Case Quizes Clinical Cases

Revisiting: It’s Maddie Again!

lewis jan image

Elaine gives the answer to last month’s quiz and analyzes the case.

Elaine re-presents our very first quiz!


Some people may wonder why I’m doing this.  It’s because the answer to our very first Hpathy Quiz is missing!

I don’t want such a valuable quiz to go unanswered!  This remedy is very important and I want you to be able to recognize it when you see it!  So, I give you, once again, “Maddie’s Sick”, from January, 2005:


On 24th October, 2003, I got an email from our friend Barbara M., who’s written for this magazine many times, saying, “Need some help.  Maddie is sick.  Maddie is 3 years old.  Poor kid has been vomiting a lot.  Illness came on suddenly.  She was fine when she woke up this morning and then about an hour after breakfast she said her throat hurt and that she might throw up.  She has vomited about four or five times since then–after drinking anything and after a banana.  This last time it was right after cold drinks.  She has a slight fever, says her throat hurts and is very lethargic.  She is not anxious or restless at all, just lying on the couch, not moving much. Her eyes are droopy and the lids are pinkish.  She wants me to carry her if she gets up.  She doesn’t seem to prefer to be covered or uncovered.  If I offer a blanket she takes it, but then if she rolls over and it falls off, she doesn’t care.  She is not fearful or anxious, but just looks sad and droopy.  She has had a cough for about 10 days prior to this but it was getting better.  Thank you!– Barb.”

Now, it would be easy for me to tell you the remedy, but, send me an email at [email protected] and tell me what you think the remedy is.  I’ll share the results with you in the next issue.

What I like about this case is that Barb understands how to present a case to a homeopath, and there’s a lot to be learned in her presentation alone.

She could have said, “What do you give a child for vomiting?”  This is how most of our acute cases are presented to us, and we can’t do anything with that kind of information.  Barb knew to give:

1. the onset (how fast the illness came on)

2. the state, by which we mean the name of the condition–fever, flu, etc.

3. the all-important mental state

4. the physical appearance or what we call “objective symptoms”

5. the modalities (things that make the condition better or worse, such as eating or drinking, the temperature of the room, the weather, company or solitude, touch, position of body, motion, time of day and so on)

6. physical generals–how the person is in general.  These symptoms usually start with “I”: I’m hot.  I’m dizzy, and so on.

7. particulars–the local symptoms; these usually start with “My”: My throat hurts, my ears hurt, etc.

By giving such a well-presented case, the homeopath can’t go wrong!  Let us know what you think.

Barb gave a 200C of the remedy at bed time and the next morning she told me, “Elaine, she’s fine, great, couldn’t be better!”


See you back here in January for the answer! (Hopefully, this time we won’t lose it!)



Veratrum alb.-2







Acetic acid


OK, everybody, it’s showtime!  Did anyone come up with the right answer?  Who’s our first caller of the new year?

Hi Elaine,

Hi Clement!

Of course I’m French: I’m unmasked….!!

Obviously Frenchies and foreign languages are “two opposite notions” like “Americans and good Cooking”…..: =


it’s a shame but it’s true for both.  I baked this cake for you!

lewis jan image


OMG!  It’s beautiful!!!!

However, here is my repertorisation:

Mind; carried; desires to be
Mind; indifference, apathy; fever; during (x2)
Mind; sadness; silent
Combined rubrics:
Eyes; closed; involuntary
Eyes; falling of lids
Eyes; heaviness; lids
Eyes; redness; lids
Stomach; vomiting; drinking; agg.
Stomach; vomiting; heat; during
Stomach; vomiting; food; eating; after
Sleep; sleepiness; heat; during
Generalities; sudden manifestations

VERAT (100/9)
PULS (97/10)
ARS (95/9)

I doubt of VERAT (she isn’t chilly, no shivers; no cramping pain, no cold perspiration; etc…)
I doubt of ARS (She isn’t restless, she don’t need company specially; no burning pain, etc..)

What is the most clear in that case is the apathy which make me think in first intention to remedies like PH-AC or SEP, but with my repertorisation only PULS can be like that in that acute case


D’oh!  Clement, Pulsatilla is thirstless with fever.  Maddie has been drinking water.

Hope I’m right.

Well, Clement, the rubric here is “Indifference, apathy, fever, during”, which you chose, and, good for you for choosing it!  And why is this the rubric?  Because we have the state (fever) plus the mental concomitant (apathy).  As you know, we’re not interested in apathetic remedies that aren’t also flu/virus/fever remedies because it appears that Maddie has some sort of flu or virus.  


Whenever you hear about a person with a flu or virus with apathy/indifference as the mental concomitant, your very first thought should be our premier flu remedy, Gelsemium!!!!!  But….even having said that….why don’t we like Gelsemium in this case?  Because we have a case of sudden onset, AND, because Maddie has been drinking water and Gelsemiums are thirstless!  So, let’s consider our Gelsemium look-alike, Baptisia.  Baptisia has a reputation as being “like Gelsemium, only worse!”  Baptisia has the flu, is apathetic like Gelsemium, BUT, Baptisia has sudden onset AND is thirsty!!!!!

So, this is all you need to know!  You don’t need to know or repertorize symptoms that are covered by the word “flu” (or you could also use the sub-rubric “stomach flu”).  Symptoms such as vomiting and sore throat—these all fall under the word “Flu”; or symptoms that are common for small children, such as wanting to be carried or being sad when they’re sick, these need to be ignored as they are all normal—common.

So, the next time you see what looks like a Gelsemium flu, but it has a sudden onset with thirst, think about Baptisia!  Bye Clement, thanks for voting!

Is the caller there?

Hello Elaine, it’s me again,

Hello Vernetta from Montreal!

ready to try my hand at the latest quiz.

Make it fast, I’ve got potatoes in the oven!

Here are my rubrics which I felt covered the case of Maddie.

Children, dullness of mind

children , slowness of mind

No no no no……. see, you are starting from the wrong place.  What we have here, for all intents and purposes, is a flu.  So, we need a flu remedy that has dullness of the mind; not a children’s remedy that has dullness of mind, as in a dimwitted child like Baryta carb or Bufo.  We need a flu remedy with the mental concomitant of dullness.

children, weak, delicate (to correspond with needing to be carried)

No, no, no, see, this is an irrelevant symptom, because 3-year-old children tend to want to be carried even when there’s nothing wrong with them; so, all it means is that Maddie is sick and wants to be carried, there’s no rubric in that, that’s just being a kid who’s sick; plus, any symptom that’s covered by the word “flu” does not need to be repertorized because the rubric “Influenza” is an umbrella for that!  So, are people with the flu weak?  Yes!  Are people with the flu inclined to lie down?  Yes; so, all this is covered once you select the “Influenza” rubric.

inclination to lie down

stomach, vomiting, after breakfast

after drinking

after cold water

I came up with silica, the dose would be 200c single dose.

I’m waiting to be rapped over the knuckles.

This won’t hurt, I promise.  Silica is just a very poor choice as it’s only in plain-type in the flu rubric (a “1”, as we call it; whereas, there are many “3’s”–such as Bryonia, Baptisia, Rhus tox, Eupatorium perf., Arsenicum, etc. and Gelsemium is actually a “4”!)  So, we’d be checking out our main flu remedies first and seeing which ones, if any, embody the characteristic symptoms of this case which are: APATHY / INDIFFERENCE, sudden onset and thirst.

So, here’s what we do.  We look at the main flu remedies and we say, “If it had been Rhus tox, she’d be achy and restless.  If it had been Bryonia there would be really bad pains or headache and she’d be worse for the least motion.  If it had been Gelsemium, there’d have been slow onset and thirstlessness and probably chilliness too.  If it had been Arsenicum, there would be fear, anxiety, constant need for company and hand-holding, not the indifference we see here.  If it had been Eupatorium perf, we’d be looking for severe bone pains as if bones were breaking; there were no pains in this case.  So, we’re looking at Baptisia now, and amazingly, Baptisia has the apathy, the sudden onset and the thirst that Maddie has; so, it seems to be a clear case of Baptisia!  Thanks for voting, Vernetta, do come again!

Is there another caller on the line?

Hi Elaine!

Hi Maria!

For this month’s quiz I am between two remedies. Phos and Gelsemium.  Here are my thoughts:

Phos is a 3 under vomiting and vomiting after drinking where Gels is a 1.

Yes, the clue of thirst in the case makes us think twice about Gelsemium.

Phos is a 2 under desire to be carried,

However, what 3 year old doesn’t want to be carried?  In other words, I don’t know how reliable this symptom is.  It may be common in most sick children.

Gels is not even there.

I noticed the date late October and drinking cold water in October Phos may fit better.
But “vomiting after drinking cold water”, the only remedy in 1 grade is Gelsemium

Actually, Maria, she was vomiting in general, due to having a stomach flu or “stomach influenza” as it says in Murphy’s Repertory.  The important thing here is that she was thirsty, which actually eliminates Gelsemium.  The first time she vomited, she had nothing to eat or drink.  She also vomited after a banana; so, I’m getting the impression that due to having a stomach flu, all influences were disturbing her stomach.  I think the best way to look at it is this, “Stomach flu with thirst, indifference and sudden onset”.

Under Apathy both Gels and Phos are a 3.

We are really only interested in apathy remedies that are concomitant to fevers.  So the rubric is: “Indifference/apathetic, fever, during”.

The sudden onset is not covered by any of two remedies but the kid had a cough for some days so maybe it is not so sudden.

No, it was sudden.  Barb said Maddie was fine when she woke up in the morning, and then an hour after breakfast…Wham!

Though Phos ranks higher, I will vote for Gelsemium because the overall droopy, apathetic state reminds me more the Gelsemium state during cold or flu etc.

It really does look like Gelsemium, doesn’t it?  That’s a good guess!  But Gelsemium has a slow onset and is thirstless.  Otherwise, Gelsemium would be a really good pick!  Phosphorus ranks high for apathy, but does NOT rank high for apathy during fever; in fact, it ranks low.

(We can’t lose sight of the STATE the person is in!  This is not a case of apathy due to grief, which might make us think of Phosphoric acid, and it’s not a state of apathy from head injury, which might make us think of Arnica or Nat-sulph.  The state here is some type of virus or flu.  Knowing the state tells us what chapter of the repertory to be in, or what the primary rubric should be.)

As I’ve often said, the repertory is not complete, and the remedy for this case, though in the Materia Medica for rapid onset of fevers, is not so entered into the repertory.

If I am wrong I will try again 🙂

Well, I might as well tell you, Maria; it’s Baptisia!  Roger Morrison says, “Rapid onset of septic states.”  Apathy, dullness, muttering, incoherence, not answering fully, collapse, stupor, prostration, etc. are all signs of septic states.  Think of Baptisia as being a thirsty Gelsemium with sudden onset.

Here’s what Murphy’s MM says about Baptisia:

Besotted look, epidemic influenza, great languor, wants to lie down, weak, prostration is rapid, foul odors (though not in this case). Dull, confused, indifferent. Gastric fever. Great thirst. High fever, sudden onset. Dizziness.

So, that about covers it!

Thank you for telling me because I wouldn’t have found it even in 100 years!
I had completely forgotten about Baptisia!  I was troubled for the onset and I was ruling out the sudden onset remedies and Baptisia did not even cross my mind!  I will definitely remember it from now on!  A thirsty Gelsemium with sudden onset!  Perfect description!  Thank you!
Great quiz!!!

Thanks! And don’t forget the foul odors in Baptisia.  I have another Baptisia quiz where foul odors was the key to finding the remedy, though there were no foul odors present here.

P.S: Happy New year with more quizzes!

Thank you!

Who is our next caller?

Dear Elaine,
first, all the best in 2013 and the years that will come!

Thank you, Anca!

second, I remembered a little of this case, in fact I had begun to take all the quizzes again from the start!

Really????  You have????  Wow!  Not too many people can say that!

and I know that the answer was Baptisia for the sudden onset and the other symptoms.

You’re right!

My question is: I saw in many quizzes that you say that only 3 remedies have a quick onset, but in all repertories are much more remedies with this type of beginning, so, do you really still think that ‘sudden onset’ means only 3 remedies? Thanks–Anca

That’s true, Anca; but, there are only two remedies in bold for Sudden Onset–Belladonna and Aconite. (I’m using Murphy’s Repertory, 3rd edition.)  Unfortunately, Baptisia isn’t even listed, which is REALLY weird because it was Robin Murphy who said that if you have a sudden onset, you’re looking at 3 remedies, Aconite and Belladonna AND Baptisia if it’s septic!  So, you would certainly expect to see it listed in Robin Murphy’s repertory!  But, as I’ve said many times, every remedy that belongs in a given rubric is not necessarily there!

But, if you look in Morrison’s MM under Baptisia, you’ll see: “Generals: rapid onset of septic state or cases rapidly approaching sepsis.”

So, hopefully we can agree that Baptisia does have sudden onset despite not being listed in the repertory under “Diseases…, sudden manifestations”.  But, let’s look at what IS in that rubric–besides Belladonna and Aconite.  (Again, they are the only 2 in bold.)  What’s in italics?  A bunch of remedies we normally wouldn’t consider in a virus, flu or infectious disease; namely, Androctonus, Tarentula, Mag-acet., Spigelia, and so on, which brings us to our “1’s” (plain-type listings).  Here again, we see a preponderance of remedies we normally do not associate with infectious disease: Formica rufa, Nitric acid, Hydrogen, Petroleum, Plumbum, Tabacum, Sulphuric acid, Thuja, Tuberculinum and so on. However, there are a few that might well show up in a flu with sudden onset: Phosphorus, Eupatorium perf, Arsenicum and Veratrum alb, and if we saw any of these remedy pictures in such a case, we would have no trouble recognizing the Phosphorus flu with its burning thirst for ice cold drinks followed most likely by vomiting; and then we would be reassured by its presence in the “sudden onset” rubric, that it could, indeed, cover the whole case.  Similarly, we should have no trouble recognizing the keynotes of an Arsenicum flu or a Eupatorium perf. flu with its “pains so bad, as if the bones are breaking.”  That, along with thirst, should assure us of a Eupatorium flu that came on suddenly.

So, as you can see, by and large, in a non-septic case, there really are 2 main remedies for sudden onset–Aconite and Belladonna.  However, seeing keynotes of other remedies would make one suspicious; so, you would then check the “sudden onset” rubric and confirm that, yes, this time, it is Arsenicum, or Phosphorus, etc.  I hope that helps.  Anyway, Baptisia should certainly be added to that rubric!

Thank you for such a detailed answer!

So, as I see it, when you hear “sudden onset” you can take it as eliminatory or on the other hand, confirmatory, when the symptoms don’t suggest the 3 main remedies.  It’s probably very important to see if it’s a cold, septic state and so on.

Flus/viruses/colds can be septic.  That besotted look Baptisia is so famous for IS a sign of a septic state, as are bad odors (another keynote of Baptisia, though it was absent in this case), plus not being able to answer or answer fully or falling asleep mid-sentence or answering “Huh?” to all questions…. It’s a sign the person is toxic, in other words; as if “drunk”.

One of the quizzes is a Pulsatilla case with sudden onset (which wants only ice cream), so in this case is a confirmatory rubric probably, but in fact the sudden onset wasn’t taken into consideration at all!

Is this the quiz where the warm bath aggravated?  Because that’s a sign of Pulsatilla.  Pulsatillas are worse for warmth: warm rooms, hot baths, etc.  OK, I just looked up the case.  This is a NWS or “ailments/from” seafood.  “Food: fish, spoiled”–there are only 18 remedies of which Pulsatilla is a “2”.  The fever came on “suddenly” after a bath; so, “Generals: bathing, hot bathing agg”–15 remedies.  Again, Pulsatilla is there as a “2”.  Here’s what Shobi, the child’s mother, says:

“He doesn’t mention a pain, but, when the fever does come, which now we have two days of it coming on, raging after a hot/warm bath, he does say he is tired and wants to sleep.”

So, if we look up “Fever: warm, warmth, affects on, agg. fever” (that’s an awkward way of saying “Fever, warmth agg.”)–there are only 7 remedies there and only 2 are in BOLD and the rest are in plain type. The two in bold are Apis and Pulsatilla!  This is really the most striking part of the case, is it not?  After the bath, the child’s fever rages!  Don’t you think that’s very striking?

The child will only eat Sherbet, which is essentially ice with flavoring.  So, the child is better for cold things.  So, under “Food: cold food amel.”, Pulsatilla is in BOLD!  Only 2 other remedies are in bold–Phos and Bryonia.  Oh, and moreover, the child was thirstless with a fever, there are only 6 remedies in that rubric and Pulsatilla is in BOLD.

This case can only be Pulsatilla!  It is not really a sudden onset case, per se.  It’s an “ailments from fish” case with a modality of “hot bathing agg.”  The case is called “Revisiting: Bathtub Blues” in case anyone wants to do a search for it.

Another one is a Lachesis case which is better from hot baths!  (The father who travelled a lot by plane).

Yes, Shobi’s father.  Funny that “Bathtub Blues” was about Shobi’s son.  But as I remember, Shobi’s father ALWAYS has this syndrome when he flies; and the reason is because, as a Lachesis person, the lack of oxygen in the recycled plane air, always affects him deeply.  The problem basically is that Shobi’s father is a Lachesis.  That was a case where the constitutional remedy and the acute remedy were the same thing.

I am a bit puzzled, when do you take in consideration this kind of symptoms that can seem real keynotes in most cases, or even eliminatory ones?

You just have to think about the case, Anca.  There’s no real substitute for having to analyze the case. Shobi said her son’s case “came on suddenly”, but we can’t just pick that up and run with it!  After thinking about the case, what do we see?  Nothing but Pulsatilla: Fever worse warmth, better cold food, thirstless with fever, ailments from spoiled fish.  And Shobi’s father had ailments from lack of air, or suffocation, which Lachesis is very susceptible to.  If you look up, “Generals: indoor air agg.” -Lachesis is in BOLD.  So, I hope that somewhat answers your question.

yes, of course, thank you!


Sooo…..Dr. B, we’ve finally got a “quiz answer” to our very first quiz, “Maddie’s Sick!” And our winners this time are….

Anca Ticu and Gabi Aguero, who was our right answer from 8 years ago!!!!!  So, congratulations go out to Anca and Gabi!  Thanks for voting everyone!  See you back here again next time!


Elaine Lewis, DHom, CHom

About the author

Shana Lewis

Shana spices up the Hpathy Quiz with her timely announcements and reviews on the latest in pop culture. Her vast knowledge of music before her time has inspired the nickname: "Shanapedia"!

About the author

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at [email protected]
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at: and

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