Welcome User!
Case Study

The Evolving Totality
Dr Reetha
Dr Sharique

Mrs SS, 40 yrs, Muslim, came with her husband complaining of

  1. Itching all over the body since last 2-3 years
    Frequency: Daily 2-3 episodes / day. Duration: 1-2 hrs
  2. Fever since yesterday. The acute totality of fever was taken:
    24/9/04: Fever with chills at 6 pm the previous evening. Bodyache², Headache², Weakness²
    Mild, thin, white, watery coryza with sneezing. Had taken cold drinks the previous day.
    Thirst: Decreased, Appetite: Decreased, Sleep: Disturbed.
    T: 101.2 F. P: 100/min. BP: 110/80. RS/CVS: Clear. PA: NAD.

Pulsatilla 200 TDS for 3 days was prescribed on the following totality

·         A/F Cold drinks

·         Fever < evening

·         Thirstless heat during

·         Extremities pain heat during

·         Headache heat during

27/9/04: Partial amelioration in the generalities but since the fever was not localizing on any system, routine investigations were ordered. No medicine was given.
28/9/07: Hb: 10.9, TC: 7,400, N: 61, L: 32, E: 8, M: 2.
MP: Not detected. Widal: O: 1:30, H: 1:60. [It was Day 5 of the fever and widal may not come positive.]
Urine routine: Albumin: +++, RBC: Occ, Bact: +, Pus cells: 3-4.

Life Space
She has 3 sons and 2 daughters. Youngest son and daughter go to school and elder three are married. The eldest DIL stays with her and with one grandson.

She is basically very shy and timid by nature. Throughout the interview she insisted that her husband be called in the cabin.

Husband gave the information that she is very dependent on him. Never goes out anywhere alone. At home she will shout on fmily for small things but outside she would be very quiet. She is fearful and if husband would scold her right now she would faint.

She was very young when her father had expired. Even today, cried while talking about him. Whenever anyone talks about her father she is not able to control her tears. Relations with her brothers and sisters is good.

Physical Generals
Sleep: Good awakes on slightest noisev Dreams: Does not remember
Cravings: Salty things³, sour².
Aversion: Sweets², spicy².
Perspiration: Profuse all over the body.
Menstrual History: Menopause since 5-6 yrs. PMC: 2-4 / 30 regular
Obstretic History: H: G5 P5 L5 A0. (All FTND)
Thermals: C4H
O/E: Temp: 100.2 F. Pulse: 104 / min. BP: 100 / 70. RS / CVS: Clear. PA: NAD.

Chronic Totality
Dependent³ will never go anywhere anytime, alone
Fearful of being scolded by others
Irritable at home
Perspiration: Profuse all over the body
Cr: Salty things³, sour³
Av: Sweets², spicy².
Has always been weak since beginning.

RemedyCalc-carb 200 I dose was given. (D/D Calc-phos)

4/10/04: Fever with chills daily evening lasting throughout the evening.
Weakness³, Giddiness³, Bodyache³. Sleep: Disturbed. App: Decreased.
O/E: T: 99.8 F. P: 104 / m. BP: 100 / 64. RS / CVS: Clear. PA: NAD.

Patient did not respond to the constitutional remedy. So Tuberculinum 1M I dose was given.

Indication: There was no fundamental tubercular miasm in this case. Neither was the totality of fever similar to the fever of Tuberculinum. (Ref - Materia Medica of nosodes by Dr H C Allen. Chapter Tuberculinum. Page 527)

Then what were the indications on which Tu-b was prescribed?

·         Pulsatilla did not act though it was covering the acute totality.

·         The chronic constitutional remedy also did not act.

·         Fever was not getting localized to any part or system and fever was still persisting inspite of treatment.

·         These type of fevers talk of peculiar susceptibility which shows lack of reaction to well indicated remedies and creates a state similar to Typhoid and Malaria which are Chronic fevers.

·         Tuberculinum is a well indicated remedy in persistent fevers.

·         When the best selected remedy fails and the case comes to a halt nosodes are indicated.

7/10/04: Within 24 hrs patient was better; fever dropped.
No complaint of fever and chilliness. Weakness:³, No Body ache, No Giddiness.
Slept well last 2 nights. Appetite Improved.
O/E: T: 99 F. P: 96/m. BP: 90/70. RS / CVS: Clear. PA: NAD.
Itching continues.


Case Was Reviewed:
Calc-phos 200 1 dose was given as the constitutional.
14/10/04: No fever and chilliness throughout this week. No other complaints.
Itching only 3 episodes, with reduced intensity. Over the next 1 mth this too reduced. Only few further doses required sporadically of Calc-phos and Tub-b