A CASE OF DEATH SENSATION OF
By Dr. Tapas Kumar Kundu
Motiwala Homoeopathic Medical College,
Nashik, Maharashtra, India.
ABSTRACT:
Angina pectoris is a clinical condition resulting from deficient supply of oxygen to the muscles of the heart and is precipitated by intense emotions or strenuous physical activities. The condition is managed by the coronary artery dilators. Here is a case, where the efficacy of homoeopathic similimum is evident in case of Angina Pectoris. The role of homoeopathic medicine came into play due to unavailability of the conventional drug and paucity of health care resources.
INTRODUCTION:
Angina pectoris is a transient chest pain with discomfort that results when the heart’s demand for oxygenated blood exceeds supply from the coronary arteries. This decreased supply of oxygenated blood usually results due to spasm in the coronary artery and is precipitated by ,heavy meal, physical exertion, emotion or excitement particularly anger and anxiety, exposure to cold, hyperinsulinism in diabetic patients, straining at stool, sexual intercourse and micturation. Stable angina and Unstable angina are the clinical types of angina. It is said to be stable when there is no change in frequency, duration and precipitating factors, mostly symptoms occurs during exertion and lasts for less than five minutes and relieved by rest. In unstable angina symptoms are more severe, angina of effort with increasing frequency and duration, provoked by less than usual stimuli and occurs at rest.
The complaints of angina are presented with Breathlessness or dyspnoea, chest pain over middle or lower sternum or behind the sternum, palpitation, sweating, chest pain with “vice like” constriction or chocking, Extension of pain to right or left arm, to neck, jaw, dizziness, faintness, apprehension, rapid heart rate. The management of the condition include administration of sublingual nitroglycerin which is known to be a coronary artery dilator.
Though various homoeopathic medicines are known be effective in coronary artery disease, their practical applications is yet to be specified by clinical research. A case of angina pectoris is reported where a homoeopathic simillimum was prescribed based on presentation and sensation of the patient and found equally effective like sublingual nitroglycerin.
CASE REPORT:
A male patient, + 50 years of age and a known case of essential hypertension, senior homoeopathic practitioner and professor by profession was supposed to lead a medical camp. The camp was held at a Awha Dang, a tribal village around 130 km away from the city . This was a charitable camp as health care facilities at the village were suboptimal. One gets dense forest en route, devoid of any facility while travelling to the said location. The journey seemed quite adventurous and at the same time risky because of paucity of medical services. A team of two doctors (one homoeopath and the other scholar an allopathic physician) and ten trainees left the city at 7:25 am in the morning which was twenty minutes delayed from the scheduled time. This triggered some displeasure but no reaction was made by the patient. They reached the destination by 10:30am and without wasting a single moment the camp was started. By 12:45 pm he had attended 72 patients. The camp was continued till 3;00 pm after 10 minutes’ break at 1:00pm with some snacks and tea. At 2: 15pm he wanted to have lunch but which he was not willing due to heat and exhaustion. He alone managed to attend nearly 80 patients by 3:00pm.They departed at 3:30pm for Nashik city; on the way the doctor decided to have a clinical discussion on the logical reasons, and his practical experiences in favor of action of homoeopathic medicines in acute conditions, There was difference of opinion between the members.. The senior professional who bears some knowledge of handling emergencies could not take up this criticism. In between the discussion, the senior doctor suddenly started perspiring and feeling restlessness with frequent eructation. He felt nauseated and tried to vomit out but could not. The driver tried to stop the winger (the vehicle) near a check post on the road but anticipating some complication that may arise at boundary in case of fatal situation, the senior doctor asked to stop the vehicle a little ahead of the check post. The vehicle was stopped a few kilometers ahead of the state boundary, he came down, took some cold water and again tried to vomit but could not. He started complaining of chest pain and sweating kept on increasing. This made him anxious and he started to call his wife and assistant physician but could not reach due to network error. Some of the students stepped down in search of a medical shop for aspirin but could not get as there was no medical store in the near vicinity. When they came back he was still busy calling someone, he wanted to inform his condition to his family members. The colleague arranged a glass of lemon juice. Students started asking how he was feeling, to which he replied, “I am feeling as if I am going to lose my breath”. And suddenly he asked one of the students to give him Arsenic album 30 one dose, which was given to him immediately from the camp medicinal kit. The driver started driving fast so that can reach home as early as possible. A few minutes later the doctor said that he was feeling better and no one need to be worry. The perspiration had subsided, there was no more feeling of nausea or chest pain. He started feeling comfortable within next 5-7 minutes; and the clinical discussion was resumed.
Everyone gave a sigh of relief. He took rest for some time when a student asked, “Sir, how did you select the medicine in such panicky situation?” And he replied,’’ The exciting cause, the presentation of the individual during acute condition, the feelings and thoughts at that moment are the important component to form acute totality. The mood was disturbed since the morning itself when the schedule was disturbed by being late (1). More over the exertion all through the day , the hot and dry climate precipitated the condition (2) which was aggravated by the difference of opinion during discussion (3). During pain I was feeling as if I am losing my breath (4) and soon will be no more (5). I was getting anxious for my wife and wanted her to know about my condition so that in case of any mishap to me she would be able to manage the financial affairs (6). All these thoughts were driving me restless and I was trying to reach any one of my family member (7).”
1. Ailments from anger
2. Gen. exertion physical agg
3. Ailments from discord between friends’ one’s
4. Death sensation of
5. Death presentment of
6. Anxiety family about his
7. Restlessness pain from
The mental state of an individual suffering from any disease is classified in three categories, i.e. Cognition, Conation and Affect. Cognition involves the thoughts responsible to initiate disease or arising as a result of suffering where as Conation is concerned with particular action taken up by the individual. The feelings developed in response to disease are classified as Affect. In above set of rubrics the sensation of death developed in response of symptoms belong to the mental state of Affect, where as the anxiety about the business and family belong to the category of cognition. This anxiety was driving to make continuous effort to get in touch with family members and in response of failure causing restlessness- Conation.
DISCUSSION:
Dr. Clark describes Arsenic album as the horse’s remedy on whose power of endurance and “wind” enormous demands are made, and Arsenic is the remedy for the effects of feats of prolonged endurance. It produces shortness of breath, difficulty to respiration and attack of suffocation, sometimes with cold sweat, spasmodic constriction of chest and larynx, anguish and great weakness. Constriction and compression of chest with great anxiety, inability to speak and fainting fits.
The presentation of the disease in an individual during acute phase is not different from the basic constitution and disposition. The innate constitution and disposition are determined by the diseases prevailed in the family, innate character and behavior of the individual, susceptibility to the atmospheric changes etc. The external physical, psychological or environmental factors affect the individual on susceptible plane so as to evolve the disease.
The most important reason of the suffering was the delay while arriving which developed annoyance. Though the reaction was suppressed, it was triggered by other physical and psychological causes i.e. exposure to heat, exhaustion , over eating and the most important the contradiction.
In the present case report ,the said doctor is a known case of Hypertension who has been consuming Temsan -40 (Telmisartan) OD and CTD 12.5(2 Chlorthalidone) since past 3 months. The patient has the family history of Hypertension and Myocardial infarct. The individual is known to belong to a personality type A. This case particularly evident the evolution of acute symptoms and sensation consistent with the basic underlying genetic disposition and miasm. The basic character of the individual is punctuality towards duty and sensitivity to criticism. This makes him to accomplish every task at set time and be clear in every aspect. This gives the basic nature as fastidious, which was reflected as “Restlessness pains from” during acute condition when he was unable to get in touch with any family member so that he could settle his affairs that evolved the “Anxiety about business”. The predisposed sensitivity made him susceptible to climatic variation, over eating, physical exertion and above all the warm conversation during discussion and debate.
In this particular case the individual is well aware of his basic qualities and the factors which provoked the angina, he also could understand the present mental state and accordingly could analyze his reactions, thus he could clearly perceive what exactly he needs. As in Aphorism 5 Dr Hahnemann says,”Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, ..etc., are to be taken into consideration.
The similar cases could be difficult to treat as the basic disposition and acute mental picture is difficult to be elicited. Surely, the present case is a medical emergency which should have been treated by the coronary artery dilators. Fortunately or unfortunately the rural premise, unavailability of the medical aid provided the opportunity to prescribe homoeopathic medicine in such emergency which was like a “drowning man catches a straw” and this medicine saved the life. It would rather be difficult to treat such emergencies with only homoeopathic medicines. In today’s modern world and in presence of expert medical facilities, exposing to such situation for a known patient of hypertension may not be an wise decision as seems. But looking at the case, one cannot deny the efficacy of homoeopathic medicines in cases of emergencies.
REFERENCES:
Homoeopathy for Angina. Homoeopathy Ezine, January 2014;Hpathy.com
John H. Clark. A Dictionary Of Practical Materia Medica; Vol 1: Indian Books And Periodicals Publishers, New Delhi.
Hahnemann Samuel. Organon of Medicine; 6th Edition, B.Jain publishers.
NOTE: The necessary laboratory tests of the patient were performed later which shows dislipidaemia and elevated serum uric acid level is enclosed herewith. As an evidence ,the photographs of the patient in the camp is also attached in a separate file to avoid fallacies.
