the 6th, and should be repeated before each of the three meals and at bedtime. As the medicine with directions were handed the patient, she record shows the following: "No, have taken no fresh colds; no, did not flow as much as the time before; there was less pain in said, "Now, what am I to expect? Are you going to cure me?" She was told that there would be a decided improvement in every respect but that I could not promise more. She was also asked to report in person two weeks after the next menstrual period. The the bowels and region of the liver; and I sleep somewhat better; no, I am not better every way, for I am more irritable and snappish than ever, and I cannot feel that I am any stronger." Changed the Kali carb. from the 6th to the 30th, five tablets morning and evening, and asked her to report again there weeks after the next period, which she did as follow: "Took cold two weeks ago, but this time it went to my throat, the menses came twenty-six days after the others, only lasted four days, and there was less other trouble with them; no, am not quite so weak but far from strong. I thought I was better natured till this cold came, but since then have been crosser than ever. Tell you all about my throat? Why, I told you all that before." The last she snapped out as if I had insulted her by my question. I then took down her former record. Examination of it showed the submaxillary glands slightly enlarged, the uvula elongated are relaxed; mucus back of uvula, and the entire larynx covered with thick, stringy mucus. The pharynx was similarly involved and there was a constant hacking and spitting of the mucus. The present condition was the same. Kali carb. 30th was continued, five tablets in the morning before breakfast. She was also given some tablets of Pix Cresole and told to dissolve one in a teacupful of hot water and gargle the nose and throat with the solution morning and evening. Five weeks later she again reported: "Those little, yellow gargle pills worked like a charm. That attack of sore throat cleared up at once and about a week ago, after a little cold, the throat trouble started again, but those pills checked it by using them these times. "Oh ! yes, the menses came after twenty-four days and were what I would call natural in every way; my stomach and bowels are better, have less indigestion, and the stools are more normal and regular. "Yes, I do need more medicine. I want something to help me in the home and schoolroom; am crosser and more irritable than ever." She was given Placebo, two doses daily, and asked to report in four weeks. She returned in ten days, saying, "Doctor! I'm desperate. My pupils have complained again to the principle and he has just had me on the carpet. If you don't help me, I'll lose my place." "Have I been worse mentally?" "Yes, I have. In addition to being cross and irritable, I have been snappish, impatient and intolerant. I can't bear any noise nor anything else. i saw a boy throw a spitball at a girl, and I took him by the hair of the head and swept the floor with him. His mother went to the principal and then he called me down. It was the second time. The third, and I go." She was given Chamomilla 30th, five tablets every three hours when not asleep, and asked to report in three days. She came in after school with the first smile I had seen on her face, and said: "Those pills worked as well on my head as the yellow ones did on my throat. I even kissed one of the little girls as she came to say `good-night.' I want supply of both kinds of pills, to keep on hand, should either the throat or head trouble return. Now, if you could only give me something to prevent me from taking cold, I would be so grateful." As she stopped talking, the two remedies, "Kali carb, and Chamomilla" kept running through my mind, as the expression goes, "Which? both? or neither?" A moment's thinking resulted in deciding to give the patient a good, long, fatherly talk, in which she was frankly told her condition, advised to let all medicines alone so long as she felt as well as she did then; but should there be a return of the menorrhagia to take the Kali carb., and should the mental condition return to take the Chamomilla, as she had taken them at first. She has been fairly comfortable for the past eleven years; has not lost her job; and the intervals between taking cold, flooding, and the attacks of irritability, etc., have grown longer. She has not been cured, but her condition has been greatly improved.



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