BHARATESH HOMEOPATHIC MEDICALCOLLEGEHOSPITAL.
POST GRADUATE RESEARCHCENTRE,
BELGAUM–590016, KARNATAKA.
Recognized by
CENTRAL COUNCIL OF HOMOEOPATHY,NEW DELHI.
Affiliated to
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BENGALURU.
SYNOPSIS
M.D (HOMOEOPATHY)
“ROLE OF SUSCEPTIBILITY IN ACUTEINFANTILE DIARRHOEA AND ITSHOMOEOPATHIC APPLICATION”
By
Dr. GOURI DEVI NINGTHOUJAM
Under the able Guidance of :
Dr. RAMADAS AMBUGA, M.D. (HOM)
Professor Guide
DEPARTMENT OF ORGANON OF MEDICINE HOMOEOPATHIC PHILOSOPHY
BHARATESH HOMOEOPATHICMEDICALCOLLEGEHOSPITAL, BELGAUM.
From:
Dr.GOURI DEVI NINGTHOUJAM
To,
Dr. RAMADAS AMBUGA,M.D.(HOM)
Professor Guide
Department of Organon of Medicine
Homoeopathic Philosophy,
Bharatesh Homoeopathic Medical College Hospital,
Belgaum.
Sub: -Application to accept my synopsis for the dissertation.
Respected Sir,
I,Dr.GOURI DEVI NINGTHOUJAM,would like to forward myapplication for the approval of my synopsis under your guidance for the following topic,“ROLE OF SUSCEPTIBILITY IN ACUTE INFANTILE DIARRHOEA AND ITS HOMOEOPATHIC APPLICATION”.
Hope you will approve the same.
Date: 30-10-2009
Place:Belgaum Yours sincerely,
Dr. GOURI DEVI NINGTHOUJAM
Department of Organon of Medicine
Homoeopathic Philosophy,
Bharatesh Homoeopathic MedicalCollege
Hospital, Belgaum.
From,
Dr. RAMADAS AMBUGA M.D.(HOM)
Professor Guide
Department of Organon of Medicine
Homoeopathic Philosophy,
Bharatesh Homoeopathic Medical College Hospital,
Belgaum.
To,
Dr. GOURI DEVI NINGTHOUJAM
Sub: - Acceptance of synopsis for the dissertation.
Dear Doctor,
I have accepted your topic, “ROLE OF SUSCEPTIBILITY IN ACUTE INFANTILE DIARRHOEAAND ITS HOMOEOPATHIC APPLICATION”,for the dissertation.
Your synopsis will be forwarded to RGUHS.
Date: 30-10-2009
Place:Belgaum
Dr. RAMADAS AMBUGA M.D.(HOM)
Professor Guide,
Department of Organon of Medicine
Homoeopathic Philosophy,
Bharatesh Homoeopathic Medical
College Hospital,Belgaum.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BENGALURU.
ANNEXURE II
APPLICATION FOR REGISTRATION OF SUBJECT FORDISSERTATION
1. / NAME OF THECANDIDATE ADDRESS / Dr. GOURI DEVI NINGTHOUJAMPRESENT ADDRESS
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE HOSPITAL, RESEARCH CENTRE,
DHARWAD ROAD,
BELGAUM-590016
PERMANENT ADDRESS
G-15, WESTERNPALACE COMPOUND,
NEAR B.O.A.T.,
IMPHAL (EAST)- 795001,
MANIPUR.
2. / NAME OF THE INSTITUTION / BHARATESH HOMOEOPATHIC MEDICALCOLLEGE HOSPITAL, RESEARCH CENTRE,
DHARWAD ROAD,
BELGAUM-16.
3. / COURSE OF THE STUDY SUBJECT / DOCTOR OF MEDICINE (HOMOEOPATHY)
ORGANON OF MEDICINE HOMOEOPATHIC PHILOSOPHY
4. / DATE OF ADMISSION TO COURSE / 15-03-2009
5. / TITLE OF THE TOPIC / “ROLE OF SUSCEPTIBILITY IN ACUTE INFANTILE DIARRHOEAAND ITS HOMOEOPATHIC APPLICATION”.
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Diarrhoea is a major public health problem in developing countries. It is defined as, “the passage of loose liquid or watery stools”.
Diarrhoeal diseases during the infancy are usually brief and self limited but it can cause significant morbidity in some infants. An estimated 1.8 billion episodes of Diarrhoea occur each year and 3 million children under the age of 5 years die of Diarrhoea.When the WHO initiated the Diarrhoeal Disease Control Programme approximately 4 million children were dying each year due to dehydration caused by it.
In the treatment of Diarrhoea in children, the aim is not only to stop the loose stools but also to improve rapidly the general well being of the child, but if this condition is not treated effectively in time, leads to mortality. Repeated and prolonged episodes of Diarrhoea have even more deleterious effects and may eventually result in growth failure and intercurrent infections making treatment and prevention more difficult.
Homoeopathy being an effective system of medicine caters to the needs of the present scenario and possesses a better scope for the treatment of Diarrhoea in children. So this needs a scientific approach in treating Diarrhoea in children by Homoeopathy based on acute individual totality.
The acute individual totality is directly related to the susceptibility; which forms the crux of Homoeopathic management in terms of posology and prognosis. Susceptibility is the only basis on which the deleterious effect of Diarrhoea can be understood and hence managed in a homoeopathic perspective.
It is obviously important to study and analyze susceptibility which depends on various criteria like age, sex, geographical area, socio-economic conditions, etc. The understanding of susceptibility is an important tool, especially in children as the paediatric age group has high susceptibility which paves way for an ideal cure.
Susceptibility is the only criteria which reflects the presence of characteristics, helps us understand the immunity, and the vitality of the child. In addition, the interpretation of miasm speaks of the susceptibility. All these are vital in the management of children.
Thus the present study is an effort to understand the concept of susceptibility and its application in Homoeopathic management of acute infantile Diarrhoea.
Hypothesis: The role of susceptibility in acute infantile Diarrhoea and its Homoeopathic application may have favorable results.
6.2 REVIEW OF LITERATURE
Diarrhoea is defined as, “The passage of three or more loose or watery stools in a 24 hour period, a loose stool being one which could take the shape of a container”. However, for practical purposes, it is the recent change in consistency and character of stool and its water content rather than the number of stools that is important.1
Incidence
Diarrhoea is a major public health problem in developing countries. Diarrhoeal diseases cause a heavy economic burden on health services. An estimated 1.8 billion episodes of Diarrhoea occur each year and 3 million under the age of 5 years die of Diarrhoea. Incidence is highest in the age group of 6 to 11 months; The National Diarrhoeal Disease Control Program has made a significant contribution in averting deaths among children under five years of age. The episodes are generally associated with other infectious disease making treatment and prevention more difficult. However all age groups and both sexes are affected. Diarrhoea is more common in a person with malnutrition. Malnutrition leads to infection and infection leads to Diarrhoea which is a well known vicious cycle. Other some contributory factors are – Poverty, Immaturity, and Lack of personal and domestic hygiene, Immunodeficiency.2
Significant dehydration disturbing the balance of electrolyte and acid-base status of the body occurs in about 2-3 percent of all cases.3
Etiology
In developing countries, Diarrhoea is almost universally infectious in origin.
- Virus- the Rota virus is the single most important cause of Diarrhoea in infants and children, Adenovirus, Enterovirus, etc.
- Bacteria- Vibrio cholera, Salmonella, Shigella, E. coli, Campylobacter jejuni, etc.
- Parasite- Amoeba, Giardia, etc. infections are associated with Diarrhoea.
- Parenteral infection
ii)UTI(2)
- Dietary
ii)Overfeeding- excess fat, excess carbohydrate.
iii)Food poisoning. 3
Pathophysiology
The alimentary tract is a coordinated structure with the function of ingestion and absorbing nutrients and excreting unabsorbed waste products. Diarrhoea is a disease of the bowel which causes the imbalance in these functions and leads to malnutrition, which if not treated in time leads to death.
Approximately 60% of a child’s body weight is present in two fluid compartments- the extracellular fluid (ECF) and the intracellular fluid (ICF). The extracellular compartment includes circulating blood, intestinal fluid and secretions. Diarrhoeal losses come from ECF and replacement fluids should be of similar components; relatively rich in sodium with lower potassium.
Large amount of water and water soluble nutritive substances such as electrolytes, metabolites and vitamins are lost from the body during Diarrhoeal episodes. Loss of water from the body causes a reduction or shrinkage in the volume of extracellular fluid compartment.
In about half of these cases, the concentration of sodium in the plasma or extracellular compartment remains nearly normal (about 140mEq/L). Since excessive sodium maybe lost in the stools, in another 40-45% of the cases there is relative decline in the serum and ECF sodium level (hyponatraemia). Sodium is a major osmotic determinant of ECF, therefore the osmolality of ECF falls, causing movement of water from the extracellular to intracellular compartment. This causes further shrinkage of the already reduced extracellular compartment volumes.4
Clinical features
i)Fever.
ii)Loose stools.
iii)Pain and straining while defecating.
iv)Crampy pain in the abdomen.
v)Thirst.
vi)In extreme cases, weak and thread pulse, low blood pressure and quantity of urine passed is markedly reduced.4
Stuart Close defines susceptibility as, “By susceptibility we mean the general quality or capability of the living organism of receiving impressions; the power to react to stimuli. Susceptibility is one of the fundamental attributes of life”. The cure and alleviation of diseases depend upon the same power of the organism to react to the impression of the curative remedy. Generally speaking, susceptibility is greatest in children and young, vigorous persons, and diminishes with age. Children are particularly sensitive during development, and the most sensitive organs are those which are being developed. Therefore the medicines which have a peculiar affinity for those organs should be given in the medium or higher potencies.5
H. A. Roberts says contagious diseases thrive in childhood because of the extreme susceptibility of the miasmatic influence; this susceptibility has an attractive force which draws to itself the disease which is on the same plane of vibration and which tends to correct this miasmatic deficiency. A proper concept of the principles of susceptibility and reaction is something that the Homoeopathic physician must seriously consider; the interplay of these principles must become as second to him, if he wishes to use well the forces of nature in healing the sick. THE SIMILAR REMEDY, OR THE SIMILAR DISEASE, SATISFIES THE SUSCEPTIBILITY AND ESTABLISHES IMMUNITY.6
J. T. Kent says susceptibility underlies all contagion and all cure. He quotes Hahnemann, that we have more power over human beings with drugs than disease cause, for a man is only susceptible to natural diseases upon a certain plane. Susceptibility ceases when changes occur in the economy that bar out any more influx”.
In Aph. 31, Hahnemann says that the disease causes are limited in their ability to effect changes health, to certain conditions and states; i.e. to susceptibility.7
M. L. Dhawale in regards to posology says that infants and children are in general highly susceptible and react well to medium and higher potencies.8
Dr. Vrushalee Mayekar, in acute infantile Diarrhoea, susceptibility depends upon Characteristics (intensity, modality, concomitants), Pace (how fast dehydration occurs), General status. Most of the times it is found to be moderate. In cases of malnutrition it is low.
Fundamental miasm should also be assessed. Assessment of dominant miasm depends upon etiology, the intensity and pace of the presenting picture and the extent of the generals. Most of the times the dominant miasm in acute Diarrhoea is Psora. But if the pace is fast and there is weakness, dehydration etc., the dominant miasm is tubercular.9
Dr. Tapan Chandra Mondalgives the relation of susceptibility with disease as, “Only those who possess the required susceptibility will be attacked by the disease, because susceptibility makes the person liable to be attacked by the morbific agent”.10
Phyllis Speight-According to different miasms, Diarrhoea is characterized in the following manner:
Psora –Diarrhoeas often induced by over-eating: patient being always hungry eats beyond capacity of digestion; movements usually watery, or consist of imperfectly digested food. Quite often they have an offensive odour with colicky pains or cutting colic. Occur usually in the morning. In bowel difficulties, gone empty feelings in the abdominal region; sometimes it is a great weakness after stool, felt only in the region of the abdomen. Spasmodic offensive Diarrhoea which usually ameliorates the patient but they have no exhaustion. Diarrhoea coming on from fright, bad news, or any ordeal, etc., also when preparing for an unusual event. Also from taking cold or from slightest exposure. The true psoric stool maybe any colour- generally offensive and not very painful. It is worse cold, motion, eating and drinking cold things; better warm drinks and hot things to eat, quite warm applications to abdomen.
Tubercular-driven out of bed by their Diarrhoeas, fuse warm or cold perspiration. It is a characteristic of these tubercular children suffering from bowel troubles to develop a sudden brain stasis, or brain metastasis. Sometimes the tubercular manifestations in the brain alternate with a bowel difficulty. General exhaustion or loss of strength a feeling as if all vitality is leaving patient at each evacuation of the bowels. On beginning of eruption of the first teeth, Diarrhoea starts in tubercular babies; plus at this stage loss of power to assimilate bone-making material in food. Sometimes stools are ashy or grey in colour showing lack of bile matter. Bloody stools. In severe cases of bowel trouble child is fretful, peevish and whiney, does not want to be touched or looked at: prostration after stools marked. Worse milk, potatoes, meat and motion. Before stool there is often vomiting and retching.
Syphilis- patients worse at night; sometimes accompanied with prostration which is very exhausting and debilitating.
Sycosis- colic rather than Diarrhoea but if the later it is spasmodic and of a colicky nature, accompanied with a slimy, mucous stool and gripping colic and rectal tenesmus. Intestinal pain colicky and makes patient angry. Bowel troubles all produce irritability – they are cross and irritable with their pains; stools are changeable, usually greenish yellow mucus, seldom bloody; greenish watery, sour smelling with cutting colic – even the child smells sour in marked cases of inherited sycosis. In sycosis, these children want to be rocked constantly, or carried or moved about. The colics are better firm pressure or lying on abdomen; they are worse eating fruit.11
6.3 OBJECTIVES OF THE STUDY
- To study the clinical presentation (individualistic) of acute infantile Diarrhoea.
- To understand the concept of susceptibility and its application in acute infantile Diarrhoea.
- To study susceptibility and its role in the selection of similimum, posology and prognosis in acute infantile Diarrhoea.
- To study the miasmatic cleavage in acute infantile Diarrhoea.
7. / MATERIALS AND METHODS
7.1SOURCES OF DATA
The subjects for this study will be collected from OPD/ IPD, peripheral OPDs and village camps of Bharatesh Homoeopathic Medical College and Hospital, Belgaum.
7.2 METHOD OF COLLECTION OF DATA (including sampling procedure, if any):
- Patients will be selected on the basis of Inclusion and Exclusion criteria.
- Minimum sample size will be 30. Simple Random Sampling procedure will be adopted.
- All cases will be taken as per the proforma prepared for the study.
- All the cases registered between the period of July 2009 to November 2009 will be selected for the study. No new cases will be taken for study after November 2009. Cases will be studied till November 2011.
- Follow ups will be seen every alternate day or as per the requirements of the individual case for a period of minimum 6 months.
- Prognosis: - Assessment will be on the general improvement and stoppage of passing of stools of the child.
Inclusion Criteria
- Subjects of age group between birth to 10 years and both the sexes, irrespective of socio-economic status and climatic conditions.
- All the cases of dentitional Diarrhoea will also be taken for study.
- Subjects suffering from any other systemic disorder.
- Subjects on immunosuppressive drugs.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
The diagnosis of the case will be done on eliciting or on the basis of the case history and clinical findings.
As per the necessity and requirement of the case, the following investigations will be performed:
- Routine Blood Examination.
- Stool Examination (ova, cysts, occult blood, reducing substances and other microscopic findings).
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, ethical clearance has been obtained from the institution.
8. / LIST OF REFERENCES
1)Parthasarthy, PSN Menon, MKC Nair et al. “IAP Textbook of Paediatrics”, New Delhi, Jaypee Brothers Medical Publishers Pvt. Ltd. 2nd Edition 2002, Revised Reprint 2003, 414 pp.
2)Park. K. “Park’s Textbook of Preventive and Social Medicine”, Jabalpur (India), M/s Banarsidas Bhanot Publishers; Reprint 17th Edition 2003, 175 and 176pp.
3)J. Vishwanathan and Avalokita. B. Desai, “Achar’s Textbook of Paediatrics” Madras, Orient Longman Limited; Anna Salai, 3rd Edition, 1989, 416pp.
4)Ghai. O. P., “Ghai Essential Paediatrics”, Delhi, Dr. O.P. Ghai; 6th Edition, Revised and Enlarged, and Reprint 2005, 270 and 271pp.
5)Close Stuart, “The Genius of Homoeopathy; Lectures and Essays on Homoeopathic Philosophy”, New Delhi, B. Jain Publishers Pvt. Ltd.; Reprint Edition 1993, 76 and 194pp.
6)Roberts. H. A., “The Principles and Art of Cure by Homoeopathy”, New Delhi, B. Jain Publishers Pvt. Ltd.; Reprint Edition 1994, 151, 152 and 156pp.
7)Kent. J. T., “Lectures on Homoeopathic Philosophy”, New Delhi, B. Jain Publishers Pvt. Ltd.; Reprint Edition 1995, 95 and 96pp.
8)Dhawale. M. L., “Principles and Practice of Homoeopathy”, Mumbai Institute of Clinical Research, Reprint Edition 1994, 252pp.
9)Vrushalee Mayekar, “Paediatrics in Homoeopathy, An Approach”, Mumbai ICR Paediatric Team, 39pp.
10)Mondal. Tapan. Chandra, “Spirit of Organon”, New Delhi, B. Jain Publishers Pvt. Ltd.; 1st Edition 2001, 86pp.
11)Speight. P., “Comparison of the Chronic Miasms (Psora, Pseudo-Psora, Syphilis, Sycosis)”, New Delhi, Jain Publishers Pvt. Ltd., 1948, 60-64pp.
9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDES
11. / NAME DESIGNATION OF
(in block letters)
11.1 GUIDE / Dr. RAMADAS AMBUGAM.D.(HOM.)
PROF. GUIDE
DEPT. OF ORGANON OF MEDICINE HOMOEOPATHIC PHILOSOPHY,
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE HOSPITAL,
DHARWAD ROAD,
BELGAUM – 590016.
11.2 SIGNATURE
11.3 CO – GUIDE (if any) / ------
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT / Dr. RAVINDRA NADHAN
M.D.(HOM)
PROF., HOD GUIDE,
DEPT. OF ORGANON OF MEDICINE HOMOEOPATHIC PHILOSOPHY,
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE HOSPITAL,
DHARWAD ROAD,
BELGAUM – 590016.
11.6 SIGNATURE
12. / 12.1 REMARKS OF THE CHAIRMAN / PRINCIPAL
12.2 SIGNATURE