A 5 Month Old girl with Cough and Respiratory Distress A Case of Sanicula

March 11, 2016

This case is a very good example that confirms once again the theories of Suppression, Exteriorization of disease and Hering’s Law of direction of cure.  These theories are given the utmost importance in the practice of homeopathy and hence placed as fundamental laws next to the Law of Similia.

A disease which is maltreated with the use of crude drugs in large doses or with an inappropriate approach gets suppressed instead of getting cured and later, after months or years the patient suffers from some other major illness. This is considered as a different disease by conventional medicine. In homeopathy such diseases are considered as different forms of the same previous disease, produced by the suppressed vital force. When such patient is treated homeopathically, the likely outcome is the exteriorization of the previously suppressed original disease. With this, permanent cure is achieved and all the symptoms are annihilated from above downwards, from within outwards and from more important organs to less important organs.  Hence, a detailed present and past case history of the patient as well information on family members are the initial steps taken in classical homeopath.

25/08/2001

A 5 month old female new born with high grade fever, severe coughing and breathlessness was brought in by her mother. The child was running a fever of 104. The cough was moist with rattling sounds from the chest and was having difficulty breathing. There was greenish yellowish discharge from nose and vomiting of greenish yellowish phlegm from mouth.

On examination:

Chest – Crepitations +++
Temperature – High grade fever 104 degree in axilla
Pulse – High 100 +, rapid
Respiratory Rate – High

Observation : The child’s general condition was poor and rapidly deteriorating. A rattling sound from chest was heard when she was coughing. Cough was moist. Respiration was accelerated. The infant was breathing through her mouth. Fanning of alae nasi was present. She was cranky and restless and not relieved by carrying or rocking. Though hungry, she would refuse to have mother’s milk due to difficulty in suckling because of breathlessness. Her mother would mechanically remove her own milk and feed the infant with a spoon.
Family history: 

Bronchial asthma in grandmother, uncle and uncle’s son.

Past history:

Hospitalisation 3 times in 5 months since she was born, for the same complaint of severe congestion in chest, coughing, breathlessness and high fever. Child was 1.5 months old at first episode of lower respiratory tract infection.
Drug history: 

Antibiotics, Antipyretics and history of nebulizer given during hospitalisation.
Current medication:

Nise (Nimesulide) to control fever and cough syrup as and when required.
Investigation: 

Previous X-ray showed severe congestion in lungs due to lower respiratory infection.

Diagnosis: Asthmatic bronchitis

Generalities:
Thermal state – Child did not like to be covered and would throw off covering even in coldest weather and would always need a fan otherwise her sleep would be disturbed.

Appetite – Poor and would refuse to have mother’s milk or vomit it on forceful feeding.

Mother’s history during pregnancy:
Mother’s mood remained unusually angry throughout the pregnancy. She used to get violent when losing her temper and would throw things out of the window. She used to shout and scream at family members without cause.  Her mood became normal post delivery. She loved to eat sweets during pregnancy. She felt unusually hot throughout the pregnancy; needed fanning always. She felt very thirsty and wanted frequent drinks.
Birth history of child:
– Full term normal delivery without any complication.
– Birth weight was 3.5kg.
– Child’s and mother’s health was fairly good after delivery.
History of Vaccination : 

Oral polio drops and D.P.T.

Miasmatic Approach Of The Case :
– Strong family history of asthma and past history of recurrent lower respiratory infection suggests Tubercular diathesis as dominant miasm.
– Violent and destructive nature of mother during pregnancy is suggestive of   Syphilitic trait in Tubercular miasm of child .
– Restlessness in child is suggestive of Psoric trait and Tubercular miasm.
– Craving for sweets in mother during pregnancy suggests Psoric trait in Tubercular miasm of child.
– Acuteness and recurrence of high fever is again a characteristic feature of activity of Psoric miasm combined with Syphilitic miasm.
– The severity of symptoms, rapid progress and underlying pathology of disease indicates again the Tubercular miasm .

– All the features mentioned above are indicative of Tubercular miasm as the dominant miasm.

Characteristic Symptoms:
1) Thirsty often (in mother during pregnancy).
2) Craving for sweets (in mother during pregnancy)
3) Violent and destructive nature (in mother during pregnancy)
4) Desire to uncover even during coldest weather in infant
5) Thermal state more towards hot side (in both mother and infant)
Totality Of Symptoms
1) Thirsty often for water (mother during pregnancy)
2) Desire to uncover in coldest weather.
3) Craving for sweets (mother during pregnancy)

Reference :
– Complete repertory
– Synthesis repertory

Rubrics:
1) GENERALITIES – COVERING ; agg.  or intolerance of; kicks covers or clothes off – weather, in coldest
2) GENERALITIES – FOOD and  drinks; sweets; desire

3) STOMACH – THIRST – often, frequent

Choices Of Remedies:

Hepar sulph
Calcarea sulph
Sulphur
Sanicula

Drug Differentiation:

This was the most crucial point in this case.  I was struggling to decide the most similar drug from the group. We can see the Sulphur element is common in all the remedies. I was tempted to give Sulphur as it is a well proved drug but also did not want to leap without looking at other possibilities. I wished I had a key-note symptom which would confirm one drug and eliminate others. I asked mother if she or any of her family members observed anything very peculiar and unusual about the baby right from her birth till now. I had studied Sanicula in depth from various sources and repertories during my internship. Like Sulphur it is a very good child remedy. Both have’Precocity’ as a characteristic symptom. However, Sanicula has one peculiarity at a more specific level in its symptom of ‘Precocity’.  The Sanicula child may have fontanels prematuredly closed before birth.

HEAD – CLOSING premature, fontanels prior to birth: Calcarea carbonica, Sanic (Complete rep)

I asked whether her baby’s fontanels were opened or closed at birth. The mother immediately said, ” It was closed already!”

Now, Sanicula was the only drug which covered all 4 symptoms of my totality. Also, when constituents of Sanicula were studied from various materia-medica it became clear that it contains Calcarea sulph and Sulphur as its major constituents. This explains why these drugs are coming up in repertorisation. Sanicula is mineral water diluted and potentised to transform its energy into a homoeopathic remedy. On further study it was evident that it reaches to the core of this case being a strong anti-psoric to anti-tubercular remedy. The anger, violent and destructive nature and restlessness of the mother during pregnancy fits perfectly into Sanicula. Sanicula is a hot drug having desire to uncover even in coldest weather.

Remedy Selection: 

Sanicula

Prognosis of the case: Prognosis seemed good with the presence of characteristic and key-note symptoms. However, frequent recurrence of the attacks of infection with rapid progress along with the strong family history of asthma was the catch here. Though there was equal risk of developing of asthma later, I felt prognosis was not bad provided the infant received the right remedy at the right time.

Potency and dosage:
The infant was already running 104 fever so very high potencies were avoided for the fear of homeopathic aggravation. I decided to give 200 in a single dose.

First prescription:
Sanicula 200 single dose. Powder to be dissolved in a tsp of water.

Follow up:
26/8/01:  Within 12 hours the infant developed diarrhoea with sticky stool. There was a temporary rise in temperature but with that the baby became cheerful, active and started taking mother’s milk on breast feeding. The temperature started coming down and became normal in one day but diarrhoea persisted throughout that day. This diarrhoea was not considered as a new complaint but as a good sign of “exteriorisation of disease” indicative of annihilation of earlier suppression and initiation of cure. Hence, symptom of diarrhoea was not interferred with. It is possible that vaccination was the stimulating cause for suppression. Anti-pyrietics, and anti-biotics further made the case complex. Strong family history of asthma was already present as an inherent predisposition to take the disease inside to the lungs.

Action:  The mother was given sac lac powder tds as baby had now started to take mother’s milk via breast feeding.

27/8/01:  2nd day no fever. No diarrhoea. Stool became normal. Cough became dry.

Action: S.L. was continued.

28/8/01:  4th day, o/e chest was absolutely clear. No fever. No coughing. No diarrhoea. Stool normal. Child was cheerful and playful. Appetite was increased.

Action : S.L.

In a month’s time the child gained good weight. General condition improved a lot.
Dentition started early at 6 months and it was painless with the help of a single dose of Sanicula.
All the milestones were early but normal. As mentioned earlier, precocity is an  indication for Sanicula. The next  3 yrs. records of follow-ups shows that there was no relapse of lower respiratory tract infection. Occasional simple colds recovered without any medication.