Bicornuate Uterus & Rt Tubal Block
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Mar / Apr VOL V NO 2.
Dr Dharamsingh Thakur
Dr Anand Kapse
Dr Prashant Koti
'Sil

Introduction:
This case represents the best cooperative effort of a team which houses the best of Allopathy and Homoeopathy. Dr Prashant Koti Gynaecologist, investigated the case for infertility and referred it for Hom. Rx. He continued to be involved in ANC care handling and checking parameters, as a bicornuate uterus can precipitate early labour. Dr Anand Kapse, Director, Rural Homoeopathic Hospital, Palghar was the main Homoeopathic consultant, deciding the course the treatment would take, and Dr Dharamsingh Thakur, RMO at our cottage hospital for the adivasis’ at Bhopoli ie Smt. Janaki Bacchu Dube Homoeopathic Hospital, Bhopoli, but attends Palghar hospital for 3 days in a week was the day to day primary homoeoapthic physician: Team work at its best.........

The Case of The Woman:
A 26 yrs married woman came to the Rural Homoepathic Hospital, Palghar on 14/04/2003 with C/o primary infertility and irregular menses. She was evaluated by our Gynaecologist Investigation - HSG showed a bicornuate uterus with Rt tubal block. The case was referred for Homoeopathic treatment.

Patient as a person
Physical Generals -
Chilly C³H² à C⁴H.
Perspiration - profuse.
Motion Sickness.
Hunger ²<
Wound healing delayed suppuration ++
Menses-Stains fast ++

MENTAL STATE
Shy³ Timid³ Obstinate².
Fearful² Slow sluggish².
Dreams-Dead bodies ++ Snake +

LIFE SPACE
She was born and brought up in a poor family. Father is a farmer and also works in other’s field along with Mother. She is youngest among siblings having 2 elder brothers and 1 elder sister. All are married. She is illiterate. All family members are illiterate except patient’s elder brother who has studied up to 5^th class.

Patient got married 6 yrs ago. Her husband works under a contractor. His nature is OK. They have a small wadi in which they grow vegetables and rice. Patient also goes to work in other’s wadis. The family comprises of MIL, 1 BIL & 4 SIL. FIL died before patient’s marriage. Patient has sometimes arguments with MIL for household work. BIL stays separately due to his work. Patient has good relation with all family members. She has fear of being alone at night² and darkness.

During interview patient was laughing more while giving answers and appeared shy³. Both the Primary Physician and the observer had difficulty in understanding patient’s language. Patient said that she gets irritated but it remains only for short time.

Interview with Husband:
The interview with husband yielded more information. Husband told about patient that she is timid, fearful and obstinate by nature. Once she decides she wants something, then she wants it. She doesn’t speak to strangers or guests immediately. She is shy by nature. She does work very slowly but it’s good in quality, neat & clean, Slow, but good. Husband told that she is very slow in understanding & has to be told every work repeatedly.

Problem Definition:
Little can be done for structural changes, but there is hope for conception by improvement in her menstrual cycle. So we deduced her irregular menses is the chief problem and it requires correction by constitutional remedy.
After above case definition I came to the conclusion of Calc-carb D/D Silica. I chose Calc-carb on following basis-slow & sluggish lady with weak memory and obstinate and timid nature. These are the characteristic mentals of Calc-carb and were confirmed by the physical generals like profuse perspiration, motion sickness, delayed wound healing & suppuration. Dreams of dead bodies also covered by it.
Then I took the case to the consultant: Discussion with consultant pointed out Silica as the similimum because she has more amount of shyness than obstinacy. She is slow and sluggish in work, but does it competently, and neatly. She is fearful and irritable and all physical generals are covered by Silica like Hunger <, motion sickness, delayed wound healing, suppuration & menses staining. Dreams of snake is also covered by it.

Planning and Programming:
We gave Silica 200 (1P) weekly considering moderate sensitivity & Susceptibility at mind & body level respectively.

Follow Up:
Sil 200 1P weekly was started on 14/04/03. She got her menses on 17/05/03. Abdominal Pain during menses had reduced in intensity. Leucorrhoea had >3. (which she had not told during case taking) within 2-3 wks. She reported that she used to get leucorrhoea after coition which had stopped now. Sil 200 was made 3P weekly. On 1/07 she reported with morning sickness of pregnancy. Urinary Pregnancy Test was positive. She has been advised to continue with constitutional treatment till delivery.

My Learning:
To understand the qualitative difference in appreciation of the remedy. All remedies have the same emotions, but it is their intensity and the presentation which can decide the constitutional remedy. This case was a great learning experience for me.

HUSBAND’S CASE
Fertility is a team effort and Infertility is not the issue of only one person. It is the couple which is infertile, hence we need to treat both. So we defined the case of husband.

Patient as a person
Calm, sincere. Punctual in work. Hard working.
Sympathetic 2. Anxious 2.
Anticipatory anxiety before exams & results.

Physical generals
Chilly. Male pattern baldness.

Dreams snakes ++

P/H asthma < Winter till 6^th class.

Life space
He is from a poor fudagi family. Both parents were farmers and calm by nature. Patient is youngest amongst 5 siblings. He has 1 elder brother and 4 elder sisters. All are married. Patient is the only person in the family who studied up to 10^thclass. (Brother studied up to 5^th class) He had a lot of anxiety before exam and results & would loose his sleep. Along with study he used to work in fields and earn money for education. He failed & would loose his sleep. Along with study he used to work in fields and earn money for education. He failed in 10^th class. He did not succeed even after another attempt, so he took admission in ITI course under economical background status. After that he got job in Panchayat Samiti.
Now he works as a hand pump worker. For that job he has to go to different places for work. Initially he used to go on bicycle, but because of dyspnoea and Chest pain now he goes in Samiti’s vehicle. He is very regular in his work, never comes late. He completes his work properly and in time as compared to other colleges. He has good relation with all his colleagues. He likes to help people. He has written in history about desire for social work. In his area there are less learned people. So for any official matter they come to him and he helps them. He is famous in the society for this.
Elder brother is irritable by nature and stays separately. Patient has good relation with him. Patient gets affected by people’s comments about their not having children. He cried when I asked him about his feelings due to people’s comments. He said I help people for their good things then why God is behaving with me like this? Patient said that he gets irritated by lies, otherwise he never gets irritated.

ACTION
After discussion with consultant we came to the conclusion of Silica considering his Anticipatory anxiety, Sincerity, Punctuality, Hardworking, Sensitive and Calm nature and dreams of snake. Chilly patient with H/O Asthma < winter also supported the prescription.

He received Silica 200 (IP) weekly. After 2 weeks patient said that his tension has decreased and now he is feeling better. Sil 200 was continued in weekly doses till the wife conceived. Now he has been advised to report only SOS ie if he has any health problems.