Subjective sensations, feelings and behaviour of the patients are characteristic points of notification which needs to be considered during homoeopathic case taking for selection of the appropriate similimum. Mental generals of nosodes are equally significant for such choice. Tuberculinum is one such clinically verified drug which is widely used in various disease conditions. The mental picture is very important in the consideration of the selection of Tuberculinum and hence this short write-up is to emphasis on those salient mental generals of the popular nosode.
Nosodes are the homoeopathic preparation from pure microbial culture obtained from disease tissue and clinical materials (secretions, discharges, etc.) 1. The word 'Nosode' is derived from two Greek words – 'nosos' means 'Disease' and cidos means 'appearance' 2. More than forty-five major nosodes have been in use since 1830 but no clear guidelines regarding their preparation are available 3. Tuberculinum, a well known homoeopathic nosode, has been used in practice since 1879 4. It is prepared either from tubercular abscess (Dr Swan) or from glycerine extract of pure cultivation of human tubercular bacilli (Dr Koch) 5.
A literature review of the mental generals for the drug Tuberculinum is made by consulting from different books of Materia medica and Therapeutics which are enriched with clinical experiences and observations from our stalwarts.
Some homoeopaths treat Tuberculinum simply as a nosode, to be given when there is family history of tuberculosis, but Kent warns against this superficial approach, he says Tuberculinum is a distinct constitutional type, to be given only when the whole picture fits 6.
Personality and Mental Generals
Of all nosodes, Tuberculinum possesses the most clearly defined and distinctive personality 7. Patient is of slender build, with a narrow chest or caved in chest, a thin or oval face, light complexion, blue eyes; hair is soft and silky, eyelashes are long, skin is fine textured, clear and translucent . They are active and precocious mentally, but physically weak with tubercular diathesis. They are referred as "Consumptiveness" – i.e. who have inherited phthisis or have died of phthisis are often of feeble vitality; takes on sickness easily; anemic; nervous and debilitated. Tuberculinum patients are unpredictable in their moods and behavior. In one moment they are refined and gentle; the next moment, they appear to be malicious and destructive 8.
Desire to travel and discover
They have a constant desire to change, travel, and go somewhere, and to do something different, or to find a new doctor. Such a condition develop in those about to go into insanity (on the borderland of insanity), about to go into some lingering disease 9. Patient is never satisfied to stay in one place long 10. This is out of excitement, fancifully and because of great restlessness. Patients always feel sense of adventure. He feels that life is too short so must be lived to the hilt 11. He usually takes jobs that involve movement and work in the open place for example like delivery boy, postman, landscape gardener etc. i.e. anything enabling him to avoid sitting at a desk 7. If Tuberculinum cannot travel physically, he travels in his mind (i.e. he fantasies of travel). He reads magazines, pursues books, watches T.V. programmes on travelling and often love to work in travel agencies or airline company for the opportunities if offers them to visit in new places 7. This type of personality is easily bored with the same surroundings (never satisfied to remain in one place long) and may refuse to go to twice to the same place for a holiday 7.
This is another important characteristic feature both on physical as well as on mental plane. They frequently change career or occupation. Here patients admit to never having a full time position for more than a year or two. Any routine makes them feel tied down, their freedom unbearably curtailed. In children, this quality is seen as the way they picks up and puts down one toy after another, being unable to amuse himself even for any reasonable period of time 7.
There is great fear of animals, especially black dogs. On seeing animal, they will cross to the other side of the road. They will refuse to visit a relative who has a dog in his house (With every little ailment whines and complaints; easily frightened, particularly by dogs; screams in terror when approached by dogs) 12.
Tuberculinum does not always keep cool and calm. When things are not going in his way, he can become not only restless, but also irritable. The more annoyed he becomes, the more he will curse 6. There is a desire to use foul language, curse and swear 13. Feels himself forced to use insulting languages, obscene and use rough words 14.
They are dissatisfied and restless, always wants a change 6. As a child he will throw uncontrollable tantrums just to spoil your plans. He will do exactly that he has been not told to do merely to be spiteful. Tuberculinum children become a constant torment to their parents 7. One of the main reasons of dissatisfaction is that he doesn't know what he really wants, and no one else can find ways to satisfying him. In their dissatisfaction, they continually seek changes. They go from job to job or from location to location - always seeking escape from their dilemmas 8.
Extremely sensitive to music and at the same time fond of it, and likes dance and art. They are full of contradictory feelings; on the one hand they seek fulfillment and change, and on the other they feel dissatisfied and irritable 8. They have aversion towards some person without reason 13. Clinical experiences have shown that tubercular patients heal better in mountain forests with dry climate. If they feel irritated, they usually want to be alone, and the best thing for them to do is to walk in the open air in the mountains. They do not feel well at the seashore.
Tuberculinum is a distinctive remedy which cannot be missed once it is understood, but it is difficult to describe concisely 8. Along with cosmopolitan nature, Tuberculinum patients are very irritable, always needs changeability, fear of animals, with destructive mentality and always dissatisfaction with him and others.
In a case of a man sixty years of age suffering from spasmodic gagging cough for twenty five years, whose brothers and sisters had several of them died of consumption, after prescriptions of Rhus tox and Veratrum album in acute conditions 10. Another case, presented with some lung trouble and continued to grow worse until the two doses of Sulphur CM, followed by Tuberculinum CM. She is remarkably improved and outstandingly there were no residual effect of these suffering 10. Apart from this, Tuberculinum finds application in clinical conditions like cerebral or basilar meningitis (when it is with threatened effusion), intermittent fever (relapsing in nature), boils (appearing in crops, painful and green fetid pus), and dysmenorrhoea and also in tubercular neck glands of children 15.
After the above discussion it can be satisfactorily said that, the nosode Tuberculinum as a classic way of prescription may be done on basis of the patients' congenital state, his inherited illnesses and the medicine work at a more profound level to stimulate and revitalize the body's weakened reactive and self healing mechanism 7. Not only do they act as a constitutional remedy, they also enable the patient to respond appropriately to the other acute or chronic remedy (i.e. often used as intercurrent remedy).
The first dose of Tuberculinum in any difficult case is, however, the weightiest prescription. The remedy should not be given without a most careful cardiac examination. As the surgeon before the anaesthetic, so must the physical know the heart before administering this drug, especially to children, and senile and to young senile. He who observes this rule has fewer clinical reproaches on his conscience. When Tuberculinum is contradicted, recourse must be had to the nearest antipsoric 13. Tuberculinum is indicated in renal affection, but caution is necessary for where skin and intestine do not perform normally even in high potencies are dangerous 13.
Patients cured with Tuberculinum needs Hydrastis to fatten 12. Belladonna is given for acute attack, may be congestive or inflammatory that occur in tubercular cases 12. According to Burnett, vaccinosis may block the way of action of tuberculin until Thuja has been given and then acts brilliantly 13. When Tuberculinum fails, Syphilinum often follows advantageously producing a reaction 13.
Caution to be remembered
Tuberculin needs more frequent repetition in children's complaints than nearly every other chronic remedy 13. Burnett recommends giving the Tuberculinum high if there is a strong tubercular element in the case; if that element is small, 30 is better 16.
Nosodes very commonly used in clinical practice based on beliefs supported by personal experience and predetermined notions. Tuberculinum also should not be specifically used merely because it is a disease product i.e. a nosode. Infact its use should be based on proving records and clinical experience as similar to other drugs from plant, animal or chemical origin.
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