Has Witchcraft done me in?
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Jan / Feb VOL V NO 1.
Dr C B Jain
'Merc

Mrs S J, 36 yrs, Educated till: 3rd Std. She is a Housewife. Married since 18yrs
Spouse: 40 yrs Occupation: Service.
Siblings: 2 Brothers, 4 Sisters, 2 sons and 1 Daughter

1. Chief Complaints

2.  Associated Complaints

3. Patient as a Person
Appearance: lean, Weight loss Period: 10-12 yrs Jaw: sharp jaw line
Fingers: long thin, Palms: long
Skin complexion & texture: cracks +3 hands/soles Suppurations: No
Perspiration: general: 3 partial: forehead 3 scalp Odors +3 offensive
Color: No
Thirst- ½ glass-½ hourly. Hunger-< giddy, palpitation.
Cravings (C): highly seasoned ³ pickles³ sour³ Aversions (A): sweets²

ELIMINATIONS: Stool: Color: N, Urine: frequency: D/N = N
MENSTRUAL FUNCTION: F.M.P.? L.M.P. 21/12/01
Menses: Regular cycle: 26 - 30dys duration 3-4 days flow: No odor: No
Stains: color: Reddish Fast 2

OBSTETRIC HISTORY
Pregnancies: 3 Gravida: 3 Para: 3
Abortions: Natural: 3 Delivery: F.T.N.D. 3 N Lactation: N
Tubal Ligation- done - 13 yrs ago.
1^st pregnancy No clots. N
2^nd pregnancy Jts. Pain+ hands+ N
Duration 2-3 months with Allo Rx. 3^rd pregnancy No. clots. N
Sleep-startling since 13 yrs.
Dreams: water2 / sea2/ black / pond2.
Children +, getting well - health
Travelling3- vehicle trains.
Sun 3< headache / eye - cannot see
Fan: Summer: fast Winter: slow
Covering: winter thin bed sheet. Summer: none Asbestos / Ventilation: good
Woolen: No Bath: Cold Summer Tepid: W Patient: Hot C2H2 C2H3
Sensory inputs: Noise - < Headache
O/E: Skin: Hypopigmentation in the following areas:
1) Face - forehead above eyebrows around eyes - Lt. Side
Lt. Cheek  till malar prominence, sensation 2
2) Back - below shoulder blade - Lt. Side size 3-4 cm in dia.
Leg: Sensation 1 on Lt. 2 on Rt till mid leg.
Hands: till mid forearm - Lt. Side 1 Rt. Side - whole palm & wrist
Pattern of loss of sensation - Glove and Stocking type.
Ulcer: Plantar aspect - Lt. Foot near Thumb size - 1cm in circumference, ½ cm in depth pus+1
Both peroneal nerves à thickness³, tender².

The Story
A 36 yrs old female, lean and thin female, saree clad with a sad, troubled look on her face, came accompanied by her husband. She comes from a middle class family. She has 1 daughter, 2 sons, 4 B/L & 2 S/L, all are at village while her own family is at Mumbai. Husband is working in a company.
Pt. was well since childhood. She is the eldest daughter & 2^nd amongst 4 sisters and 2 brothers. As a child she did not have any difficulty with anybody. She she was a mixing type, got along with all, and lived an easy uncomplicated& simple life. She is educated till 3-4^th std. did not study further as there was no opportunity. No regrets. Both the parents were cool, co-operative. Father owns some land & is a farmer. They lived in a village near N.
All her problems have started after her marriage18 yrs back, her husband lives in a joint family. All her in laws are good. She is the 2^nd DIL. Pt’s husband lived in Mumbai while she hails from village. She came to Mumbai 6-7 months after marriage. Some years after marriage, she had acidity for which her cousin FIL gave some ayurvedic medicine. It was some loha bhasma, suvarna bhasma, which she had to take for about 8-9 months. Pt was not ready to take medicine from him. It was such that this FIL did not have an issue. He considered patients husband as his son and had wanted him marry a girl of his choice, which husband as well as his parents refused saying the girl was not good. This hurt him a lot. He was as such famous for doing some witchcraft on people. He was known to give some poisonous substances to people. One of her SIL had cautioned her and told her everything. But the way he behaved, at that moment pt did not even suspect about anything; nor did her husband. Then all her complaints started. The tingling, Nnumbness and then leprosy. Gradually and slowly the real color of FIL came up. He spread word through out the village that pt is having leprosy. Pt was extremely angry and hurt. She was sure that this person had done some witchcraft on her that is why she is suffering. This terror caught up with her up. These thoughts continuously crowd her mind and make her weak. The trouble is, nobody believed her that this is the issue. Hence, she felt all alone and isolated.

And further . . .
All this came to light when once suddenly her eyes started watering and she went blind. The doctor said she had to be operated as her eye got spoiled. This everybody attributed to the witch crafting. That they had a heated argument on this issue, when FIL said that pt is not going to get better, if she does, "I will grow a hair on my palm". All this caused difficulty in relations.Now the situation was tense . Pt’s mother was ready to take her home. But husband agreed to take care of Pt.

Since than, her complaints went on increasing. She developed white patches which was treated with dapsone for 3 ½ yrs. Yet she is not totally out of it. Later pt and her family separated from that cousin FIL. They were not on talking terms. 2 yrs back he died. Pt did not go to see him even in the end. All her relatives had gone to see him. Her relations with his wife also are the same. Now inspite of that person’s death, she is not able to overcome those fears. Says that you cannot revert back these changes. So now, this will go with her only and she will never get well.

She is a religious person. Since, she came to know about this, she started fasting, going to temples, (navasa) etc. for herself. Yet there was no improvement. As days passed and her children grew up, these created more difficulties. Children started calling her superstitious. This causes more pain and trouble to her. Felt rejected. As if, I am alone, nobody listens to me when I was telling you and now you try to explain to me. Now also she feels as if somebody is there in the window and gets afraid. She has kept herself totally aloof.

Husband commented that she is stubborn by nature and will not listen to anybody. eg If told to wear slippers, told not to work in water, as may aggravate.
She needs everything neat and clean; wants everything in place; gets angry/upset if things are not in place. She is a bit irritable by nature especially if people don’t listen to her. Initially used to hit children but now does not. Her relations with all her other in laws are fine. They have always supported her. But she herself does not have hope in her.

To summarize: we have
Involvement of nerves - of both extremities, ie ulnar and peroneal of both sides.The pathology is a slow gradual process, presenting as tingling and numbness of extremities with glove and stocking type of Anaesthesia.
Anaesthetic Hypopigmentation of skin at multiple sites, which appeared after 3^rddelivery.
We also see Recurrence of boils with delayed healing
Atopic ulcer on foot.

With this data we conclude the diagnosis as ATOPIC ULCER WITH LEPROMATOUS LEPROSY.
She also had eye complaints in terms of loss of vision. Unfortunately, we do not have further information of the same, so diagnosis becomes difficult. The doctor advised surgery, with which her eye sight was restored.
Lepromatous leprosy, is a Granuloma formation, where chronic inflammatory process goes on in the nerves, gradually increasing. It is a slow, on-going process.
At the functional level, we see the sensations getting affected first at thermal ie hot and cold than the pin prick and lastly the glove and stocking type of anesthesia.
The form presented as tingling and numbness with few characteristics; the recurrence of boils with suppuration & delayed healing also point towards low susceptibility.
The process of inflammation is not controlled inspite of Dapsone for 3¹/²yrs.
The inflammatory process goes on to ulcer formation which is again not healing, with suppuration. All this points to a low state of susceptibility.
On this system it also had another microbial infection of Tuberculosis, also a granulomatous inflammation, thus making the state of susceptibility too low. All these on going granulomatous inflammation with nerve destruction, non-healing ulcer formation represents Syphilitic miasmatic activity.

LETS EXAMINE THE WHOLE CASE: After marriage the Pt has remained in a state of vexation and depression. Over the next few years, her depressed state has gone on to the extent of hopelessness of recovery; she has lost confidence in relations. Losing hope in that sense points towards syphilitic activity. Her problem with FIL remained unresolved even after his death. She is still vexed and the hatred continues. This aspect of emotion certainly leads towards destruction, where Pt maintains an unresolved state. She is not able to form relations with the people because of the mental state. The physicals complaints are aggravated at night, so-night aggravation, cravings for spicy, pickles, sour and aversion to sweets. Her dreams of travel points to her inner desire to travel, which is very well mentioned in the Materia Medica as uncontrollable desire to travel far away. This when combined with aggravation sun and noise, chilly Pt and syphilitic dimension of the case in the form of ulcer formation of non-healing type, Merc-sol comes as the deep acting remedy.

14/5/02 to 28/9/02: Merc-sol 200 QDS

There was a gradual improvement in the Ulcer. But as the improvement stopped and susceptibility improved in terms of hypopigmentation decreasing, potency was increased from 30 to 200, repetition keeping the same

Potency selection: as discussed above, the tissue susceptibility is low and the sensitivity is moderate, so the potency selected is low to moderate potency with frequent repetition.

FOLLOW UP:
The case was defined on 2/1/2002. Tub-b 200 was released considering the on going suppurative process, with scarring tendency. There was no response to Tub, as there was syphilitic dimension.

As the disposition was not clearly available, we took into consideration the mental state and behaviour pattern and Merc-sol 30 QDS was started.
4/1/02 to 7/5/02 Merc-sol 30

There was steady improvement in her complaints. Her corns and callosities were the first to go. Hypopigmentation of face was the next to decrease with increase in sensation. Wound showed slow progress. Her generals also showed improvement as weight gain and decrease in tingling and numbness.
There was activation of the inflammatory process at the sight of the wound. Suppuration increased with pain, redness, swelling. This episode responded to Puls 200 4hrly. This shows that the susceptibility was reacting, a positive sign, it also built up our confidence on Merc-sol.

5/10/02 to 31/1/03 :Merc-sol 200 qds.
Now ulcer showed faster healing, but not complete. Sensations of extremities improved, hypopigmentation reduced to large extend, patch on back disappeared as the improvement stopped at the ulcer we shifted to Merc-sol 1M daily.

The ulcer increased to some extent, so she was kept on SL for 1¹/² month, to see the response of the system, how far the susceptibility is able to take care of the disease activity. Ulcer started improving gradually.

On 5/4/03
She came down with Herpes Simplex eruptions on her Right thigh. Small patch 2cm x 1cm. Vesicular lesions, redness, burning and itching. The whole episode subsided in 10 days with SL only. Dermatologist opinion was taken who reported that the immunity of the Pt has definitely improved to the extent to localize the viral infection to a small area. Otherwise in Lepromatous Leprosy where the immunity is low, viral infection takes a faster pace and greater depth, and wide spread, which is not seen in this case. Thus, we can conclude that the immunity of the Pt has definitely improved, the susceptibility has also improved.

Overall we can see the improvement at all levels, anesthesia of glove and stocking has decreased, pt can feel the hot and cold sensation, patches have disappeared, ulcer is also healing.

A lot still remains to be done in the case. But much has been done which speaks a lot about the role of homoeopathy in such dimension of cases.