A Case of Bovista

D: Doctor

P: Patient

A ten year old girl came to the clinic with fever. She lives in the vicinity and her mother sends her for consultation when she gets a bout of cough or cold.  I was surprised she had come unaccompanied whilst running a high temperature. As I took the case, I saw that in her fever symptoms there were hardly any characteristics to prescribe on.  I had seen her before, but this time, she went on talking, narrating her state very clearly and I did not want to miss the opportunity to understand her more deeply.  I didn’t initially intend to take a constitutional case.

D:  You are burning!

P: Yes auntie. I was not feeling well since yesterday. I felt feverish.  I did not eat my dinner. I did not feel like eating anything. Mummy said, “Eat your favourite Maggi”. But still I did not.  Also I was in tension. I could not sleep well.

In the morning I had to go to school since there was a test.  By then I had got the fever. Had I known I was to get the fever, I would have taken medicine at home. With lot of difficulty I wrote the test.  I was shivering because of the AC in the class. The teacher made me sit outside so that I could write properly without shivering. But still I was feeling cold. The teacher also scolded me. She said. “You should not have come to school when you are so unwell”.

D: Why didn’t you leave the test and come home? The teacher could have called up your home.

P:  I did not want to come home. My result was to be uploaded. This time after I have come into the sixth grade, I had told my parents, “Don’t put me for tuitions, I shall study on my own.”  I had studied. But my math and English papers were not very good. It would be very awkward for me if the result was not good. I was thinking, I could have done well, if I had watched less TV.  Also, I had wasted a lot of time.  My parents would scold me very badly on seeing my marks.

I am happy I have got fever. At least my father will not beat me when he comes home.

D:  Does your father hit you if you get lower marks?

P : No. He scolds and tells me to do better next time. But other kids’ fathers beat them. So I thought he can also beat me if I get bad marks.  Auntie, I want to do very well in studies, get very good marks. I want to go to Oxford college to study.

D:  Oxford ? In UK ? (I was tempted to interrupt)

P : In London. (she corrected).

D: Why Oxford ? (suppressing a laugh).

P : Everyone says it is the best college. I think if I get good marks, I shall be able to get admission. When I get good marks I feel very happy. I feel now I shall be able to get admission in Oxford college. But when I don’t get good marks I feel I shall have to go to Nirmala college.

D : What is bad about Nirmala college ?

P :  Rachna didi, she lives in our building. Everyone said she is going to get very good marks in her board exams last year. But she got bad marks and got admission in Nirmala college. It is not a good college. The children there are corrupted. (colloquial for bad moral values). If I get bad marks, I shall also have to take admission there, no option! Then it will be very awkward for my parents. What will they tell people? That I am going to Nirmala college!

D : Never mind ! Now you go home and take the medicine for your fever. We shall talk later when you come next time. (I had to make her stop, since in fever too she was going on talking).

P : Yes auntie. Next week I shall come for my medicines to increase my height. I have decided that I shall do some physical activity next week onwards and then take medicine. You had said taking medicines is not enough, you have to do some physical activity also, only then will my height increase. So my mother said to get medicines only when you are doing some exercise or else it is a waste of money to take medicines, since they will not work.

ANALYSIS : 

Aphorism  98  of the  Organon states :

“ We should listen particularly to the patient’s description of his sufferings and sensations and attach credence especially to his own expressions wherewith he endeavours to make us understand his ailments.”

Also,

• 211 states :  “This holds true to such an extent that the state of disposition ( natural tendency to, temperament) of the patient often chiefly determines the selection of the homoeopathic remedy as being decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician.”

Therefore, before I could go about analysing her case, what struck me was her simplicity. She did not mince words and narrated things as they were. Also she was talkative. In fever too, she went on talking and I had to stop her.

Rubrics: 

She wants to make her father proud by getting admission in a good college.

Ambitious

Seriousness, earnestness

Embarrassment a/f  ( Father will feel awkward if I don’t go to a good college: her perception).

She is sensitive to being scolded and is therefore worried about her studies.

Sensitive, reprimands, reproaches to

Fear of pins, pointed objects (means, fingers pointed at him, accusations)

Cares , worries full of.

She is hopeful when she gets good marks. But when she gets bad marks, she feels she shall not be able to make it.

Hopefulness

Hopefulness, alternating with despair

Helplessness, feeling of (when she is not able to do it).

Also she is impressionable being the person she is.

Sensitive, impressions to external. (Parents of other children hit them when they get bad marks, hence her father could too.)

Loquacity, heedless, careless.

Loquacity, open hearted

Truth, tells the plain.

This is BOVISTA

This reminded me of an incident many years ago when my daughter was three.

She was very social and would very openly talk to the watchman, lift man, courier boys and any stranger, maids, servants. Also she had no sense of discretion on how much to share. Therefore, I explained to her that she should not talk to the servants or strangers so much since it was not safe. Once when we were in the elevator, a servant working in the building greeted her, since she used to talk to him. She remained quiet. In fact, she put on a very grim face. He was surprised and asked her, “What happened? Why are you not talking today ?”She looked at me, straight faced and replied, “My mother has told me not to speak to servants.” I was shocked and very embarrassed.

That day I realised what “ Truth, tells the plain” means. This girl was simple. Her understanding of the world was also simple. She spoke of Oxford University as if it’s a college next door. She was talkative and went on speaking her heart without any reservations.

Naive

Honest

Indiscretion

Childish behaviour

Truth, tells the plain

Loquacity, open hearted

Loquacity, heedless, careless

Heedless, Careless.

Mildness

In Bovista patients their mind is not much evolved. This explains their simplicity. The following rubrics indicate their defects of development. (not seen in this case)

Absent minded

Imbecility

Senses; blunted, dull

Ideas, deficiency of

Concentration, difficult, attention cannot fix

Confusion of mind

Mistakes, localities of

Mistakes, space and time, in

Awkward.

There is increased desire for sex, alcohol.

Due to all this, there is increased sensitivity to reprimands, criticisms.

After a point when she can’t take it, she becomes irritable as suggested by the rubrics:

Irritability, takes everything in bad part

Quarrelsome

Cursing, swearing

Fight wants to.

Eventually there is a cut off from society as suggested by the Rubrics:

Aversion, company to

Aversion, everything to

Indifference, apathy company, society, while in

Indifference, life to

Jesting aversion to.

RX:   I gave her Bovista 30 to be dissolved in half cup water and 1 teaspoon to be taken every ten minutes for three doses.

Follow Ups : 

1st Follow up 15 days after the fever episode.

She said that after taking the medicines, the whole night fever was there. Next day the fever subsided. No other noteworthy symptoms, except that this time she did not keep talking. She said that she needed a quick refill of the medicines since she had a test the following day.

2nd Follow up a month after the first follow up.

P: Today I can  talk. Last time I had to go since there was a test at school.

D: How were your tests?

P: They were good. I have noticed that now I do not worry as much. Even my father told me.  “Don’t  take tension regarding studies. Since you are managing your studies on your own, we are happy.” Therefore, I am relaxed. Nowadays I have started writing a diary, whatever good happens to me every day. I have to hide it from my mother. I keep it with my books in my school bag. At home I write in it secretly. It is like an adventure.

She saw me again a month later. She continued to be less anxious regarding her studies and would now even go to play in the evening, which she had stopped doing.

After that I stopped giving the medicines since she was well. Visited me last week to bring her sister for consultation and told me that she is still well. She no longer feels acutely ill and also she is calmer before exams. She no longer has that kind of anxiety.