Clinical Cases

Comments on Case of Santiago

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Dear Elaine Lewis,

On attempting to analyze the case, you have pointed out Aphorism 153 from the OrganonThank you very much. In reality, we often forget about the teachings of Hahnemann, and to my judgment ? the diverse prescriptions being made by different homeopaths for a certain case is mostly due to this reason.

PQRS of the Case

You started analysis of the case stating –

?Clearly in this case, the milk obsession could be described as the most ?striking? and the most ?peculiar? part of the case. When I read ?screams his head off? if you don?t give him milk; I thought, ?This is quite extreme?.

EXACTLY SO!

BUT you stopped there! ? for reason unknown, and jumped onto another topic -? ?concomitant?, and you stated –

?Another way of looking at this is that the milk obsession is the “Concomitant” in the case. In case-taking, the concomitant–the symptom that comes with the complaint despite having nothing to do with the actual complaint, can be the deciding factor in determining a remedy.?

Why do we need to look at the other way in this case???

Don?t our Materia Medicae or repertories contain remedies for these two PQRS symptoms (Craving for milk, and Anger if refused), which should be underlined, I think, four times, and the craving for milk may safely be made ?eliminating symptom? in this case?

To my understanding, the following four rubrics (I take these from Synthesis 9) describe the two most essential symptoms of the case in hand:

GENERALS – FOOD and DRINKS – milk ? desire (104)
MIND – ANGER – refused; when things he wants are (4) ??????????????? |
MIND – ANGER – contradiction; from (64)???????????????????????????????????????? |?????????? [Combine]
MIND – CONTRADICTION – intolerant of contradiction (129) ?????????? |

?Striking? point is that ? Aethusa does not turn up in any of the rubrics!

Singular term super-rubrics like ?Irritability?, ?Ill humor (~fretful)?, etc. are too general and too big ? containing most of the known remedies of our MM!

Concomitant

You said ?the concomitant — the symptom that comes with the complaint despite having nothing to do with the actual complaint?. However, I?m not sure whether the examples you put after that statement really fit to what you stated or clarified the aspect of concomitants.

Anyway, a little exercise with your examples:

SymptomKentMurphySynthesis 9/[RU]Elaine
Headache with vomitingIP, MELI, PULS, SANG and many remedies with 1 and 2IP, IRIS, NUX V and many remedies with 1 and 2IP, [IRIS], MELI, PULS, SANG, [SEP], and many remedies with 1 and 2Ip
Headache with despairRubric NA!Rubric NA!Rubric NA!

[Arn(1), Ars(2),Bell(1), Coff(2), Zinc-val(1) – RU]

Aur
Headache with anguishRubric NA!Rubric NA!Acon(2), Aur(2), Coloc(1), Glon(1)

[Same remedies ?RU]

Ars
Headache with burpingRubric NA!Rubric NA!Chel(1)

[Calc(2) ? RU]

Carb veg.

(So, Dr. Elaine, you need to re-check your references for the 2nd, 3rd and 4th rubrics!).

Boenninghausen?s method of analysis with Location, Phenomenon (sensation), Modality and Concomitant is absolutely sound and rational. However, the concomitants invariably mean symptom(s) that accompany the totality in a symbiotic mode ? be there any apparent reason/explanation or not. In the case of Santiago, following your examples, we need actually ?milk craving with milk allergy? ?not ?milk allergy? alone.

Milk ?Allergy?

I think, you meant Milk Agg.

In fact, there are around a dozen of bold-face remedies in the repertories for Milk Agg:

SymptomKentMurphySynthesis 9
Milk, agg.AETH, CALC, CALC-S, CHIN, CON, LAC-D, HOM-XYZ, MAG-M, NIT-AC, SEP, SULPH and many remedies with 1 and 2AETH, CALC, CALC-S, CHIN, CON, LAC-D, MAG-M, NAT-C, NIT-AC, SEP, STAPH, SULPH, TUB and many remedies with 1 and 2AETH, CALC, CALC-S, CHIN, CON, LAC-D, HOM-XYZ, MAG-M, NIT-AC, SEP, STAPH, SULPH, TUB and many remedies with 1 and 2

So, why only Aethusa came to your mind for ?Milk Allergy (agg!)?

Yes, Aethusa is quite famous for Milk Intolerance. But what other symptoms make the case an Aethusa case?

One point worthy to be reflected upon:

A little kid of two, after fasting a whole day ? drank ravenously (and almost constantly) milk (and juice?) in the night; prior to this, the boy?s vital force have already been weakened (and also vitiated by the use of 3-4 remedies?) seriously by severe inflammatory processes. Then, having diarrhea in the following morning – – – is it really striking? Is there any such evidence in the past that whenever Santiago drinks milk ? his stomach/abdomen upsets? I think, you have much over-rated the ?Mik Agg? symptom in this particular case.??

You confirmed your choice in consideration of Aethusa?s ?burning thirst?.

OK, another little exercise:

SymptomKentMurphySynthesis 9
Burning (vehement) ThirstACET-AC, BRY, MERC, PHOS, TARENT and many remedies with 1 and 2ACET-AC, BRY, CANN-I, MERC, PHOS, TARENT and many remedies with 1 and 2ACET-AC, BRY, CANN-I, MERC, PHOS, TARENT and many remedies with 1 and 2

In all the repertories, Aethusa is only a 1!

Well, taking into account the two rubrics (Milk, Agg. and Burning Thirst), Kent?s yields the following result as shown in the figure:

You see, along with Aethusa, there are nearly two dozens of remedies (using Kent only!) for the two symptoms you considered; and having the same intensity of milk aggravation, there are 5 other remedies: Calc, Sulph, Chin, Mag-m and Nit-ac.

What, then, is the compelling reason to select Aethusa for the case in hand?

Where is the violence of Aethusa in this case? The characteristic vomiting of milk? None, in fact! And should we simply forget about the characteristic nasal discharge (green, bloody) and the rattling in chest ? for which no mention of Aethusa has been found in even Synthesis 9 or RU.

The Other Way Around

Let?s look a little other way around. It?s that, Aethusa is known to have marked aversion to milk (at least, my knowledge says so). I checked that in the repertories, and it came up like this:

SymptomKentMurphySynthesis 9RU
Milk, aversionAeth (2)AETH (3)Aeth (2)AETH (3)

It is interesting to note that in Murphy, there are only four remedies with 3 for Aversion to Milk ? and Aethusa is one of them!

When, a remedy?s characteristic symptom(s) go directly against the PQRS symptom(s) of a case in hand, what do we do? Look at ?concomitant?, according to your definition?

In fact, in line with your examples of concomitant, the desired rubric for the case of Santiago should be ? ?Desire for milk which agg?, NOT ?Milk Agg? alone!

In fact, you also stated: ?So, in this case, I felt the concomitant was a milk allergy — the craving of a substance that, at the same time, makes the person worse.?

But, then again, you jumped to the conclusion, ?So, I said, “We need a milk allergy remedy here!? You excluded the extreme craving for milk, and took into consideration a general symptom only ? the ?milk allergy?! That?s really, really strange!!

There is an interesting concomitant of this case having ?Burning Thirst?, which is Santiago?s ?Aversion to Water?. Why don?t you consider this? It?s also quite prominent in the case.

The Sick Image

Let?s forget about the extractions from repertory stuff. When one closes his/her eyes to portray Santiago?s sickness, what is painted? Something like this ?

A two years? old boy, after passing tough time of severe conjunctivitis and fever, and then fear of being alone and nightmare, has green-bloody nasal discharge and rattling in the chest; after fasting a whole day, he drank milk ravenously in the night ? and got diarrhea in the morning. He is drinking milk constantly ? he must have it, nothing else; no desire for water even. He is fretful, and is much aggravated by the warmth of the bed.

Is this Aethusa???

To refresh my understanding of Aethusa, I again went through Boericke, Boger, Nash, Blackwood, Allen (Keynotes), Tyler, Phatak, and Clarke of course. Sorry ? I can?t match Santiago?s sick image with any of the pictures of Aethusa contained in these authentic Materia Medicae! Analyzing ?Fool?s Parsley? . . . . I really feel foolish!?

A Refresher

Robin Murphy in his Keynotes of Materia Medica wrote about Aethusa:

?This is ?Fool?s parsley?. Why did they call it ?Fool?s parsley?? Because if you eat it, you will immediately start having severe projectile vomiting. You thought it looked like parsley, you thought it was parsley, and you were a fool for eating it! So it?s Fool?s parsley ? you eat it and you get immediate, severe projectile vomiting.

Aethusa and Natrum carb are your two major milk allergy remedies in children. Natrum carb is from stomach down, it has belching and regurgitation of milk, but it has more gas, bloating and diarrhea. Aethusa has more vomiting and spasms.

A joke I used to tell is that when you come in to treat one of these children, you have a shield in front of you, and you look at the child and you get ready to protect yourself. Or you walk in and you look around the room and you see vomit on the walls and you write on your chart ?Aethusa?.?

What a lucid deliberation on Aethusa! I was not taught by Dr Murphy, but I salute him several times for putting down the genius of all the useful remedies in his Keynotes.

Conclusion

Dear Dr Elaine!

You concluded by saying –

?I went with Aethusa, a little trepidatious because I had never prescribed this remedy before, but, once again, it proves the value of a strong concomitant or striking, peculiar symptom in a case!?

You have abandoned the most striking, peculiar symptom (Craving for Milk) of this case in the first place. And considered ?Milk Allergy? alone as the ?concomitant or striking, peculiar? symptom. To me (apology in advance!), your argument is regrettably crippled and unsound. Notional prescription like ?this remedy is famous for that? is absolutely outside of the perspective of true homeopathic prescribing ? which you know. Abelmoschus has an abnormal fear of animals ? insects, spiders, snakes, ?? etc. But surely, we do not prescribe Abelmoschus in all the cases with strong fear of animals. Why? ? every homeopath knows!

Postscript

In the April issue of Hpathy?s e-zine, the Editor (many thanks to Dr Bhatia!) has rightly pointed out one important aspect as below:

?Every school of homeopathy (!) tries to show their supremacy. The time has now come when unified efforts are required at international front to find answers to the questions that still puzzle the homeopathic community and give food to the sceptics. Let us take a pledge today to rise above our personal differences and work together for the cause of homeopathy.?

To my opinion, I would like to reiterate that these differences in the thoughts and approaches are principally due to non-adherence to our Master?s teachings. To rise above ?personal differences? (it should be little or no actually), we need to stick to Hahnemann ? in the beginning, in the middle and up to the last.

Hpathy?s e-zine is an excellent platform to expedite the process of coming together. As such, I propose the following, for you as well as those who submit case reports, to present in the e-zine in every case (I also draw the kind attention of the Editor on this respect):

1.      Evaluation of symptoms, considered for analysis, in the order of importance

2.      Underlining of the symptoms to show their relative weights

3.      Repertorization of the case (preferably with Kent?s, as it?s available with most of the homeopaths; occasional reference to modern ones would be fine)

4.      Differential analysis of the most prominent remedies

5.      Compelling reason to select the prescribed remedy.

I hope, if the five points are clearly presented in the case analyses, our differences would reduce to the minimum in course of time. This educative manner of presentation is the most desirable ? if we really want to share/learn something from case reports.

Warm regards.

Mir Mostafa Kamal
Dhaka, Bangladesh.?


— Elaine Lewis’ Reply —

Dear Dr. Kamal,

Thank you for the information you’ve given. Yes, it’s true what you say about Aethusa–being better known for vomiting than diarrhea, being more likely to dislike milk than having a craving it.

Still, something must account for the fact that this remedy worked so resoundingly. My starting-off point was that a food allergy is frequently, paradoxically, attended by a craving for the very food one is allergic to. The fact that Aethusa is rated so high for “aversion” to milk, signals–because of the phenomenon of “polarities”–that it may also have the opposite case as well. For instance, Nat-mur. may have a craving or an aversion to salt. Thuja may hate onions and garlic or love them. So, when I saw “milk allergy” in bold in Murphy’s MM for Aethusa, I didn’t rule out the possibility that it could desire milk as well as have an aversion to it. As you know, our Repertory is incomplete and many remedies are missing from rubrics where they clearly belong.

However, I was able to find Aethusa as a “3” in Murphy’s Repertory under:

Rectum: diarrhea, children, in

and

Rectum: diarrhea, milk, after

Thanks again for taking the time to write to us!

Elaine Lewis, DHom

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Mir Mostafa Kamal

Mir Mostafa Kamal

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