CASES

Case I:  This case is presented in full as it illustrates some interesting points is both cases analysis and management.  Cases 1 & 3 and 4 were all done as consults.  It is of course not possible to address all the subtleties of the analysis in an article of this length.  The author welcomes any questions or comments 
  
Christsopher P. age seven 
29/3/89 : Recurrent infection  x 3 months. Began with high fever 105°. Spike up and down  x 3 days.  Epistaxis with fever.  Then rhinitis and cough.  Past week has pain in left ear.  Now has rhinitis.  Past Hx unremarkable physically.  In past; school problems, lying related to step brother with drug problem.  New sibling since February.  No apparent jealousy.  (Contradicts mother constantly (2))  (Very irritable in office because he was being spoken about (2))  Ashamed and embarrassed to speak about problems (2).  Will not cry in front of others (1).  Extremely irritable if woken in morning (3).  Allergic to all furry animals (2).  Fear robbers (2) dark (2) (Not a likeable child, adult and sullen.  Skin has yellowish caste).  Loner, not popular at school.  Restless (2).  Problems at school.  Poor concentration (2).  Warm (2).  Deceitful (1) devious.  Nasal obstruction (2) mouth breathes, at night.  Flatulence (2).  Desires sauage (2) Sweets, nacon, eggs, lemonade.  Averse tomatoes(1) spicy, mushrooms.  Thirst cold.  Offensive perspiration feet(1). 
  Rx Nux vomica 200. 
  
Comment 
  It is clear that the center of gravity of the pathology lies in the emotional sphere.  That is to say it is in the realm of the emotions that the main obstructions to the free flow of energy lie, the main limitations to his freedom of expression.  Thus it is from this realm that the chief features of the similimum are to be found.  On careful consideration of the case we find ourselves, confronted with morose, sullen child, who is strongly averse consolation, and exhibits a marked tendency to contradict.  Although the remedy is not well confirmed on the physical level it appears as the best choice with a fairly clear essence.  The fact that he is quite warm blooded must be taken into consideration but, as children in general are much warmer than adults, this fact is insufficient to negate the selection.  Other considerations were Thuja, Nit.ac. Lycopodium. 
  
17.5.89:  Looks quite different.  Much more outgoing, cheerful, communicative.  Behavior problems at school subsided. Doing well.  No infections/colds.  Nasal onstruction slight amel. but still has coryza.  Fears markedly decreased.  No longer irritable in the morning.  Enuresis is much improved. 
  
21.6.89: Mother says still a problem.  Manipulative (2) bossy especially at home.  Aggressive.  Enuresis returned. 
Rx Lycopodium 30c. 
  
21.7.89: Serious behavior problems.  Hitting (1) aggressive (2) and very mean to other children.  Malicious towards little sister(2).  So angry he cannot help himself (2) just comes on so suddenly.  Hardness, does not care if scolded.  Fears are returning, dark, robbers.  Hates the wind (2) nates fat(2) Suspicious (1) and contradictory. 
Rx Nux vomica 1M.   

Comment 
  Here we meet one of the great obstacles to cure, prescriber error.  It is clear that the Nux vomica had an effect on the case.  The question is what sort of effect, and what do we expect from this type of reaction‌  Six weeks after the remedy on 17.5.89 the child is in quite a different state.  We see that the remedy has affected every level of the organism.  This sullen, irritable, unlikeable person has opened outwards to the world, he is much more free emotionally and physically in every way.  A beautiful action of the correct similimum.  Now one month after this he has relapsed for no apparent reason, the prescriber, not appreciating the depth of action of the remedy, doubts the validity of the initial prescription and changes course.  Homœopathy is a lawful science, nature is lawful, events do not just occur at random, there is order.  When we see our remedies act deeply, clearly, when we see the case unfolding towards health in this fashion, things do not just go wrong.  The case does not relapse within a month or so. 

  Only the correct remedy will produce a result such as this, and the movement begun by this contact will unfold in an orderly fashion.  It were reason in this way we arrive at the conclusion that there is something about the progress of this case which is very odd, very suspicious.  What is probably happening here is a combination of a transient (and quite lawful and expected) dip in the child’s vitality, difficulties in the home life, especially in relationship to the mother, and a mother who is intolerant of the child’s symptoms and is exaggerating them to impress upon the clinician just how bad things really are.  The prescriber is lured into the trap and, when month later the case presents in a truly relapsed state, is thrown into confusion by the apparent disorder of the case and the failure of the indicated remedies to bring about the expected result.  From a distance this may look all rather obvious and simple, but when one is lost in the details and has no guiding principles to order the thinking, the way out is hard to find. 
  
15.2.90:  (Child is pleasant, friendly, co-operative) Mother is terrible historian.  She has Hx gonorrhea at least twice.  Not doing well in school.  Restless (2), poor concentration (2), always talking to the other children.  Constant rhinitist(1) agg. left side.(2), excoriating (1) (Allergic salute (2)).  In past nasal obstruction was much worse, now looser and excoriating.  Enuresis is amel.  malicious is amel.(2), not aggressive to little sister at all.  Can get angry, throw and bang but only in his room when confined there.  Hates restriction (1), being told what to do.  (Child by previous marriage, part time with either parent, observe that mother does not reallylike him). 

  Hospitalized in December 1989, bad flu, dehydration.  Stomach aches (1), wakes in morning with this.  Feels as if will vomit (1), feels it in his throat.  Hates fat (3) obsessed with this (2).  Desires pasta, salami, bacon,sausage.  Fear dark, robbers.  Bad dreams about robbers.  Cat allergy much ameliorated (2).  Weeps easily, likes consolation.  Does not like the wind. 

  Rx Phosphorus 200c. 

Comment 
  Here, nice months later, we see quite a different picture.  Our earlier suspicious are confirmed by the observation of the prescriber that the mother is both a poor historian and does not have a good relationship to this child.  The picture now is fairly clear for Phosphorus, the extroverted, diffused nature of which matches closely to the child’s current hyperactive state as well as his fears etc.  this “essence” is well confirmed in an unusual way by the picture of his allergic, symptoms.  These present a clear demand for Allium cepa, and it is the complimentary relationship of this remedy to Phosphorus which confirms it as the deeper “constitutional” remedy.  Often some apparently small consideration may tip the scales. If there had been a strong desire for onions, one might have gone with Allium cepa first.  It is interesting to note here that his allergy to cats was removed by the Nux vomica. 
  
Case 2:  Stephanie S.  age eight years. 
15.12.88:  Asthma (2).  The first episode occurred in April 1988 shortly after the family moved from a bigger into a smaller home.  This lasted a few weeks and then subsided.  Now it has returned and she has been on medication (Slo-Bid) for the past month.  (She is a sullen child.  She sits with her fingers in her mouth (2) most of the time and sats very little in response to my questions.  When she does talk it is mostly to contradict her mother). 

  Sleeps through the night despite Asthma (2).  Sleeps right side (1).  Eczema (1) since age 2.  Dry (1), itchy (2) skin.  Family History:  Both mother and father have allergies.  Headaches (2) 2-3 times week.  Frontal (1) ameliorated by eating(1).  Not a complainer (1).  Does not like to tell the teacher if she is ill (1).  Desires liver (2) fruit (2) seafood (1) sweets(1).  Averse meat (2) fish (1) Chicken (1).  They moved because her father lost his job and has been unemployed.  Since this move she has become quiet(2).  Normally “bubbly, outgoing with a mind of her own”.  When ill she just gets quiet (1).  She  is a person (1), averse to consolation (2).  Above average student (2) Likes to read (2) (Here I observe that while her mother is not looking she, without provocation, forcefully jobs her younger sister in the back with a stick like toy she has in her hand.)  gets frustrated easily.  Irritable in the mornings(1).  Musty (1) body odor from axillae. 
  Rx Nux vomica 200c. 

16.1.89:  Used inhaler 2 times around Christmas, no other medication.  No wheezing.  Attitude is great (2).  No longer irritable in the morning (1).  Energy is 100%(1).  No headaches, no body odor.  Still sucks fingers but 50% less. 

Comment:  The basis for the prescriptions here is fairly obvious.  Sullen, withdrawn child, probably secondary to the mortification (anger) at her change of life circumstances; contradicts her mother and is malicious to her sister.  Confirmed by the rubric Asthma in children. 

Case 3:  Lauren G. age three years. 

  Cannot approach child, will not be friendly.  Has been Rx with Silica in the past with good action.  Recurrent colds with high fevers.  Irritability (3).  Wakes extremely irritable and angry (3) from afternoon nap (3) in morning (2) Obstinate (3).  Willful (3) Demanding (3).  Frequent waking at night and will not sleep alone after this.  Wakes especially 2:00 a.m.(1).  Pushes and hits everyone except mother; says, “Go away you are ugly”.  Picky eater (2) prefers liquids (2).  Desires sweets(3) cheese (2) nuts(1) butter (2) salt(1) shrimp.  Aversion meat(1).  Thirst cold drinks(1) Fears dark (2) strangers, ok alone as long as she knows mother is in the next room.  Stool/urine strong odor.  Constipation (2) with normal stool.  Holds stool in as painful.  Likes to stay up late (1).  Sleeps abdomen(1) 
  Rx Nux vomica 200c. 
  
Comment: 

The choice here rests upon three legs.  Irritability is the center of the case.  The remedy has a strong complementary relationship to Silica which acted well in past and it is confirmed by the constipation with tenesmus.  This latter fact may not be obvious from the case but we can reason that if the child has a normal stool with no rectal pathology the mother’s interpretation that the passage of stool is painful may well be inaccurate, and what is painful is the characteristic “against the flow” peristalsis of Nux vomica.  Other thoughts included Lycopodium, Chamomilla, Stramonium, Silica. 

30.10.89:  Good response to Nux-v. 200c January 89.  Otitis 25.9.89 responded to Hepar.  Tired lately.  Few colds, one otitis.  Less irritable but hitting again.  “makes me feel good”.  Gets very frustrated if can’t get things right.  Fear dark (2). Mother says this did not really change.  Dances to loud music.  No problems in school.  Quite popular, a leader.  Large stools with no pain/problems at all.  Does not like to be alone.  Demands a lot of attention. (much more open, friendly and pleasant)  Cannot stand to be touched on the top of her head.  Little shy.  Desires liquid foods(2) rather drink than eat.  Cheese (2) spicy (2) liquids(2) sweets(3) salt (2).  Sleeps abdomen.  Fears the sea.  Perspires feet. 
  Nux-v. 12c daily for 1 week with good response. 

Comment :

  Here we see a relapse after 10 months.  A little shorter than expected for a 200 potency in a child.  Thus we consider that either the acute ailment and/or the acute remedy may have caused this regression.  Thus 12c daily is given to see whether the vitality can be restimulated without committing ourselves, in this case, to a relatively extreme measure.  The subsequent response was excellent and there is no other indication to take us away from a remedy which has acted well.  

Case 4:  Zoe T.  Age 18 months. 

6.12.88:  (Bright, restless, demanding, into everything).  Flu for 6 weeks, Rx antibiotic 3 weeks ago for bronchial infection.  Began with diarrhea, fever, loss of appetite.  Vomiting with fever initially.  Now: cough(1) agg. At night Gags(2) with cough.  Agg. Motion (2).  Agg. Overheated (1)  Amel. open air (2), desires open air (2).  Perspires vertex(2) waking and sleep.  Heat on vertex(2).  Agg. twilight(2).  obstinate(2), mischievous(2) bites (2).  (Bit me when I took her toy away).  Fearless.  No remorse, cannot make her feel guilty.  Fastidious(3).  Vomits undigested food(2) if ill.  Diarrhea has fishy odor.  Syndrome: fever; vomits undigested food, greenish, fishy stool, then to chest.  Sleeps right side.  Desires salty(1) eggs, sweets.  Thirst warm(1).  Desires open air in general(2). 
  Rx Nux vomica 200c. 

Comment

  The two most predominant features of the case are irritability, and fastidiousness.  Only one remedy covers both these symptoms with the requisite intensity.  Other thoughts were Carc., and Sanic. 

Notes

1.  Pocket manual of Homœopathic Materia Medica.  William BOERICKE, 9^th edition 1927. 
2.  The Complete Repertory Vol.1.6.  Roger van ZANDVOORT, Holland 1990. 
3.  This rubric is credited to GALLAVARDIN in the Complete Repertory.