This is a case of a 19 years old woman who was married for four years. After a year of marriage a child was born to her, but after that she had three miscarriages in a row. Two miscarriages happened at two months while a third one at the start of fourth months.
Twice the fetus growth was not normal for which she had to go through D and C while a third time the fetus and placenta were not properly attached and thus there was not normal growth. Questions and answers for getting details of the case are as follows:
Note: ‘D’ stands for ‘doctor’, ‘P’ for ‘patient’ and ‘M’ for patient’s ‘mother’ who is present during case taking.
D: How did miscarriages happen, please explain in detail?
M: She had gone for exams, she was stepping up the stairs quickly and she felt bleeding. The doctor said that the pregnancy has not been lost yet. She should take medicine and she will be fine.
D: (to the patient) please tell me the details yourself.
M: Wherever we go I have to speak, she doesn’t speak often.
D: Doesn’t she speak at home too?
M: She speaks at home too much. She is sharp in front of her mother, not elsewhere. I too had her conception with great difficulty, I too had many miscarriages.
D: What other problems do you have?
M: Sometimes she feels her head very heavy and it seems as if there was no blood in her lips.
Observation: The patient whispers something to her mother.
D: What did she say?
M: She said that she has pain in her muscles.
D: Any other problem?
M: She feels tired.
D: Any other problems which you want to tell me?
P: (first time the patient herself speaks) I have pain in abdomen.
M: She often has constipation.
D: Please tell me about the abdomen pain in detail?
P: It is on the left side of the abdomen.
D: What is the type of pain, please describe it?
P: It starts from the left side and goes to the lower right side.
D: (to mother) you said that she is sharp in front of you. What does it mean?
M: She is kind of a spoiled child. I had her with great difficulty. I bore a boy and then three miscarriages happened, then a girl and again two miscarriages. When she was born, she had been much pampered. Still she is being much cared for.
When someone talks to her a little bit harshly she starts crying; when she has a slight stress she starts weeping. Still I wash and iron her clothes and even clothes of her husband.
D: She starts crying? Please say a little more about it?
M: As if she is much angered. From one year she has become very angry.
D: Please tell a little more about her anger; what is her condition in anger?
M: She is very angry. There is too much anger. Whoever speaks to her she replies bluntly.
D: (addressing to the patient) your mother said you are very angry. Please tell me a why are you so angry and what is your condition in anger?
P: For no reason, when someone says a word on me, I get angry. I am scared.
D: How are you scared, please say in detail?
P: I am scared as if someone from behind me is doing something to me. Then I feel sad.
D: Please tell a little more how are you scared?
P: As if some woman is behind me telling me to do this or that.
D: Please tell more.
P: I can’t stay at home alone. When my husband or mom say something to me I feel very strange. Now what did happen to me I don’t know.
D: You can’t stay at home alone. Please tell a little more about it?
P: I am scared. When I am alone at home all back side of the body is stretched.
D: Yes please tell in detail.
P: As if some ghost is behind me. As if some woman is coming out of the rooms. I can’t sit alone. If I sit the body feels differently.
D: Differently how?
P: I feel scared. As if someone is holding me from behind.
D: What happens then, please tell a little more about it?
P: Nothing more.
D: How is your health in pregnancy?
P: Strange thoughts come in the mind.
D: What kind of strange thoughts?
P: There is woman who says “I would strangle your child. I would not let it be born. In both D and Cs during my unconsciousness she came and said “have I not done what I had told to you”?
D: She says that she would strangle your child. Tell a little more about it?
P: She had a black cloth in her hands. She put it on my face and said: “Have I not strangled your child”?
D: When you see that woman what is your inner feeling?
P: Being scared I try to get up and recite verses of the Holy Quran.
D: When you sit up, what are your inner feelings? Please think a little and tell me the exact feeling of that time?
P: There is a lot fear, the heart starts to panic. When I see this dream I feel like my body is going to be lost.
D: The heart stars to panic. Please describe this condition?
P: I feel heat in the body and as long as pregnancy goes on that heat persists.
D: Tell a little more about that heat?
P: As if it is fire. There is a lot of heat and as long as pregnancy goes on that heat continues. When the pregnancy terminates that heat also ends.
D: Please tell me more.
P: There is much heat in the palms and soles. When the pregnancy terminates that heat of palms and soles also ends.
D: That woman tells you “I would strangle your child”. Tell me a little more about it.
P: The patient makes a gesture. She opens fingers of both hands and moves them from up downwards as if strangling someone. And she is in dark black clothes. First time when she did this, the next day miscarriage occurred. Second time also when she did this, next day the fetus came down and then was aborted.
D: When she says that she would strangle your child what is your condition? Can you please describe your inner feelings at that particular time?
P: She puts a black cloth on my face. I perspire and some words involuntarily come out from my mouth.
D: What do you feel inside you at that time?
P: I feel oppression.
D: Please tell about the oppression a little more.
P: I feel strange.
D: Strange meaning?
P: Like my breath is difficult, you say it is like suffocation.
D: Please describe this condition in detail.
P: It is heat. I want to take bath. I want to go out. I want to call my mom or someone else should come here.
D: Anything else?
P: During menses there is pain in the abdomen and back and there is much gas in the abdomen.
D: What kind pain and how does it get better or worse?
P: It is pain and it is during menses.
D: Anything else?
ANALYSIS OF THE CASE
The patient has extreme fear when alone. When alone, she feels that someone very frightening or a horrible face or a dark black very horrible woman is coming from behind and that is very frightening to her. She neither has survival nor competition issues like animals, nor issues of structure like minerals.
Rather she is affected by a particular situation and from that situation she develops symptoms which is peculiar to the plant kingdom. Being alone is a situation and the patient is very sensitive to the same. She suffers from being alone. This is a central theme of the case. Thus she belongs to the plant kingdom.
From the study of the sensations of plants’ families we come to know that fear, fright, terror, murder, darkness, black, frightful things, ghosts and spirits, delusions of black frightful faces are the themes or sensations of the Solanaceae family. So far we come to understand that she needs a remedy from the Solanaceae family of the plant kingdom.
Now we have to choose the correct remedy with the help of miasms. The patient several times mentions suffocation and oppression. She says “my breath is difficult, I feel suffocation”, that black woman puts black cloth on my face and says that she would strangle my child, she puts black cloth on my face and I start sweating”.
She also says “I want to run out”. When we study Sankaran’s characteristics of miasms the oppression and suffocation is found in the tubercular miasm. The tubercular remedy of the Solanaceae family is Atropinum. Let’s see whether repertory confirms this selection or not.
When I searched the repertory, I was surprised to see how beautifully rubrics of the repertory are linked to our selection.
- Mind- anger- irascibility.
- Mind- anger- irascibility- trifles at.
- Mind- Delusion- imagination- specters, ghosts, spirits, sees.
- Mind- Dreams- ghosts, specters.
- Mind- Dreams- rousing the patient.
- Mind- Dreams- frightful.
- Mind- Delusions- imaginations- people- sees- black.
Through the above rubrics Pulsatilla and Atropinum come up. It is obvious that there is no single characteristic of Pulsatilla in the case where as the central theme of Atropinum is very clear, which is fear of ghosts, spirits, dreams of ghosts and fear of dark etc. Now we see how clearly materia medica gives a picture of the case.
“Immediately upon closing the eyes after retiring, the mind would become filled with strange and fanciful ideas, rambling, incoherent speech, spectral illusions, with frequent fits of uncontrollable laughter. The delirium and spectral illusions continued through the night”. “Frightful fancies, spectral illusions (first night).” Screaming from fright, terror was depicted on his face and he clung to his nurse’s neck or he threw himself in different directions to escape the frightful objects.”
Vithoulkas compares Atropinum to Belladonna and says:
“Atropinum is a remedy that deserves closer study by homeopaths, as it will be found to correspond to several incurable conditions. It will probably not be needed as frequently as Belladonna, but should be used much more frequently than it is used presently. A general rule for its use should be to give Atropinum before trying any other medicine whenever you have a case that looks like Belladonna but where this remedy does not act. Atropine, as the most active principle in Belladonna, produces quite a number of its symptom, but at the same time the two are not identical. Atropine, as we have said, has a predominant action on the nervous system, both central and peripheral, but does not have the degree of suddenness of Belladonna. Moreover, the acuteness, the stormy and devastating character of Belladonna and its excessive congestions are also absent.”
Clarke cured a case, by this remedy, in which a female patient used to see a shadow where from she passed on.”
Through the sensation method we arrive at Atropinum and then repertory tells us that all the main features of the case are covered by the rubrics. So the remedy comes up through the repertorization. Then materia medica also confirms that its main characteristics are fear of ghosts, specters fear of dark etc. These features resemble Belladonna but it lacks the suddenness, the stormy and remittent nature of the same. Thus Atropinum is the most similar remedy.
The case went on with us nearly one year. At the start the patient continued follow ups regularly and after being markedly improved she used to visit whenever she needed. The case was on the delusion level so she was given Atropinum 1M. Detail of follow ups is as follows:
29-01-2018: After taking the first dose her eyes became red as if there were red streaks in the eyes, also itching on the body, swelling around both the ears with pain. Muscles pain ended and there was no pain before and after menses. When asked about her fear very surprisingly it was almost gone. There was much fear but very much less than before. She was given placebo with a dose of the remedy to be taken if the condition reversed.
19-02 2018: She was okay. Last week she had headache and by taking the given dose it was gone. She had headache once or twice a month but not as severe as before. Her backache, bellyache and anger also ended. Remember: during case taking when she was asked about her anger she said that her anger was due to fear. So when the fear was gone the anger also went away. She was given placebo.
07-03-2018: She was quite okay and was given placebo.
29-03-2018: Abdomen pain relapsed. A dose Atropinum 1M repeated. Placebo continued.
17-04-2018: She had leucorrhoea. On questioning she stated that she had it previously. There was no fear at all. Energy level was very good. Previously she had severe dysmenorrhea which now had completely gone. Bleeding was less in menses. She was given placebo.
11-05-2018: From this morning she had pain in right hypochondria and back as she had previously. She had no fear but headache persisted. A dose of the remedy was repeated.
24-07-2018: She had flu, cough and pain in ribs. One dose of the remedy was repeated.
26-08-2018: Today again she had headache. A dose was repeated.
14-11-2018: Patient’s mother came to clinic and said that the patient had pregnancy of 24 weeks. Everything was okay, however her Hb was less at 8.8. She was given a dose medicine with instructions to improve her diet and take fruits abundantly.
06-01-2019: 9th month of pregnancy was going on. Heartbeat of the fetus and everything was normal. Next month delivery was expected. There was cough and coryza. One dose of the remedy was given with placebo.
Nearly two months later the patient’s husband informed us that a very healthy baby girl was born normally and both the child and mother were quite okay. I congratulated him and asked for a picture of the baby to keep in my records. The patient’s mother said that the delivery was completed in only half an hour and was very easy. The child was very healthy and was nursing on her mother.
Here is a point. Vithoulkas says that if the case looks like Belladonna but it doesn’t work, before applying any other remedy you should apply Atropinum. He also says that it doesn’t have the suddenness and the stormy nature of Belladonna. Although the difference between the two remedies is revealed by this statement, yet it doesn’t explain the practical application of this difference.
Sankaran, keeping the same difference in view, clearly differentiates the two remedies. He groups Belladonna into the acute miasm due to its suddenness and stormy nature whereas Atropinum into the tubercular miasm due to its oppression and suffocation. This is why the author had no difficulty or confusion in selection of Atropinum.