Acute respiratory disease in childhood

THE

OF HOM(EOFATHY

FACULTY

R I C H A R D H U G H E S MEMORIAL L E C T U R E , 1961 ACUTE RESPIRATORY DISEASE IN CHILDHOOD

B y H. W. BOYD, M.B., CH.B., F.R.F.P.S., D.C.H., F.F.HoM. MR. I~ LADIES A:NDGENTLEMEN, I feel greatly honoured to have been asked to give this Richard Hughes Memorial Lecture. The life and work of Richard Hughes has been very fully discussed by several of m y colleagues in the last few years with a much wider knowledge than I could bring to the subject, and I shall not attempt to repeat these observations. Hughes was a student of Materia Medica, and I hope that in this paper I m a y be able to describe the application of some of the well known remedies to the treatment of disease. I propose in this paper to review a series of cases Of acute bronchitis and bronchopneumonia treated in the Glasgow Homceopathic Children's Hospital during the past three years, and then to describe some of the hom~eopathic remedies used in the treatment of these conditions, with illustrations of patients actually treated. Firstly, let me say t h a t the following series are in no way true comparisons because all cases received homceopathic remedies, and because m a n y had received some form of chemotherapy prior to admission. ANALYSIS OF CASES There were 32 cases of bronchopneumonia which I have divided into two groups, the first containing 22 cases treated with homceopathic remedies alone, and the second 10 cases treated with additional antibiotics. I n Group I at least 8 had received an antibiotic before admission.

Group I

Group I I

Severity:

Severe Moderate Mild

9 12 1

Severe Moderate

6 4

Age:

1 year 1-5 years 13 years

11 l0 1

~ 1 year 1-5 years II years

6 3 1

Clearance of clinical signs:

5=12 days Average 6 days 3 relapses One death in a b a b y of 2/52 just admitted

22

4-21 days average 8-12 days 2 recurrences Penicillin only 6 Chloromycetin only 1 ChloromycetinPenicillin 2 Chloromycetin, Penicillin & Terramycin 1

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I n addition 31 cases of acute bronchitis were treated in the following age groups: Age: < 1 year 22 two cases received Penicillin 1-2 years 5 in addition to homoeopathic 2-3 years 3 remedies. 6 years 1 These figures are quoted merely for interest and not in an attempt to prove or disprove the advantages of homceopathie treatment. The length of time during which clinical signs and symptoms remained was so variable that accuracy in this matter is difficult to record. A Table giving a summary of the main clinical features and treatment of the 22 cases of bronchopneumonia treated with homoeopathic remedies alone is appended at the end of this Paper. DESCRIPTION OF I~EMEDIES AND CLINICAL CASES

I now propose to take a few remedies which were used in treatment and to describe their symptom picture in some detail, followed by illustrative cases. I n my own experience the full picture, as described for example by Borland, from whom I shall take much of m y description, is not commonly seen at the present time. This may be due to the fact that most pneumonias are patchy bronchopneumonias, and not the classical lobar variety of the past, and also that many of the symptoms are masked by chemotherapy prior to admission. Bronchopneumonia. I n the treatment of bronchopneumonia a large number of remedies were used, sometimes several in the one patient, but I have selected a few in which the response to the one remedy was clearly marked, and these remedies I shall describe in more detail. I n the treatment of bronchitis the remedies most commonly used were Pulsatilla, Antimonium tartaricum, Carbo vegetabilis, Calcium carbonicum, and Chamomilla. Let me describe the picture which suggests the use of Ant. tart. Ant. tart. The patient is usually pale, pinched looking with bluish discoloration of the skin and cold sweat, the extremities tending to become bluish and legs cold. I n spite of this he is < stuffiness and heat, and does not want to be wrapped up. The lips are livid or pale if he is collapsed, and are dry, as also is the tongue, but without thirst. The tongue is often coated thick white. There is oppression of the chest, and dislike of any weight. Excessive mucus can be heard rattling up and down in the bronchial tree, but little is expelled and vomiting may occur in an effort to cough up sputum. There is a loathing of food, especially milk which produces nausea. The patient wants to be left alone and does not want to speak or be spoken to. Jacqueline aged 1 year 10 months, was admitted with a history of harsh cough, irritability and vomiting. She had a previous history of two attacks of bronchitis and of dysentery. On admission she had a harsh cough and widespread rs and crepitations throughout both lungs. She was lethargic with sunken eyes and refused to eat. Ant. tart. 30 was given two hourly for three days, then four hourly for a further day, and finally three dry doses of 1M as she still had a degree of spasm. She made a good recovery. Moira aged 7 months, was admitted with a history of cough, wheezing, sweating and fever for six days, She had coarse crepitations at both bases and rhonchi all over both lungs. Ant. tart. 30 was given four hourly and she improved and the fever settled, but on stopping the remedy there was a prompt rise in temperature. Ant. tart. 200 was then given and the condition cleared up very well in a further three days. Richard aged 6 years, was admitted for removal of tonsils and adenoids. Two days after operation he developed a high fever with widespread rs

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throughout both lungs. His tongue was coated white, and he was without thirst. Ant. tart. 30 was given two hourly and then four hourly, and he made a good recovery. Phos. 30/3 completing the cure.

Pulsatilla. I n a small child one gets the indications for this remedy mostly from appearance, mental reaction and the character of the sputum or nasal discharge. These children are often fair-haired with blue eyes, and a mild gentle disposition, tending to weep, and wanting someone about and some attention. They are usually warm and want air, and in spite of fever and often a white sticky tongue and dry mouth, they are not usually thirsty. A tip that I once received from an older physician is to remember that a child m a y ask for drinks, and then push them away. They are not really thirsty but want attention. The discharge from the nose or sputum is usually yellow or green, sticky and often bland. The cough tends to be loose in the day and hard at night, and the patient is generally worse in the evening. A characteristic attitude of the Pulsatilla child is lying with the hands stretched above the head. Francis aged 4 months. This baby was admitted with a history of illness of three weeks' duration developing into bronchitis which was treated with penicillin, but he was getting worse and was vomiting with the cough. He was fevered and flushed with a hard spasmodic cough, worse after feeds and at night, with wheezing respiration, sticky eyes and thick green nasal discharge. He had widespread rs and rhonchi in both lungs, Pulsatilla 30 was given two hourly and then four hourly for four days and he made a good recovery. James aged four months. This b a b y took ill with fever, cough, green stools and wheezing respirations. On admission he was vomiting with the cough and had scattered rhonchi in the chest. Carbo Veg. 1M was given, but it only helped slightly. The stools were green and undigested and the cough harsh. He was drowsy and not thirsty in spite of the fever. Pulsatilla 30 was given in water four hourly, and within four days the chest was clear, the stools normal and the cough away. Carbo vegetabilis. This type of case is very like the Ant. tart. patient with blue colour, chilliness and coldness and sweat of the extremities. The lips are swollen and purplish and the tongue dry with a yellow brown dirty coating. There is often a bad taste, and usually thirst for sips of cold water, unlike the Ant. tart. case which is without thirst. The pneumonia tends to be p a t c h y consolidation with accompanying bronchitis. Cough is often spasmodic with redness of the face, and the sputum is difficult to raise, the patient being exhausted after bringing it up. There is often a sense of oppression or load on the chest, and he wants to be propped up. Distension of the abdomen and flatulence is a feature of these cases and the patient m a y sleep into an aggravation like a Lachesis case. This description corresponds to a serious, advanced pneumonia, b u t Carbo veg. is still very valuable in less drastic cases, with some of these symptoms. Catherine aged 5 months, was admitted with a history of illness for three days, with loose cough and wheeze, worse at night, fever, pallor, sweating and cyanosis. She had had penicillin "V " for three days, but was still febrile. On admission she was crying furiously, red in the face, sweating and with a short cough. She resented being handled. Rs and crepitations were extensive at b o t h lung bases. Chamomilla 1M/3 was given t h a t night. The following day she h a d rapid wheezing respirations with a short cough, dirty irritating nasal discharge, sweating, and green stools with a good deal of wind. Carbo reg. 30 was given two hourly, and then four hourly, and she made a good recovery. A dose of Drosera 30 cleared up some residual cough. Dennis aged 5 months, had a history of short spasmodic cough with vomiting

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and wheezing for four days, and sweating of the head. On examination he had dullness in the left axillary region and crepitations at the right base. I n view of the type of cough, Carbo veg. 1M was given four hourly and he responded very well to this remedy. Two further bouts of cough and wheeze cleared up quickly with Carbo veg. 1M, and Tub. bov. and Calc carb. helped his general condition.

Bryonia. These cases usually have a fairly gradual onset, the patient being unwell for several days and then starting to shiver. He is often congested and h e a v y looking with dusky colour and hot damp sweat, mentally dull and hating to be disturbed, irritable and upset by noise or talking. There m a y be muttering delirium, and talk of wanting to go home, and anxiety. Giddiness on sitting up, and frontal headache < talking, sitting up or moving is characteristic. The lips are dry, cracked and duskyin colour, with dry mouth and tongue heavily coated with white. Thirst for large cold drinks is a prominent symptom, these making him sick. The characteristic pneumonia often involves the pleura, usually although not always on the right side, with sharp sticking pains > pressure or lying on the affected side and < moving. Coughing is painful a n d he will hold the side and sit up, taking short shallow breaths to limit movement. The voice m a y be hoarse and the cough is worse in a warm atmosphere. Joseph aged 9 months, was admitted with a history of a cold, then fever, cough and wheeze for four days. He had been given penicillin intramuscularly and then Achromycin Syrup for three days. On admission he had fever with flushed cheeks, grunting respirations, d a m p sweaty head, and short loose cough. He was thirsty for small amounts, and cross, resenting touch and interference. The tongue was white in the centre. The breath sounds were harsh over the left lung and there was possible impairment of percussion note at the right base. Bryonia 30 was given two hourly in water. The following d a y there were moist sounds at both bases, but general improvement. Bryonia was continued four hourly. The next day the cough was looser and expiratory wheeze and loose rs were present over both lungs. Ant. tart. 30 was now given two hourly and then four hourly. He made a steady recovery, and some residual moist sounds at the left base cleared up with Sulphur 30/3. Follow-up X - r a y was clear. Mary aged 13 years, was admitted with a history of fever and pain in the right side of the chest for 24 hours, with thirst and an irritating cough. She had been given Ferrum phos. b y her own doctor, and had seemed a bit better. On admission she was fevered, sweating with slight cough and brownish sputum. She had pain in the right lower chest > b y pressure and was thirsty for big cold drinks. Her tongue was white. There was slight impairment to percussion in the right lower axilla and a few crepitations at the right base. She felt a bit better, so Ferrum phos. 200 was continued two hourly, and then four hourly. However, the fever continued and definite dullness developed at the right base. She was anxious and had the appearance of a Phosphorus child with brown eyes and hair. Phos. 1M was given two hourly and then four hourly. The following day the sputum was bloodstained, but the pain was still bad and signs suggested effusion. Phosphorus was continued. Two days later a pleural rub was audible in the right axilla, and as she still had fever, Bryonia 1M was given four hourly. The following day her temperature was normal and she made a good recovery. On looking back over the case, one might wonder why Bryonia was not given earlier, but she never had the irritability or aversion to touch more commonly associated with this remedy. Natrum su!phuratum. This remedy is very useful in the bronchopneumonic cases seen today, and the illness often comes on during d a m p wet weather. The left lower lobe is predominantly affected. The patient is cyanotic and sometimes has a yellowish tinge to the skin, which is hot and sticky. He m a y be

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restless and if old enough m a y complain of heat in the legs from the knees down. Occipital headache is a feature and there is a general aggravation or exacerbation of fever or cough about 3-4 a.m. The cough is loose with a fair amount of greenish, even bile-stained sputum, and the tongue is greyish green, with a bitter taste in the mouth, but not much thirst. Although the cough m a y be loose there is acute stabbing pain and soreness of the sides of the chest wall by coughing. The patient must sit up and support his side. These patients are depressed, gloomy, and hate to be disturbed or questioned. They are irritable and sensitive to noise, heat and stuffiness. Ralph aged 1 year and 3 months, was admitted with a history of catarrh and cough for two weeks which had not responded to cough medicine. On admission he was fevered with sweating, grunting respirations, thick green nasal discharge and clinical signs of pneumonic consolidation at the left base. Natrum sulph. 30 was given two hourly, and then four hourly. He made an excellent recovery and the clinical signs were completely cleared up b y the fifth day. Follow-up X - r a y was clear. Helen aged 6 months, was admitted with a history of being ill for two days, flushed, fevered, coughing and vomiting with the cough, which seemed painful. She was irritable, resenting handling, and was sweating without much thirst. She had received penicillin for two days prior to admission, and on admission had no fever, but there was dullness at the left base with bronchial breathing. iVatrum sulph. 30/4 was given. T h a t evening the temperature rose sharply again, and the remedy was continued in water four hourly. Coarse crepitations developed at the left base and then she made a steady recovery. Follow up X - r a y was clear.

Lachesis. These pneumonias often occur in the late winter and early spring when the weather is becoming warmer. They are usually predominantly left-sided. The patient is toxic, fuddled, drunken in appearance with thick speech and difficulty in articulation, stumbling over sentences--the opposite to the commoner Lachesis loquacity. She is very sensitive to touch, noise, smell, and light, and m a y be delirious, suspicious and refuse to take medicine, because she thinks it m a y be poison. She is cyanotic with swollen looking lips, which are very sensitive to touch, and the tongue is dry, swollen and red. There is a suffocating feeling with a sensation of choking and a dislike of anything touching the neck. The cough is difficult with scanty sputum, sticky stringy saliva, and a rattle in the chest but sputum cannot be expelled. The patient hates to lie down or go to sleep, because of this sensation of choking, and the fact that she sleeps into an aggravation. There is violent surging headache with the cough, as if the blood were forced into the head. The head is hot but the feet and legs are often cold. Stabbing pains in the chest m a y occur, and these are < pressure, the chest wall being sensitive to touch. Janet aged 11 years. I do not propose to give the whole course of this patient's illness, which was long and difficult. She had a great m a n y remedies and also some antibiotics. She was admitted with fever, harsh painful cough, cyanosis and widespread rAles and crepitations in both lungs. She was very toxic in appearance and sulky and difficult to approach. She had periodic attacks of fever with a markedly spasmodic cough and asthmatic wheeze, usually with cyanosis. Ant. tart., Kali carb., Nat. sulph., and Carbo reg., all helped her a bit, but it was after she received Lachesis 30 in water for several days t h a t her recovery really began. Not only did it help her chest and cough, but her mental attitude changed. From being sullen, resentful and suspicious, she became h a p p y and co-operative, and helped in the ward. _Natrum tour. finally completed the cure.

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The Phosphorus pneumonia often starts with a sense of oppression or tightness in the chest, and then a dry cough and hoarseness or loss of voice. This m a y proceed to an irritating tormenting cough with rawness in the chest, and gradually a little sputum, streaked with blood and then rusty. The patient is flushed red, with hot moist skin, but feels chilly and the cough is made worse b y draughts. He is anxious and worried, desiring company and wishing his hand held. A characteristic attitude is sitting up with the head tilted back and the chin up. He m a y be tremulous with shaky hands and twitching facial muscles, t h e respiration embarrassed with nose flapping and chest heaving. The tongue is d r y and red or lightly coated with white, and there is usually thirst for large cold drinks, often juicy or sour. The right lower lobe is most often affected, and the patient likes to be on the right side. Symptoms are generally improved by sleep. Jack aged 2 years and six months, was admitted with a history of cough and vomiting for two days with fever. On admission he was flushed with bright red cheeks and lips, profuse sweating all over, and a white tongue. The cough was loose and he was quite thirsty. On examination he was found to have extensive dullness over the right lower lobe with diminished air entry and fine rs over most of the right lung and in the left axilla. Phosphorus 200 was given two hourly. The following day the dullness was less marked, and he looked better, so the r e m e d y was continued in spite of the further rise of temperature. He progressed v e r y well and in six days the signs were practically away except for slight residual dullness and for rs on the right side. One dose of Tub. Boy. 12c was given, and this completed the cure. Follow-up X - r a y was clear. I should like to finish b y describing one of the most striking cases of pneumonia I remember treating at home. Penelope aged 11 years, had been unwell for four days before I saw her, with loose cough, vomiting of yellow and green material, green diarrhoea, and fever. She was flushed with a white tongue and thirst for large cold drinks. She was anxious and wanted company. Her temperature was 104-2 ~ F. and there was dullness in the right posterior axillary line, but no adventitious sounds. Phos. 30 was given two hourly in water. Next day she felt better, she had slept well and h a d no vomiting or diarrhoea. Temperature was normal and pulse 80 and her tongue cleaner. There was no change in the physical signs. The remedy was continued four hourly. The following day there was a report of some epistaxis and one vomit and a few crepitations were audible in the right upper zone. The remedy was continued. The following d a y there was a slight fever and signs suggesting a right pleural effusion, but she felt better. Tub. Bov 12c/3 was prescribed. Thereafter she made steady progress, and b y the eighth day her chest was clinically clear. A tuberculin jelly test was negative. Six days later, 14 days from m y first visit, she was able to go for X-ray, and the report was rather surprising: "There is consolidation at the base of the right upper lobe probably tuberculous in nature." I n view of her good clinical condition, and the fact that there were no physical signs, I gave no further homoeopathic remedy, as I considered that the Tub. Bov. already given would continue to act. A month later a further X - r a y showed almost complete resolution in the right upper lobe, and in view of the rapid change the condition was considered to be a simple pneumonia. She has had no further chest trouble and is now 15 years of age. I f we disregard the 12 cases in which antibiotics were given, this series describes 21 cases of bronchopneumonia and 29 cases of acute bronchitis, in infants and young children, who all recovered with no treatment other than nursing, vitamins, and homceopathically prepared remedies of 30c potency or over. I t is difficult to believe t h a t these patients can all have recovered spontaneously,

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or as a result of psychological influence, and it seems reasonable to assume that. the homceopathic remedies did, in fact, help their recovery, some in fact responded to Homceopathy when they did not react to previous antibiotics. I believe that the additional use of antibiotics is sometimes necessary a n d justified in the seriously ill patient, or in a case where selection of the remedy is difficult, or response is not rapid to the homceopathic treatment. I think, however, that a cure with pure Homoeopathy is often more lasting and the risks o f monilial infection are eliminated. As can be seen from the foregoing description it is not easy for the homceopathic physician to produce clinical statistics or control studies, because each, ease is an individual one, and the remedy which helps one patient will nov necessarily help another with the same disease. The problem which faces us as homceopathic doctors is not whether the remedies work, but how we can select the correct remedy more accurately for the particular patient. Opinions m a y differ on the place of Hom~eopathy in medical treatment b u t if these remedies have a curative action, as those who use them are convinced that they have, then this is a matter of much greater importance to science in general, because this form of activity does not fit in with our present knowledge. I t is not enough to look at the method of preparation and say that it is impossible for the medicine to work, we must look at the effects and then search for an understanding of them. Research at present is confined to a few private indiv i d u a l s - w h a t is needed is a large scale study by skilled scientific workers with an open mind, not to prove the case for or against Homceopathy, but to search for an explanation for the activity of substances prepared b y the homceopathie method of serial dilution and succussion. SUMM-.ARY

A series of 63 cases of bronchopneumonia and acute bronchitis in children ia described, in which 22 cases of bronchopneumonia and 29 cases of acute bronchitis were treated with homoeopathic remedies alone. The results are discussed and the suggestion made that large scale research is required to s t u d y the activity of these preparations.

ACUTE

RESPIRATORY

CLINICAL No.

I Sex

1.

M

Severe

~

.

I

!M

IN

29

CHILDHOOD

SUMMARY OF CASES OF B R O N C H O P N E U M O N I A Type

Agv

DISEASE

Severe

i L

t

Clinical Features Spasmodic cough Sweat Dullness L. Axilla Creps. R. base

Thick nasal discharge Purulent conjunctivitis Patchy dullness mainly L. base Tubular breathing L. base R~les and rhonchi both lungs

~learanec o] Remedies Clinical signs 6 days Carbo veg. 30 Recurrence Carbo reg. 1M of cough

12 days

A n t . tart. 30 Zycopodium 30 ~ a t . sulph. 200 Calc. carb. 200 Sulphur 200 Syeotic co. 30 Pulsatilla 30

E

Moderate

Dullness L. base Coarse crepitations

6 days

Nat. sulph. 30

Moderate

Dullness L. base Coarse tales

7 days

Sulphur 30 A n t . tart. 30 Calc. carb. 30 Calm car& IOM

7 days

A n t . tart. 30 Zycopodium 30

14 days

Lycopodium 200 Fyrogen 200 A n t . tart. 30 Tub. bov. 12

Grunting respirations Green nasal discharge Dullness L. base Tubular breathing, creps. L. base

6 days

Nat. sulph. 30

Dullness R. base Crepitations R. base

6 days

Ferrum phos. 3O

Dyspncea and wheeze Dirty nasal discharge Green stools Crepitations and r~les in both lungs

6 days

ChamomiUa 1M Carbo reg. 30

Rhonchi both lungs Crepitations L. base

6 days

1Vatrum sulph. 30 Pulsatilla 1M

B

Recurrence of fever after two weeks I

H Severe i

ri

Rales and rhonchi both lungs Creps. R. lower lobe Recurrence of dullness R. lower lobe

i I

1t c F i

iN F [

i~5

Moderate

: Moderate

Severe i

iF

3

Mild

F

~

Moderate

R~les and rhonchi both lungs

6 days

A n t . tart. 30 Ant. tart. 1M

M

~

Moderate

Grunting respirations Short cough Riles both bases

10 days

Bryonia 30 A n t . tart. 30 Sulphur 30

13

Moderate

Cough with brown sputum Pain R. side Dullness with creps. R. lower lobe

12 days

Ferrum phos. 2OO Phosphorus 1M Bryonia 1M Lycopodium

f 10. - -

!

il.

i

12.

i F I

30 No.

13.

THE

Sex

Age

Type

F

~:

Severe

14.

15.

BRITISH

Moderate

1~

1~r

I Severe

16.

:r

Moderate

17.

2{

Severe

HO]YI(EOPATHIC

JOURNAL

Clinical Features

Widespread r~les and crepitations Collapse

Clearance of Remedies ! Clinical 8~gns Died Carbo reg. 10M Ant. tart. 30 Laurocerasus 30

Dyspncea Bloodstained sputum Dullness and crepitations both bases

6 days

Sulphur 200 Natrum sulph. 200

Gr tinting respirations Dullness and crepitations R. base ]~ccuITence

9 days

Bryonia ~0 Phosphorus 10M Phosphorus 30

Coarse crepitations both bases Slight recurrence

5 days

Carbo reg. 30 Carbo veg. 30

Cyanosis R~les and rhonchi both lungs especially 1%.

8 days

Ant. tart. 200 Zycopodium 1M Lycepodium 30 Lycopodium 2OO Lycopodium l 0M PulsatiUa 10M Morbillinum 30 Chamomilla 30 Ant. tart. 1M Aconitum 30 Ant. tart. 1M

Recurrence with measles

18.

19.

M

20.

M

21.

F

22.

M

3~

l~oderate

Widespread r~les and rhonchi both lungs Recurrence after I1 days

5 d~ys

~

Moderate

Dry cough Harsh breath sounds and r~les R. lung

6 days

Severe

Extensiv~ R. lower lobe consolidation

5 days

Phosphorus200 Tub. boy. 12

Severe

Widespread r~les and crepitations both lungs

6 days

Ant. tart. 80 Ant. tart. 1M

Moderate

Rs rhonehi and crepitations both lungs

7 days

ChamomiUa 30 Ant. tart. 30 Cale. carb. 30

2~

89

r

Phosphv'~s 30 Gale. phos. 30