The Irresponsible Father
NATIONAL JOURNAL OF HOMOEOPATHY 2000 May / Jun VOL II NO 3.
Dr C B Jain
Dr Bipin Jain
Ars-iod / Phos / Tub

Now let us take the actual case and try to:

1. Learn to evolve the concepts of

1.   case-receiving

2.   clinical record

3.   clinico-pathological immunological and miasmatic correlation

4.   totalities

5.   problem structuralisation.

2. Management of a complex pediatric case.

Name: Mehta Yogesh K 
Dt 28-6-95 Age: 4y
Father: 30 years, auto driver- hired vehicle.
Mother: 25 years, housemaid

Chief Complaints

Assoicated Complaints

Patient As A Person:
Lean, no bleeding tendency, no cracks, no suppuration, no coldness, no heat. Sick-looking, malnourished, cranky child with unclean running nose, dirty clothes, unwashed dirty look and lusterless skin. Mother also mal-nourished, but certainly better in appearance.
Perspiration: diminished. Mainly around neck, abdomen
Appetite: increased, frequent small quantities.
Stool: Dry, hard since two months, strain+, no lienteria.
Urine: day/night 4-5 times quantity adequate.
Milestones: teething: 9 mths no problem. standing and walking:1and1/2 yrs because of weak health. Speech 11/2 yrs. Breast feeding till 11/2 yrs, solids after two yrs.
Thermal: sun no aggr. Fan in summer and winter, never covers. No Woollens, likes cold bath.

Family History: PA and PGM - Hypertension
O/E: BP 120/80. Wt 10 Kg, Nails - pallor, frontal bossing, conjunctival xerosis ++, oedema- periorbital & below eyes Liver + 1 F RS/CVS- NAD

Investigations - CXR PA VIEW
25.09.92: para-hilar ? Retrocardiac infiltration, increased, thickened bronchial wall favours bronchopneumonia.
17.08-95: Right hilar haziness.

Mentals And Life Space: Egoistic. Irritated if touched and if harrassed further, hits and beats. Beats a child who offends by words or opposes him. Obstinate3- lies and rolls on ground.

Pt does not get along with elder sister, so harrasses and beats her. Likes younger sister and plays with her. If younger beats elder then feels bad and starts crying. POSSESSIVE3 about own things. Afraid of father, who has beaten and scolded him twice. But he is not afraid of his mother inspite of a lot of beating. No other fears More history was obtained after mother wrote down full history form:

Family Set Up: Patient has 2 sisters- 6 and 2 yrs. They live with their parents and PGM. One paternal aunt, who has left her husband's house in Gujarat, also stays here with her children. Another paternal aunt recently committed suicide. Her children also stay with them.

Father is an auto rickshaw driver working irregularly and not shouldering responsibility. This financial constraint lead to strained family relations at times Pt has a violent temper, will not rest till beats up the one who offends him. The intense obstinacy manifests through lying on floor and rolling on ground.

Mother spontaneously said that he has much attachment for both sisters, even cries if they have some problem. As such he is possessive about his own things, but if mother beats this same demanding elder sister, patient starts crying and gives things to sister immediately. Weeps with anger, when dominated, when his own demand is not fulfilled or he is scolded..

Follow-Up of previous treatment at the OPD

Patient Came To Us At This Stage :
Till now case was treated under other Homoepathic OPD and under paediatrician. Taken AKT for 5 days when he came to us on 15/7/95. On seeing the case history, treatment and state of patient, first important thing was to understand the clinical state with general vitality and immunity.

Following Understanding Was Arrived At
Chart  Clinical Clinico pathological co-relation (chart is done separately. ) Looking at the above evolution it is clear that the immunity status of the patient is poor and he has nutritional deficiency with Protien Energy Malnutirtion(PEM) A +ve Mantoux test becoming -ve while the disease is active, : it is not a good sign as it points to a poor immunoligical status, the reaction to stimuli is reducing along with a progress of disease. All these point to very low susceptibility. The only solace was THE FEW Characteristic Symptoms thrown up, viz:

Fever with chillines < night, thirst++, hot. Severe weakness along with pathology. These point to Ars-iod as a phase remedy for this present state. AKT was stopped. At this juncture, looking at general state and susceptibility, introduction of the constitutional can provoke a fatal reaction as warned by Boenninghausen in TPB.

Then again in this present state, it was difficult to decide the constitutional remedy. (Editor: maybe this is the wisdom of the body, not to throw up the constituional indications, so that it would not be administered!)

Explanation Of Ars-Iod: It is a phasic remedy indicated by characteristics of Ars plus Hot pt.

About Repetition: In a rapidly advancing disease, you need to repeat frequently so as to halt the progress, while maintaining caution that no aggravation ensues. If aggr, stop. When the suceptiblity came up, (see FU of 20-7) and the frequent cold-cough set in, (which indicated improved susceptibity), then this indicated the readiness of the body to receive deep-acting constituional.

A Summary Of Events: With this understanding, Ars-iod 30 was given, which brought about immediate improvement. It was continued with same frequency till next X-Ray/ESR on 21/10. Paediatric opinion concured substantial improvement clinically. Now Pt started showing frequent URTI symptoms though Weight improved from 9 to14 kg. Nutritional status improved substantially But the frequent URT symptom were not responding to Ars-iod. The improved susceptibility suggested that the constitutional should be introduced at this stage.

Constitutional Totality: Obstinate++, shy++, active+, delayed milestone led to Calc-i 30. Just 1 dose settled the patient completely. He still reports for infrequent URTI symptoms.

Next Opinion Of Paediatrician: patient is free from Koch's.

Follow Up Criteria

1. irritability
2. sleep
3. App
4. Teeth grinding
5. weakness/lying
6. fever/skin
7. cough/cold
8. O/E Temp
9. Chest/cervical gland
10. weight

Detailed Further Follow Up As Per Criteria 1-10

21/10 Hb-11 94 WBC - 12, 200, N- 40, L-56, ESR - 17

Present Nature/Behavior/Effect Of Rx Uptill Now:
About his mental status, his Mother said:
Previously he used to spend the whole day in crying, now he plays whole day, is always active, anger has reduced dramatically though is still very obstinacy. Previously if looked at him, would start crying and complain of being teased. Rolling on the floor. Previously if elder sister asked for something, would not give it, now he shares with her. 27/10 Patient came with sibling, 2 skin eruption on scalp. (? disease externalized ? good sign)

From 27/10 - 15/12 patient was on some doses but he started frequently getting cold/cough problem, the episode of fever with no response to same medicine with similar frequency. Upper Resp tract symptoms were not clearing completely.

Characteristics Of Patient: Lean, thin patient comes with mother and other relatives to clinic. Shy++, active ++, will not talk until forced him to talk, cooperate in, nutrition status has improved well, obstinate ++ about small things. Takes time to settle. Irritability is much less, if scolded cries but cools down easily. Calc-shy, Nat-loner) delayed milestones, irrtiablity is not a Nat kind, who does not settle down. Earlier irritation was more because of the nutritional status, ( in protien energy malabsorption, the pt is irritable)

Conclusion:

1. Successful Homoeopathic treatment of Koch's requires clear evolutionary understanding of individual's clinical presentation, pathological changes, immunological status, miasmatic status with in terms determine the susceptibility.
2. Only this understanding helps to determine reliability of cure, approach to case Posology and expectation from case.
3. Importance of investigations in determining the state of disease and susceptibility.
4. Interplay and determination of susceptibility in terms of immunity and hypersensitivity (allergic) play important role in outcome of cases.