A DIFFICULT CASE

Read before Bureau of Pediatrics, I.H.A., June 24, 1949.

FRANK J. CORBETT, M.D.

 

Mr. Chairman, officers and members of I.H.A., friends, guests, I want to thank you for the privilege of presenting this case. It was very difficult and trying to me. We general practitioners do see and have to handle very difficult problems.

The patient in question is Nancy O., an 8 year old, white, fair complexioned, slender, vivacious little girl, whose mental alertness and rapid questions and answers keep everyone around her on the alert. She is normally always on the move and full of fun and laughter.

One evening while attending a social gathering, she was suddenly seized with a spell of weakness and tiredness and wanted to go home immediately.

Her mother, thinking that she had perhaps eaten something that

disagreed, thought she would be all right in the morning. The little patient had no pain, but pale tired and weak and wanted to go to bed.

Nancy had had “spells” of weakness since she was five years old but the taking of food or rest caused them to quickly disappear with no apparent after effects. So in the morning, when she was no better, I was summoned and found a restless, anxious little girl with a slight temperature and still feeling very tired with slight flush or cheeks. Aconite 1M was prescribed hourly for three doses and to be followed by sac. lac. Word was left to call, if worse, and that she would be checked in the morning.

The next morning the patient was no better and had a slight headache, dull and bilateral in character, with no apparent extension. The patient was rechecked because headaches as a complaint in children are always important. Additional questioning brought out that she had been wading in a cold water stream a few days before and that her previous attacks of weakness had always been shortly after exposure to cold or dampness and never on warm of hot days. Belladonna 1M, q.3h., was resorted to with sac. lac. to follow.

Improvement lasted a few days when restlessness again became a prominent symptom, but now there was marked palpitation of the heart with both forceful and fast beats, worse on exertion and excitement. A soft, blowing systolic murmur was heard at the apex and transmitted to the left. There were no joint pains now or throughout the whole course of this case. Endocarditis was suspected. The P M I was almost to the anterior axillary line and dropped to the 6th interspace, indicating marked cardiac enlargement and involvement of the muscle itself could not be disputed. Family history both sides was rheumatic.

Nancy was young, and chances were this could either be fatal or she could recover only to get another attack. What was I to tell her mother who was now two months pregnant? Thinking fast and trying to show no alarm, I told her mother, she was quite sick, but that I believed continued bed-rest, no company and only liquid diet, together with her prayers and some medicine would help our little patient.

Now I was in a fix. Had I trusted Homoeopathy too far? Was my understanding of its principles too limited? Would it fail me now? Realizing emotion has not too much place in prescribing, efforts were made to “think without confusion clearly”. This is not always easily done.

The old school would push sodium salicylate to the limit, flushing the bowels with laxatives, and quieting the nerves with sedatives. But Dixon and other have said that was not necessary and, in fact, harmful. Now what course to pursue?.

Well, I decided to try more Homoeopathy and repertorizing brought out Arsenicum album and it was given in 1M, 3 doses q 4 hrs., followed with sac. lac. Observation next A.M. showed some improvement and more comfortable night. At least our hopes went up and lasted a few days, when restlessness returned, palpitation and weakness began to appear and my patient’s mother asked me, “Doctor, do you think Nancy will get well? I know she is very sick. Dose she have rheumatic heart disease?” You see, she had suspected and read. You can’t put questions like this aside. So we faced the facts as gently as we could, trying to leave Mrs. O with a few rays of hope.

Now with the appearance of new symptoms of anxiety and fear of night and darkness, Stramonium 200., 4 doses, followed by sac.lac. relieved for three days.

With development of a more severe, loud machinery-like double murmur and violent heart action, it was evident that the endocardium had definitely become involved. Realizing the extreme seriousness of the condition, I suggested consultation and the pediatrician substantiated the diagnosis of rheumatic endocarditis with extremely grave prognosis, in fact, he did not expect the patient to recover. He suggested sodium salicylate, phenobarbital, and magnesium sulphate.

This was done but still the temperature ran a course between 99.8 and 101.4 with a daily rise from noon to 8 P.M., its peak. The patient’s pinched, drawn facial expression indicated that she was more critical than her temperature indicated. Drenching sweats occurred about this time. After a few days of the suggested medication, with improvement, the patient was desensitized to the above mentioned medication with the idea of removing any drug aggravation from the picture.

Shortly following this, vitamin E became very much publicized and an account appeared in papers of “Rheumatic Heart Child Going to Canada for Vitamin E Treatment. So vitamin E was given in large dose for two weeks with no evidence of improvement. A sudden change for the worse, and Brucellosis, Streptococcus, and T.B. intradermal tests (Mackenzie technique) showed Brucellosis very positive and strong, with Streptococcus and T.B. indicating some action. After skin tests there was some improvement which lasted for a few days and then the patient began to grow worse until the following weeks sudden attacks of unconsciousness, extreme weakness and cyanosis developed.

“It looks like the end,” the crying mother phoned the office nurse. No being immediately available this emergency call was referred to the pediatrician who promptly told the mother after seeing the patient that she would not get well.

Arriving shortly afterwards, I found the patient with cold sweat on forehead,in shock, and apparently soon to die. Veratrum album 200. was placed under the tongue and in a few minutes Nancy opened her eyes, knew her mother, the shock condition slowly improved, but this was only temporary.

Aureomycin was just announced and investigation showed that it was particularly valuable in combating. Brucellosis to which Nancy had showed marked sensitivity. The crude drug was ordered but before given to the patient, a small amount of it was removed from one of the capsules and was potentized, first to 500 and later to 1M. Two capsules of thy crude Aureomycin was given q4 hrs. for 6 doses, then 2 capsules q 6 hrs. for 2 doses, when nausea and vomiting developed and aureomycin was temporarily discontinued. The patient was closely observed, had a crisis that night and by morning better. The potentized aureomycin was held in readiness as a desensitizing agent, should it be needed.

The patient’s condition continued to be improved. In one week the remaining 16 capsules of the “gold dust” were given, one capsule q6 hrs. for 4 days. Slight nausea developed after the last capsule and it was decided to stop Aureomycin.

After one week, the palpitation of the heart and the harsh machinery like murmur, together with the cardiac enlargement showed marked improvement. The patient was now carried along for another week on sac. lac.

Realizing that perhaps I had suppressed these acute symptoms, I gave the patient Aureomycin 1M one dose intracutaneously. This indicated sensitivity and I feel it has done much to neutralize any suppression from the new drug.

Steady improvement continued for four weeks and the patient became greatly improved and all symptoms disappeared. Fluoroscopic and X-ray examination of the heart revealed no heart enlargement: a complete blood count showed only mild evidence of secondary anemia and a slight relative leucocytosis. Sedimentation was normal and the EKG showed no evidence of prolonged P-E interval, slurred QRS complex, nor any inverting of the T wave. The patient now leads a normal, healthy life for a child of her age.

In conclusion, I want to say that I regret that my limited knowledge of Homoeopathy did not permit me to carry this case through in strictly homoeopathic manner and I hope that any suppression of these acute symptoms has been neutralized by desensitization. However, I am still endeavoring to find Nancy’s constitutional remedy and I believe it will greatly aid her in the future.

What would you have done under the same circumstances had you been, like me, an allopath, trying to work out the principles of Homoeopathy as best you knew, all things being considered?.

Leave a Comment