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Managing Cases with Scanty Data

In day-to-day practice, every homeopath comes across cases with a scarcity of data. Poising problems and confounding even the most skilled in accurate prescribing. As one learns more about the art of case taking in the practice of classical homeopathy, and after attending many seminars where we see several cases with a long case histories, we unconsciously come to expect plenty of data to work with. It is easy to get perplexed and annoyed when a case has scanty data and lacks a well-described state of mind.

Managing Cases with Scanty Data
by Dr. Rajesh Shah, M.D.
The Homeopath,U.K., Autum No.63, 1996

In day-to-day practice, every homeopath comes across cases with a scarcity of data. Poising problems and confounding even the most skilled in accurate prescribing. As one learns more about the art of case taking in the practice of classical homeopathy, and after attending many seminars where we see several cases with a long case histories, we unconsciously come to expect plenty of data to work with. It is easy to get perplexed and annoyed when a case has scanty data and lacks a well-described state of mind.

Usually, in seminars and journals carefully selected "show" case are presented for discussion. Such cases have more than enough information.so that when a sincere homeopath meets with a case which lacks lengthy information and symptomatology in his own consulting room her gets discouraged. In reality every practitioner. However learned and senior, treats this kind of case on a daily basis. What I would like to discuss here is how we deal with cases with scanty data. However I would like to make it clear that cases of scanty data one sided cases are not the same.

 

Scanty but complete
Receiving information during an interview in homeopathic practice is highly specialized technique calling for considerable skill on the part of the physician. It is important that the homeopath painstakingly collects all the necessary data according to our standard rule. We must go step by step in to all the details of the sickness, the chief complaint, the chief complaint, the modalities, the associated complaints, appetite, cravings and aversions, thirst, perspiration, thermal state, discharges, sleep, the past and family history, the general constitutional traits of the patients and last but not least the mental stare of the individual. Only when we have done this can we say we have taken a complete case history. However, on occasion instead of several pages of notes we only get one or two sides, "there's nothing else, everything is normal" the patient says. This is then a case with scanty data.

If a case with deficient data is due to the inefficiency or carelessness of the homeopath that has not gone through the above steps conscientiously, then there is every chance that they will fail in the treatment of the patient because they are missing some of the important features. On the other hand many cases are taken very diligently but the amount of information obtained seems to be quite small. In such cases if we feel that the data collected is as complete as possible, then we will be able to process that data with more confidence. We should still be alert in such cases to form a totality with the available data. The absence of obvious and conspicuous symptoms should not hinder us in our search for the simillimum. With experience, a homeopath should be able to find a essential features of the remedy which will form a totality and guide him to the Simillimum.

 

Scanty but definite
Strictly speaking there is no such thing as too little or too much data. It all depends on how we look at it. It is not the quantity of the data that one gather which is important, but the quality. Reliable, definite symptoms will give you a strong concrete totality. The data should be specific and not vague, logical and not imaginary, if this is the case, then the totality of symptoms you have decided on will lead you to remedy that will work well.

 

Brief but solid totality
Most of the difficult cases treated or presented have primarily few, but very definite, indication of the remedy. The rest are often made up of supporting indications. If based on the characteristic and constitutional symptoms of the patient a brief totality will not be an obstacle to selecting the correct remedy. Hahnemann wanted to base his science on the solid rock of perceptual knowledge of facts.

 

A balanced totality
When constructing the prescribing totality, it is important to make sure that it is complete. What I mean by that is, however scanty the data may be, if it covers the three different aspects of the individual, namely, the mental symptoms, the generals and the local affections in a definite form. These will constitute a whole, and the remedy can be ascertained. The totality of symptoms implies not merely the presence of strong mentals, characteristics or general. It should not tilt towards any one aspect of the whole, it should be balanced. Any totality without mentals and generals is anti-Hahnemannian. So any totality must cover mentals, physical generals an local affections otherwise it is incomplete and doomed to failure. When we say the case has a small totality, it should not stop us working out the remedy. However small the totality may be the word totality implies completeness, and as such adjectives like large and small should not be necessary.

 

Clear concept and solid approach
It is never the case that a larger number of symptoms facilitates the selection of remedy. Only clearly applied homeopathic principles about constitutional prescribing along with sound knowledge of materia medica and repertory will help you prescribe confidently. Processing the data irrespective of whether it is scanty or large, and using the proper approach. Not only help to select the remedy but also helps you to be confident about it and not change it too hastily

 

Keynote symptoms
When the data collected is scanty, the importance of keynote symptoms increases. Well-defined and definite keynote may help towards selecting the remedy especially when the data collected is not profound.

 

What is available is enough
Many prescribers will have had experience that even after a couple of hours of case taking something is missing and they feel the totality is incomplete. In such a case if you are sure that you have been thorough. It may be that you have a case with scanty data. Scantiness or abundance is all-relative.

Do not misunderstand what I am saying. I am not suggesting that taking only scanty data is enough. If you are prone to take the case insufficiently, there is a good chance that you will fail with it. Working out a case with scanty data should not be by choice.

 

Notes about the cases

Some of the cases illustrated highlight how we construct a prescribing totality with so-called scanty data. They have been selected with this idea in mind. And also to show some other aspects; for example, uncommon remedies, long follow-ups and repetitions, use of Facets and phenomena in difficult diseases.

 

CASE ONE.
Mr. B.S 70 years of age but looking much younger. Tall and dark. First seen 18/06/94. Chief complaint: corns (callosities) on his right sole for three years. The corns were multiple and painful. Burning pain. He had applied corn-caps several times without relief.

Associated complaints: eczema of his left foot for 20 years, with occasional itching. Constipation for several years, stool has to be removed mechanically. Other details: appetite is good; he craves sweets and murabba (a sweet jelly like pickle). Thirst and perspiration are less. He is thermally hot. Likes to sleep late and has no dreams..

Family unit is himself, his wife and his unmarried daughter of 40. He has another daughter who is married.

Mind: He is mild person. He looks a little unhappy. He gets angry sometimes and when he is angry he keeps quite. "Who shall I show my anger to?" he may close his eyes and chant a mantra. Sometimes he has a dispute with his son in low and feels sad as a result. When said may weep and he also feels anxious.
Past history: rental calculus 10 years back.

  • This case presented with the following totality:
  • Sadness with weeping and anxiety (* Characteristic mental)
  • Craving for sweets (Physical general)
  • Hot (Physical general)
  • Eczema, painful corn (Local affection)
  • Constipation (local affection)

At the end of the above case taking, I felt a sense of satisfaction. The totality from seemingly scanty data clearly suggested Sulphur as his constitutional remedy.

Treatment and follow ups:
18.06.94 One dose of Sulphur 30, followed by placebo for 1 week. 09.07.94 pain in corns better 50-60%, Eczema status quo. 10.08.94 corns better 60% Eczema status quo.

13.08.94 acute prostatitis with frequent micturition, urgency and straining. Had similar symptoms 3 years ago. Given Sulphur 30 twice a day for 5 days. This acute illness provided an opportunity to stimulate the vitality with more of his constitutional remedy

18.08.94 as expected, urinary problem 30% better and his eczema aggravated. Corns are better. Watch and wait. Placebo.

25.08.94 all symptoms of prostatitis are better. Eczema remain aggravated. Given placebo.

03.09.94 Eczema betting better. Prostate 80-90 better. Corns over 90% better. Wait further. Give placebo.

19.09.94 Eczema over 50% better ( Note he has had it 20 years). Prostate and corns, no complaints, placebo continued.

01.12.94 Suggested terminating treatment and report after 6 months.

 

CASE TWO
Bhavya, 8 months old boy. Brought with profound vesicular eruptions on palms, hand and fingers, and scattered on legs and abdomen. He had received allopathic treatment with little relief. We recorded his case on video.

This child had no other important features. When I do not get a feel for a case. I like to state at it for some minutes to obtain more information. During this process, I observed two important points. The child was unusually smiling and laughing all through the interview and while we took photos of various part of his body, holding his legs and hands, he looked quite joyful. Another observed point was that he often scratched his left ear. On questioning the Mother, she confirmed that it was his habit specially when sleepy.

For me it would have been an important rubric if I could have found one for “Itching before sleep” but no such rubric exists. I too the following totality:

  • Joyful, happy (Allen)
  • Itching, left ear (Kent)
  • Eruptions, vesicular, plums, hands, fingers (Boericke)

The above totality consisted of a mental, a key-note and the peripheral expression (specific organ affinity). The remedy date came through was Anagallis ( Scarlet Pimpernel) and he was given this one dose for 7 days, followed by placebo for a month. The eruptions cleared completely.

 

CASE THREE
Mr. J.66 years. Brought by his son to Bombay for treatment. He lives in a small village in Rajasthan while his sons run a business in Bombay. He was operated on for renal calculi in August 93 and after surgery he went in to a coma. He was investigated and treated at a leading HN hospital in Bombay. His CT scan and M.R.I showed a pituitary adenoma approximately 2.3*2.23*2.06 cm. He was also hypothyroid and was given Eltroxin (thyroid supplement).

On diagnosing and pituitary adenoma, he was offered immediate surgery. Due to the tumor he had already his vision in the left eye. Being a typical old country man he refused any more surgery and decided to return to Rajasthan. His complaint was complete loss of vision eye. Occasional headache, loss of weight and weakness. His speech was not affected and he had no vertigo and vomiting. He was pale and looked tired. His teeth were very dirty and irregular and his mouth was foul smelling as he was a tobacco (and jerda) addict for the last 40 years

 

Other Details:
Appetite is poor. No strong likes and dislikes. Very chilly+++ Clear bowels and urine. Good sleep no drinks His family unit is himself and his wife. His two sons are engaged in business in Bombay while he looks after the agriculture side in Rajasthan

 

Mind:
His son says, his soft as well as hard. Sometimes he may be generous and sometimes very obstinate. If he decides not to give something to someone he will not give. He can not spend money. He is always concerned about accumulating more money. He spends very little. He hates to spend money for himself. In fact that was the main reason why he had refused surgery for the tumor, he did not want to spend money. He gets excited and very angry when he is not understood. With anger he shouts and become violent and strikes at the offending person. He is strict.
understand anything else, He has a good memory and no fears.

  • Anger when misunderstood (Synthesis)
  • Anger with striking (Allen T.F.)
  • Avarice
  • Narrow minded
  • Chilly
  • Brian tumor

The totality considered suggested Bufo rana, which was suggested even though it did not have avarice.

 

Treatment:
07.10.93 Bufo rana 200. 2 doses administrated with placebo for 2 months as he was returning to Rajasthan that evening.

02.12.93 Patient in Rajasthan, no proper report gave Bufo rana 200 one dose at monthly intervals.

28.03.94 His vision has improved considerably. Gave Bufo rana 200 one dose monthly

29.07.94 Has normal vision in left eye. No problems with day to day work. No complaints.

07.11.94 report from son who has recently father. No complaints. Normal vision in left eye. Dose not feel it necessary to continue medicine!

It was suggested that he repeat his CT scan or M.R.I but he is not inclined to do either as he is symptoms free. He also does not want to spend the money on expensive investigation! Without a scan it is impossible to know what has happened to the tumor but as there can be no doubt about the diagnosis of the fact that he now can see we can only surmise that it has shrunk.

;A middle-aged gentleman was brought to the college out-patient department with the complaints of bronchial asthma of a few year standing. He was working in a mill, which had closed for the last six months because of a strike.

He had frequent attacks of difficult respiration every day. He had a long standing dry cough with some vague symptoms. On further enquiry, we found ha belonged to a poor family and was responsible for feeding his family of four. Even though he was jobless because of the strike. He had no motivation to look for another job. There was a strong elements of laziness associated with sense of contentment.

  • Indolence with content.
  • Indifference with irritability

The above important aspect of his case led me to consider a rare remedy which I have never used in my practice. On referring to the source book. I also found it to have symptoms relating to the respiratory tract, thus matching the case well, Zizia 200 was given frequently during early treatment and infrequently later. It brought about good control over his asthma. This case shows how if you process the information in a specific way, you will be able to come up with an uncommon remedy which you will be able to prescribe confidently.


Dr. Rajesh Shah is the founder of 'The Foundation for Homeopathy Research' In Bombay and is editor of Homeopathy Times and author of My Experience with Ferrum Metallicum.

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