THE UNMANAGEABLE PATIENT

[Krishna]

A patient is supposed to be subservient to his doctor, but suppose he challenges or argues with the doctor. He is crossing! Here two top-ranking remedies that should at once come to your mind are Chamomilla and Nux-vomica.

Rarely do we come across patients who are unmanageable.* (*Under the remedy Lycopodium in Boericke Mat. Med. we find the symptom 'haughty and arrogant when sick' which is a botheration for those around the patient, the family members and not for the doctor. This is altogether a different matter.)

In respect of the so-called unmanageable patients you should not quarrel or argue with him, nor argue to say that his attitude is not justified.

The word cross should come to your mind while dealing with such harsh and unmanageable patients. Without keeping this word in mind mere repertorisation has led to failures. Actual cured cases alone can illustrate this to avoid failures in these cases. An allopath, in such cases, may simply write on the case sheet 'patient unmanageable and not co-operating.' But in homoeopathy "the high and only mission of the physician is to cure always…" (Section 1 of the Organon.)

Case 1: A boy of twelve was having unbearable muscular pain in abdomen/hip extending to knee and it was intermittent. A few months prior to this complaint, after diving in a swimming pool this pain started in a few hours. Later it went off. Now for the last few months the pain had been occurring intermittently but almost daily.
The mother pointed out to me one thing. Seeing no improvement with various doctors of several systems of medicine, whenever a new doctor was proposed, the boy would tell that he would give only thirty days (one month) time. If not cured within this time, he would stop that doctor.

This patient is `crossing' the doctor. No sane person would enter into argument or put conditions on the doctor. Before learning the remedy for this case let us see next case.

Case 2: Lady, forty-five, around menopause. For a year she had been under my treatment for burnt hands. I had been giving her herbal remedies. Once I was asked to visit this patient. She was in bed and her daughter told me that her mother was having excess bleeding from uterus. When I entered the house, the patient asked the daughter (in this case the attendant of the patient) to get out of the room; after she left, the patient asked me in an irritable tone, "I have profuse and excess bleeding (menses.) Is it because of the heavy herbal remedies (that you have given me) that caused this bleeding?"

I recalled that she never talked before in such a harsh tone.
A note on on the treatment of acute diseases.

In respect of repertorising in acute disease you need not pay much attention as to whether a symptom is 'valuable' or not. You take only those symptoms which are changes from his otherwise formerly healthy state… Section — of Organon)

Final Repertory — IRRITABILITY: 12 remedies

I read the above twelve remedies listed under "HAEMORRHAGE FROM UTERUS" (Lilienthal.) In Chamomilla I found among other symptoms the word `irascibility.' Again in the chapter "MENSTRUATION AND ITS AILMENTS" under the remedy Chamomilla I found the following:
"… great irritability and crossness all the time, though unnatural to her when well."

Chamomilla-10M single dose arrested the excess bleeding and also she calmed down. When I saw her a month later, lot of improvement in the burnt areas in her body.

When patient is irritable, cross and unmanageable, and there is not much of other valueable (uncommon, rare-strange-peculiar) symptom the two remedies which should come to our mind are Chamomilla and Nux-vom.

For case No.1 on page 1, we read both Chamomilla and Nux-v. in Lilienthal under colic and backache. In the chapter `Colic' under Chamomilla the words "Colic returns from time to time" agreed with the case under `Neuralgia' under Chamomilla we find the word `crossiness' (One important note: In Nux-vomica the picture is slightly different. Chamomilla patient shows crossness in words; Nux-v. patient in action.)

Long ago a patient went abroad to consult a popular homoeopath. That doctor was about to leave his clinic after a day's hectic practice. When this patient entered and started telling his symptom, the doctor asked his assistant to give the patient Nux-vomica. The patient, having come from abroad, took the doctor by his collar and said, "I have come such a long way not to get snap-shot prescribing. I learnt that you take down the symptoms of patient, then work out the case. Do it in my case also."

The doctor sat down, took his symptoms, worked out the case and Nux-vomica came out.

In the practice of the author, a certain patient consulted for impotency. I noted down on the Case Sheet (case sheet means plain white sheet on which you write the name of the patient his age, and date on the top.)

After he finished talking, I told him that I would give him herbal remedies for one month. At that point he got up and said in a snappish manner, "I read in your books that you cure patients completely with one dose. I want you to do that." To this I replied that it is possible in some cases, but his case requires herbal remedies too. He took away the case sheet from my table and went away saying "In that case I don't want your treatment."

Sometimes you get the symptom after you have prescribed! I phoned up the doctor who referred that patient to me to give him Nux-vom.
The attitude of the abovesaid two Nux-vom. patients is aptly described by Boericke in his Mat. Medica in the preamble. "Fiery, zealous temperament."
---—————
`Crossness' (more often found in children and sometimes in adults) along with the symptoms and remedies (found in my forty-two years of practice) are given below for ready reference:

Saccharum offic. (cane sugar.) (Scrofulosis) - child dainty and capricious, cares nothing for substantial food, but wants always sweets or nicknacks; cross and whining; indolent, everything seems too much for him; large-limbed, fat and bloated children, with tendency to dropsy; scrofulous ophthalmia with opacity of cornea.

Abrotanum (Atrophy or marasmus of infant/children) - marasmus with emaciation, sometimes only of lower extremities; voracious appetite, craves bread boiled in milk; weak, sinking feeling in bowels; frequent colicky pains; distended abdomen; hard lumps may be felt in different parts of abdomen; alternate diarrhoea and constipation; food passed undigested; helminthiasis, especially ascarides; hydrocele; emaciation, mostly of legs; great weakness and prostration with some hectic fever; face wrinkled as if old, cold and dry; comedones with emaciation; peevishness; child is cross and depressed, by heat, wants to rest head on shoulder of nurse.

Chamomilla (diarrhoea of infants) - stools watery or greenish, or like eggs beaten up, with the odor of rotten eggs, and are excoriating, from pressing teeth together; gums swollen; mouth dry, thirst; veins in forehead and hands distended; uneasy sleep, though the pain is bearable; toothache during sleep.

China-off. - ill humor; cheerful persons become cross and irritable.
Cimic. (Drunkards, diseases of) - no disposition to talk, cross and dissatisfied, very restless, cannot sit long in one place, as it makes him frantic; tongue brownish yellow and heavily coated; nausea and retching; dilated pupils; heavy pressing-out headache, trembling of limbs; obstinate sleeplessness; terrible fancies at night as if from some impending evil, talks incessantly, changing from one subject to another, quick pulse, wild look in his eyes; delirium tremens, imagines strange objects on the bed, as rats, mice, sheep, etc. general tremor hardly visible, but apparent to the touch, with sensation to the touch of others as if cool, clammy sweat would break out.

Cina - the cina patient is hungry, cross, ugly and wants to be rocked.

Cina (Cardialgia, gastralgia, gastrodynia) - gnawing sensation in stomach, as if from hunger; epigastric pain, aggr. on first waking in the morning and before meal, amel. by food; desire for many and different things; exceeding crossness and obstinacy.

Cina (Chorea) - pale, earthy, yellowish face, eyes staring; objects look yellow; choreic motions extend to tongue, oesophagus and larynx, causing a clucking noise from throat to stomach; gnawing sensation in stomach as from hunger; urine clear or turns milky on standing; clear, red tongue; child outrageously cross and peevish, does not wish to play; twitching, jerking and distortion of limbs; by warmth and keeping quiet and in fresh air; confused feeling in head, with icy coldness of body, even when warmly covered or when sitting near the stove (lach.), she finds it impossible to make the least mental effort; severe sharp cutting pain in one or the other temple, waking her at night; neuralgic pain in left side of head, followed by a film over right eye, with inclination to rub it off, but gives no relief; excessive dandruff in head; has the "blues," is cross and irritable. - Very cross and irritable only while headache lasts.

Ledum (Dropsy) - gout, constant chilliness, only at midnight sense of suffocation, patient throwing off all covering and becoming restless and cross; dry skin, want of perspiration. ailments, as dropsy, from abuse of alcoholic drinks.

Lycopodium (Chorea) - involuntary alternate extension and contraction of muscles; on awaking; cross, kicks, scolds, or awakens terrified, as if dreaming; hungry when awaking at night; great fermentation in abdomen; incarcerated flatus; trembling and jerking in extremities; red sand in urine or urine leaves a red stain; constipation.
Lycopodium (Diarrhoea of infants) - thin, brown, faecal, mixed with hard lumps, after eating a little; sleep disturbed, child springs up terrified and shrieking, is angry and cross; cold feet.

Lycopodium (Atrophy or marasmus of infant/children) - abdomen bloated, while limbs are wasted; face earthy, with blue rings around eyes; wrinkles in face; milk-crust thick, cracks and bleeds, and emits a mousy smell; tendency to capillary bronchitis; inordinate appetite, but food soon satiates; abdomen distended, with much rumbling of wind, especially in left hypochondrium; gastric region distended and intolerant of any pressure, especially after nursing; urine has a red sediment or is suppressed; sleep disturbed by frequent awaking; child weak, with well-developed head, but puny, sickly body, is irritable, nervous and unmanageable when sick, after sleep cross and pushes every one away angrily.

Lycopodium (Diphtheria) - diphtheria of right side and nose and spreading to left side; desire for warm drinks which are grateful to the throat; children are cross and naughty when awaking fromir nap; yellow, thick, acrid discharge from nose; fauces brownish-red, dry tongue, and inability to breathe through nostrils; tonsils, tongue and fauces swollen, with spasms on swallowing; he is forced to keep his mouth open to get breath; parotid swellings; projecting tongue and silly expression; perfect stupor, every symptom hinting to cerebral paralysis, drooping of lower jaw; rapid, rattling breathing, snoring, unconsciousness; grinding of teeth, even when fully awake.

Lycopodium (Dropsy) - hydrops siccus from hypertrophy of heart; hydrothorax; dyspnoea worse when lying on back and by motion; constipation; rumbling in left iliac region; red sand in urine; very cross after getting awake. ascites from liver affections, abuse of alcoholic drinks; after venesections, intermittent fever; oozing out of water from sore places in the lower extremities, without formation of pus; urine scanty with red sediment; upper portion of body emaciated, lower enormously swollen; one foot cold, the other hot; restless sleep; sad and sensitive, complaining; small, weak pulse.

Lycopodium (Scarlatina) - abnormal cases child becomes drowsy and awakens from sleep frightened, clinging to the crib, seems to know no one; soon they drop asleep again, only to reawaken with the same symptoms; they are very cross and irritable after a nap, kicking and fighting; when the rash suddenly pales the glands swell and the face becomes bloated and paler than natural; urine scanty, with or without red sandy deposit. deep blood-poisoning, showing itself by diphtheritic symptoms, stoppage of nose, rattling in throat, coma, deafness and purulent discharge from ears; great peevishness and crossness on getting awake, worse from being covered too much; scanty, dark-red and albuminous urine, with strangury; oedema of face, hands and feet; ascites; secondary eruptions of dark-red blotches on hands, thighs, back and face; colic during desquamation with costiveness.

Lycopodium (Typhoid fever) - comes in at the end of second week when the rash fails to appear and the patient sinks into an unconscious state with muttering delirium, picking at the bedclothes, distended abdomen with great rumbling of flatus, constipation, sudden jerking of limbs here and there, involuntary urination, leaving a reddish sandy deposit in the clothing or retention of urine. the continued high temperature leads later on to cerebral paralysis; patient lies in a stupor, eyes do not react to light; lower jaw drops and hangs down; breathing snoring and rattling; tongue swollen, blistered and cannot be protruded, and if patient tries the dry tongue rolls from side to side; pulse intermittent and rapid; cold hands and feet or one foot hot and the other cold; restless sleep, at ease in no position, full of anxious dreams and jerking of limbs; when aroused cross, irritable or awakes terrified as from a heavy dream; great emaciation and internal debility, paralysis; upper parts wasted, lower parts swollen. compare calc. and lyc., follows often after lach.
Lycopodium. - sensitive, irritable disposition; peevish and cross on getting awake; easily excited to anger; cannot endure slightest opposition, and is speedily beside herself.

Lycopodium. - suitable for?: old women and children; persons of keen intellect, but feeble muscular development; upper part of body wasted, lower part semi-dropsical; lean and predisposed to lung and hepatic affections; herpetic and scrofulous constitutions; hypochondriacs subject to skin diseases; lithic acid diathesis, much red sediment in urine, urine itself transparent; sallow people with cold extremities, haughty disposition, when sick, mistrustful, slow of comprehension, weak memory; weak children with well developed heads but puny, sickly bodies, irritable, nervous and unmanageable when sick, after sleep cross, pushing every one away angrily.

Lyssin. (Hydrophobinum.) - very cross, so much so that his children expressed great surprise; he took offense at veriest trifles, scolded his wife and children, felt wretched, could not concentrate his attention on anything; sullen, does not wish to see or speak to any one.

Lyssin. (Hydrophobinum.) - very cross, so much so that his children expressed great surprise; he took offense at veriest trifles, scolded his wife and children, felt wretched, could not concentrate his attention on anything; sullen, does not wish to see or speak to any one.

Lyssin. (Headache) - maddening, outward pressing pain in forehead, he presses his head against the wall; severe headache in both temples and over the eyes, when lying perfectly still on back; constipation; languor, chills, rheumatic pains in limbs; recent prolapsus from sudden wrenching of body.

Pulsatilla - disposition mild and gentle, never cross. Habitual constipation.

Silicea (Febris intermittens) - scrofulous children; burning heat over the whole body; red, bloated face; bloated abdomen with constant diarrhoea. during apyrexia children very cross, cry on being touched or spoken to.

Staphisagria (Crusta lactea, porrigo larvalis) - scales yellow, moist, offensive, itching violently; hair falls out; eruption worse on occiput; scratching changes the place of itching; suits cross, sickly children with pale face and dark rings around eyes; crusta lactea breeding lice; after abuse of mercury.

Staphisagria (Eczema) - offensive humid vesicles, burning and itching, about head, face and ears of children; a yellow scaly eruption on cheeks and behind ears; yellow thick scabs on scalp holding offensive pus, breeding lice. scratching stops itching in one place, but it goes to another; skin peels off with itching, hair falls out. sunken face, nose pointed, blue rings around eyes. cross words injure feelings; irritable children.

Stramonium (Sleeplessness, insomnia) - child awakes cross and irritable, as if frightened, knows no one, shrinks away or jumps out of bed; awakes with a solemn air of importance, all things seem new to him; sleepless and tossing about.

Stramonium. - child is very cross, and strikes or bites.
Sulph-acid. (Drunkards, diseases of) - pyrosis, morning vomiting, inappetency, trembling, especially mornings. drunkard on his last legs looks pale, shrivelled and cold, stomach will not tolerate any food, he cannot even take a sip of water unless it contains whisky; liver enlarged, with dry stomach-cough; haemorrhoids; offensive watery diarrhoea; cross and irritable.

Sulphur (Blepharitis) - inflammatory redness of lids, with burning pains; secretion of mucus and eye gum; great aversion to water, so that he cannot bear to have the eyes washed; eczema around the eye and in other portions of body; blepharitis after the suppression of an eruption or when the patient is covered by eczema, especially in strumous children, who are cross and irritable by day and feverish and restless at night.

Sulphur (Atrophy or marasmus of infant/children) - emaciation; skin dry, harsh and wrinkled, giving the child an "old man" look; offensive odor of body, not removable by washing; eczema (capitis) dry, easily bleeding, itching more at night, scratching relieves but causes bleeding; intertrigo, especially at anus; glands swollen, particularly cervical, axillary and inguinal; appetite voracious, child grasps at everything within reach and thrusts it into its mouth, or drinks much and eats little when the violent thirst is on; abdomen distended and hard; constipation or diarrhoea slimy, green, watery, changeable, > at night; sudden urging awakens him in the morning, followed by copious watery stools; restlessness at night, awakens screaming or on going to sleep is annoyed by sudden jerking of limbs; child cross, obstinate, cannot bear to be washed or bathed; dentition slow, bones and muscles develop tardily; easily fatigued; face pale and sunken, with deep, hollow eyes; hunger at 11 a. m.; heat on top of head and cold feet; ravenous desire for sweets which make him sick.

Sulphur (Ophthalmia) - chronic blepharitis in strumous children who are irritable and cross by day and feverish and restless at night; edges redder than natural (graph., paler), in winter; itching, biting, burning, or sensation as if sand were in the eye; lids swollen, red and agglutinated in the morning; cannot bear to have the eyes washed; eczematous affections of lids; blennorrhoea of lachrymal sac, fistula lachrymalis; acute or chronic catarrhal conjunctivitis, with sharp darting pains like pins sticking into the eye, or pressing, tensive, cutting and burning pains; ophthalmia neonatorum, with profuse, thick, yellow discharge, swelling of lids; pustular inflammation of cornea and conjunctiva, with sharp sticking pains as if a splinter or some other foreign body were sticking in the eye; photophobia and profuse lachrymation, considerable redness, especially at angles; discharges acrid, corrosive, or tenacious, lids swollen, burn and smart; chronic scleritis; hypopion, cataract, choroiditis and choroi-retinitis, if accompanied by darting pains and where the disease is based upon abdominal venosity, stagnation in portal circulation, habitual constipation, cerebral congestion, or upon metastasis of chronic or suppressed skin diseases.

Uran-nit. - great despondency; ill-temper; cross; disagreeable.

Uran-nit. (Albuminuria) - patient is compelled to rise often during the night and urinate, which disturbs his sleep; ill-tempered, cross and irritable; pains over left eye; disturbed stomach, faintness of stomach, even after a hearty meal; cardiac complications; diabetes; pregnancy.

Veratrum-vir. (Sleeplessness, insomnia) - restless, quarrelsome and cross; insomnia of acute fevers, of puerperal fever and of puerperal mania, or from excitement preceding or following epileptic fits; melancholia activa.

Zincum -met. - child cross toward evening; brain affected.
Zincum-met. (complaints in children during dentition) - coma interrupted by piercing screams; slow development of teeth from lack of vitality; slow pulse in long waves; child drowsy and lies with its head pressed deeply into the pillow, eyes half open and squinting; face pale and rather cool or alternately red and pale; trembling all over, boring fingers into nose or pulling nervously at the dry, parched lips; automatic motions at different parts of body, and restless, fidgety movements of feet; child excessively cross and irritable, especially at night, while the eruption of several teeth at once undermines his strength.

Zincum-met. (convulsions of children) - child cries out during sleep, and if awakened expresses fear and rolls its head anxiously from side to side; twitching in various muscles; the whole body of child jerks during sleep; child has been cross and irritable for days previous, with hurried motions, distended abdomen and more frequent urination than usual; pale children during teething; child has not strength enough to bring out the eruption; after the disappearance of old eruptions.
—————

[Teresa Kramer]

Subservient my foot! That's back in the Dark Ages. Teresa (Eddystone)
---- krishna wrote:

[muthu kumar]

It is better to understand different cultures before showing your feet

Assessing a patient within a cultural context is important - In India there used to be a belief - and even now in some circles - that the medical profession is so noble that doctors should literally be venerated - look at how much medicine men were venerated -

This case is not a current case probably - but probably twenty years back

25 - 30 years back when I was working in a rural hospital all patients stand up when I enter a room - not even in my own clinic - this is a government hospital and I was a just a 3rd year medical student then - I used to cringe but that is how the situation was

you always assess a patient in comparison with how all the other folks, under similar situations behave and that is how something becomes a symptom or not

I am not defending the expectation that any one should be subservient - but how we need to assess things within their cultural contexts- otherwise as some critic commented about homeopathy - we will end up treating chinese ( based on their yellow skin) for jaundice
--- In minutus@yahoogroups.com, wrote:

[Teresa Kramer]

I worked as a German/English teacher in two lycees in Madagascar in the 60s and 70s. The students had to stand when ANY adult entered the room, especially a teacher. The overall discipline was admirable. Not sure it was not over-enforced, however. I also cringed--internally.

Now I am in the US and am horrified by the thought of patients being subservient to their doctors--probably because so MANY are. Can't imagine that a good homeopath would want a subservient patient/client. (Maybe that's why the word client is preferred.) Anyway, I don't treat anyone except our dog.

I have been termed non-compliant a number of times by conv. doctors--for using homeopathy or refusing conv. meds. It was not pleasant. Teresa (Northern VA)
---- hahnemannian2002 wrote:

[Shannon Nelson]

But I think worth noting, the examples that he had given were *not* merely not subservient, they were (if memory serves me) rather more belligerent than is really helpful. For that reason I do think it was a "symptom" in those patients.

[Vera Resnick]

I wonder if this type of reaction can be taken in the direction of non-compliance in Western society - people who absolutely refuse to take the remedies as prescribed, prefering to self-medicate than follow the homeopaths instructions.

I think also belligerence can come from different reasons and causes. Some patients are suspicious, some have had bad experiences with homeopaths in the past, some have an over-weening belief in their own superiority and see the homeopath as a servant, some feel homeopathy is a minor modality and not deserving of respect, and some are belligerent simply because they are so frightened by their own disease that they use anger and aggression to shore up their hope.

There's nowt so strange as folks...

Vera
------------------------------------
Vera Resnick
Classical Homeopath
054-4640736
e-mail: vera.homeopath@gmail.com
www.jerusalemhomeopath.com
www.materiamedicastudymethods.wordpress.com

[John Harvey]

So a boy whose experience is that on balance doctors cost him more than he gains in benefits by their administrations is "crossing", "non-compliant", even "haughty and arrogant when sick".
And a woman who asks the perfectly reasonable question of whether a prescription of large polypharmaceutical doses of crude drugs by her "homoeopath" may be responsible for her worsening condition is "cross", "unmanageable", "irritable".
And both are "belligerent" and "non-compliant".
The "homoeopathic" treatment resulting from the prescriber's sensitivity to insult? For the boy, a medicine that has two symptoms: crossness and colic. For the woman, a medicine that has irritability, crossness, and uterine haemorrhage.
Never mind that dozens of other remedies share these symptoms. Never mind that an ignoramus has spoiled one case with grossly allopathic polypharmacy and steered both cases on the winds of presumption rather than take a proper history. Never mind that in both cases any "crossness" toward him was completely warranted in the circumstances. The problem cannot be one of the practitioner's own ignorance, his own presumptuousness, his refusal of the possibility that he has made profound mistakes, his utter ignorance of the basis of homoeopathy; the problem is, of course, that the patient has failed to be subservient.
The belligerence of fools is breathtaking in its audacity. There may, as you say, Vera, be nowt so strange as folks; but there's little stranger than the unshakeability of the insufferably ignorant. Why anybody accepts that this particular fool did not warrant a sharp rebuke from his patients -- who at least restrained themselves from getting out of their sick beds to knock him off his pedestal and into the dust -- leaves me bemused. If it's because he claims to be a homoeopath, then look afresh at what and how he practises.
Cheers --
John

[Shannon Nelson]

As I remember, this thread began with reference to two specific cases, with rather detailed descriptions of the two patients' behaviors--but those initial descriptions have been deleted from the thread. If he discussion is still with reference to those, could anyone perhaps re-post them? Or are we just passing on to the abstract?

Shannon

[John Harvey]

Hi, Shannon --

The original posting was very long; thank goodness somebody did truncate it. If you have deleted your copy, I'll send you it to you privately rather than inflict it on everybody again. In answer to your question: no, its author, after mentioning the few particulars upon which he prescribed (particulars I quoted), stated (it's at the bottom of your own message) that one should think of Cham and Nux vom. if the patient "challenges or argues with the doctor", on the basis that the patient "is crossing". This was the author's lapse into over-generalisation rather than anybody else's. The "rather detailed" descriptions of the two patients' "behaviours" captures their narrator's sense of wounded dignity rather than any basis for a rational prescription that accords with the rational healing art.

Cheers --

John
--
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"What we're suggesting is that something that doesn't really interact with anything is changing something that can't be changed."
-- Jere Jenkins, on the apparent influence of solar neutrinos on rates of radioactive decay, 23 Aug 2010

[Vera Resnick]

John,

"there's little stranger than the unshakeability of the insufferably ignorant" - this expression is brilliant! Can I quote you on it? Although I still wonder why it should be so. And often just mere ignorance is unshakeable.

Regards,

Vera
------------------------------------
Vera Resnick
Classical Homeopath
054-4640736
e-mail: vera.homeopath@gmail.com
www.jerusalemhomeopath.com
www.materiamedicastudymethods.wordpress.com