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Management of leukaemia and allied haematological disorders in homœopathy
Management of leukaemia and allied haematologial disorders in hom eopathy DR R. S. PAREEK Agra
Summary A brief look is taken at the history, classification, pathology and present-day clinical presentation of the group of diseases referred to as 'leukaemia and allied haematological disorders'. Their management is discussed and illustrated with case histories. Following in the footsteps of the Master, we have many opportunities to procure palliation and cure. It is suggested that Hahnemann's theory of miasm is perfectly rational in the light of modern medicine.
Hahnemann's theory of miasms and theory of chronic diseases are the study of a life-time and should never be neglected in present-day medical work. Rather than talk about the principles of chronic disease and of miasms, I prefer to take up a particular group of disease conditions and approach it in the light of Hahnemann's genial philosophy. The theme I have chosen for today therefore is leukaemia and other malignant haematological disorders. These have been known for quite some time and are recognized as diseases of modern times. The one basic question being asked again and again by both laymen and medical practitioners is: 'What has hom0eopathy to offer in conditions like leukaemia?. It is not easy to give a simple answer to this, but perhaps an answer will gradually emerge in the course of this paper.
History of leukaemia Cases of splenic enlargement accompanied by purpura and swelling of lymph glands have been described in the earliest medical records. Ayurvedic medicine has records going back over 2,000 years. The history of medicine on the other hand does not tell us much until the middle of the 19th century, which is regarded as the time when present-day leukaemia was first recognized. A paper entitled 'Observation of Abdominal Tumours and Intumescence Illustrated by Cases of Diseases of the Spleen' by Richard Bright of Guy's Hospital, Physician Extraordinary to the Queen, makes clear the position of advanced medical opinion on the subject in 1836. It is interesting to note that by this time clinicians were close to the idea of the disorder of'sanguification' involving the spleen; pathologists and microscopists had been surprisingly slow to exploit and extend the microscopic study of blood and recognition of white corpuscles initiated by William Hewson in 1774. Definite recognition of leukaemia came with the marriage of clinical and microBased on a paper presented at the 35th LMHI Congress in Brighton in 1982.
96
The British Homoeopathic Journal
scopic evidence which was brought about independently in several centres between 1839 and 1845. The introduction of differential staining methods developed and expanded by Paul Ehrlich from 1877 onwards greatly facilitated advancement of knowledge relating to leukaemia. Cases of leukaemia, with clinical, post-mortem and microscopic findings, were later independently published in Paris, Edinburgh and Berlin. It was Virchow who in his description of further similar cases published in November 1845 identified the abnormal corpuscles in the blood as WBC and in 1847 proposed the name leukaemia for the disease.
Classification Various forms of leukaemia are distinguished according to the anticipated acute or chronic course of the disease, and the predominant type of cell involved. A detailed clinical classification would go beyond the limits of this short paper.
Pathology The basic pathological changes in leukaemia are related to primary proliferation of leukopoietic tissue and to secondary changes consequent upon disturbed functions of involved orgasns.
Clinical manifestations Clinical manifestations are varied, but some of the important and common manifestations are principally due to: --hypermetabolism associated with rapid growth and destruction of leukaemic tissue. - - b o n e marrow dysfunction. --abnormalities in organs involved in leukaemic proliferation. The increase in metabolism is manifested by fever, weight loss and fatigue. Bleeding and easy bruising are associated with thrombocytopenia. Deficiency in normal granulocytes is associated with extensive infections. Leukaemic infiltration may cause enlargement of liver, kidneys and testes.
The homQeopathic view The classical clinical and laboratory evidence in a case presenting for the first time as leukaemia is only of secondary interest in homo~opathic medicine. We must grasp the diseasse symptomatically before considering pathological evidence.
The miasmatic basis of leukaemia It is true that Hahnemann never made or gave a classification of any particular disease category such as leukaemia. He had no interest in doing so. As a thinker, he was far ahead of his time, and his work on chronic diseases, with special reference to miasms, includes every aspect of disease, not only past and present, but also those to come in future. The study of miasms has been a very rational and interesting study, but confusion has arisen from time to time. We should be very clear concerning the basic idea that Volume 75, Number 2, April 1986
97
no specific pathological condition results from a particular miasm. All three miasms can lead to any pathological condition, and leukaemia may therefore arise from any miasm or combination of miasms. The age at which the disease occurs is a measure of the number of miasms involved. Let us consider two patients with leukaemia. Patient A develops leukaemia at the age of 70, after a lifetime in good health. In this case it is probable that only the psoric miasm is involved. Patient B' develops leukaemia in childhood, and there is a likelihood of more than one miasm being dominant. This is easily determined by taking the full history. It is of interest to consider the views of von Grauvogl in this respect: 'The glandular enlargement and accompanying cachexia described by Virchow were familiar to older physicians under the name of sycosis.'
Von Grauvogl admits an infection of the system by gonorrhoeal poison and its accompanying condyloma as only one of the exciting causes and believes the essential condition to be one in which the blood contains too much water. The patient feels worse from cold, damp weather and from rain, and complaints are aggravated by bathing, drinking too much fluid, etc. 1 have personally observed these again and again in cases of leukaemia, suggesting dominance of the sycotic miasm.
Management Before we enter into the world of management it must be clearly understood that the basic principle is to manage not merely the leukaemia but the patient as an individual with leukaemia. It is not enough for us to know that it is a case of leukaemia or even a case of acute lymphocytic leukaemia. What we need to know is how this individual person differs from every other person presenting with this disease. This is our basic philosophy, and at no time can we afford to neglect it. It is the first important hurdle for us to cross. There can be no compromise at this basic primary stage, and we must proceed with an open, unprejudiced mind. Despite the advances in radiotherapy and selective chemotherapy, leukaemia still remains an ultimately fatal disease. Palliation may be achieved, but basically the course is set. Clinically, patients may be divided into three categories:
Patients presenting with features suggestive of leukaemic disorder but no pathological evidence of the disease. This is the field where we can be most effective. Such patients as a rule show derangement more marked in the mental sphere. Green (1949) reported studies on twenty males and thirty two females with leukaemia and concluded that the majority of patients suffered from various types of personal loss or separation from a key object or goal, with resulting sadness, depression, hopelessness, weakness and anorexia persisting for months prior to onset of the clinical syndrome. Here we have to individualize the patient, considering both the mental and the physical sphere. We have to determine the dominant miasm and go directly for the appropriate similimum.
Patients presenting with a definite leukaemic pattern supported by pathological 98
The British Homoeopathic Journal
evidence. Generally speaking, these patients do not come for homceopathic outpatient or inpatient treatment but prefer to go for the more popular chemotherapy and radiation. Yet appropriate homceopathic treatment has time and again relieved suffering at this stage. Established cases, where the patient has had adequate radiation and chemotherapy. These are cases one often sees on homceopathic wards when the last ray of hope has gone. Homoeopathy still has something to offer at this stage, and palliation in these terminal cases presents a real challenge to the homceopathic physician. These patients will as a rule show a good temporary response to the acute remedy which has to be changed constantly to match the ever changing totality. With patients who have already had adequate steroids and chemotherapy, it is a great problem to exhibit deep-acting chronic remedies. Time and again these evoke a reaction in the body from which it is difficult to arouse the patient. In my experience it is best to see these terminal cases of malignant haematological disorder daily, changing the acute remedy constantly and timing the dose according to the ever changing totality and severity. Finally there is the dying patient. Our role as homceopathic physicians still consists in minimizing suffering at the time of death. As the time of death approaches, the role of homeeopathy changes from the process of cure to the goal of offering the patient a maximum degree of awareness with a minimum amount of suffering.
Important homceopathic remedies The main remedies recommended by yon Grauvogl are
Nat. sulph, and Thuja
Lilienthal in a study of leukaemia recommends consideration of
Nat. tour.
Richard Hughes in his Principles and Practice of Homceopathy sees a promising remedy in
Picric ac.
W. Boericke in his Pocket Manual refers to
Arsen., Picric ac. and Thuja occ.
Kent's Repertory (p. 1370) lists the following as first and second grade remedies under 'leukaemia'
Julian in his Materia medica Homoeopathic Remedies refers to
of
Calc., Calc. phos., China, Nat. ars,, Nat. mur., Nat. phos., Nat. sulph., Picric ac.
New X-ray and Sulphanilamidum
These are some of the important remedies recommended by the older generation of homeeopaths. They do of course in no way limit the number of remedies to be used, with the similimum remaining the final goal.
Volume75, Number2, April 1986
99
Clinical cases Mr J., age 38, first sought medical advice in March 1978 on account of enlarged lymph glands in the neck. Examination revealed gross lymphadenopathy in all palpable sites, the glandular masses measuring up to 7 cm in diameter. The spleen extended to 10 cm below the umbilicus. Sternal marrow aspiration and lymph gland biopsy confirmed the diagnosis of chronic lymphocytic leukaemia. Irrespective of the clinical diagnosis, I preferred to consider the symptomatic picture. Mr J. was asking for Bryonia alba in every respect, hie was always wanting to lie down. Feeling a little better lying on the enlarged spleen when sleeping. A dry spasmodic cough, hard, dry stools and dryness of lips added further weight. Bryonia 30c was prescribed t.d.s., along with Ceanothus americanus 5 drops b.d, The patient responded well, with marked reduction in the size of palpable lymph glands and spleen and a general feeling of well-being. I was aware at the time that Bryonia on its own would not cover the case and was on the look-out for a deep-acting chronic remedy. On repertorization, Phosphorus and Calcarea shared equal honours. Phosphorus was decided on, as the patient had a tall cylindrical appearance and his mother reported that he used to be afraid during thunderstorms. A single dose of Phosphorus 1M was prescribed. It was followed with several doses of placebo and other acute remedies. The patient was feeling better all the time. Complete investigation done exactly six months later showed spectacular improvement: hgb 12.2 g.m1-1 platelet count 350,000 per mm 3 total WBC 4,000 per mm 3 spleen not palpable Full remission was maintained for almost two years, then recurrent lymphadenopathy, hepato- and splenomegaly developed in April 1980. This time the patient and his family preferred to go for chemotherapy which was given for about two months, with the patient's condition getting worse. It is important to note that the patient never felt well mentally. He was brought to me again, but in spite of repeated efforts did not respond and died two months later. Comment. One basic difference observed time and again between well selected homoeopathic remedies and chemotherapy is that with hom~eopathic remedies patients are all the time feeling better mentally. They feel happy and cheerful, which is most important. A boy of sixteen coming from a middle-class Indian family was first seen in early July 1977. The chief presenting complaint was loss of appetite and a painful, hot, swollen stiff right knee joint. On examination a moderate splenomegaly and lymphadenopathy was found. Laboratory investigation revealed primitive ceils in the peripheral blood, 90% of lymphoblasts in the sternal marrow 1O0
TheBritishHom~eopathicJournal
B e l l a d o n n a 30c was prescribed b.d., as this was a typical B e l l a d o n n a case. Whole blood transfusion was given in support. Laboratory investigation on the twelfth day revealed normal bone marrow and pheripheral blood cytology. After a two-month remission, a severe relapse rapidly developed, with gross splenomegaly and lymphadenopathy in all palpable sites. The acute condition called immediately for R h u s tox., which was prescribed in the 30c, again b.d. The patient did not improve, getting a little more restless. R h u s tox, 200c was prescribed to ameliorate his condition. This helped to improve the acute situation. It was followed with other acute remedies, namely C o l c h i c u m , B r y o n i a and F e r r u m p h o s . Whilst the acute condition was to some extent relieved 1 was on the look-out for a chronic remedy. A strong family history of tuberculosis, the patient's habitus, emaciation and ever-changing symptoms found their similimum in T u b e r c u l i n u m which was prescribed in the 1M potency. The patient made a good recovery and was able to resume his day-to-day activities two months later. Laboratory investigations done in mid-October 1977 showed
hgb platelet count total W B C
11.4 g.100 ml -~ 80,000 per mm 3 8,000 per mm 3
The only abnormal physical sign was a just detectable splenomegaly. The patient was discharged and asked to come for follow-up every month and later every two months, Later we did not hear from him for eight months, as he felt in normal health. He again reported to the out-patient department with a severe relapse in early November 1979 and died three days later with severe bronchopneumonia and cerebral haemorrhage. C o m m e n t . We have a number of patients who are doing extremely well. I particularly wanted to present this case to show that we could not do much in this instance because the patient did not come for regular follow-up examination. The good response seen with numerous patients depended on regular follow-up. It is important to note that patients who have not had chemotherapy respond fairly well to the well selected remedy, BIBLIOGRAPHY HayhoeFGJ. Leukaemia Research and Clinical Practicepp. 1, 2 and 6. London:J. & A. Churchill. Nelson WE ed. Textbook ofPaediatrics 8th edn. Price. Textbook of Practice of Medicine. HughesR. Principlesand Practiceof Homceopathy (1878)3rdedn. pp. 6, 11-12.Calcutta:C. Ringer& Co. 1983. BoerickeW. Pocket ManualofMateria medica (1927),withrepertoryaddedbyBoerickeOE. NewDelhi:B. Jain 1984. KentJT. Repertory of the Homceopathic Materia medica p. 1370.New Delhi: WorldHomceopathicLinks 1983. Julian OA, Materia medica of New Homoeopathic Remedies tr. V. Munday, p. 601. Beaconsfield Bucks,: Beaconsfield 1979.
Volume 75, Number2, April1986
101
Summary A brief look is taken at the history, classification, pathology and present-day clinical presentation of the group of diseases referred to as 'leukaemia and allied haematological disorders'. Their management is discussed and illustrated with case histories. Following in the footsteps of the Master, we have many opportunities to procure palliation and cure. It is suggested that Hahnemann's theory of miasm is perfectly rational in the light of modern medicine.
Hahnemann's theory of miasms and theory of chronic diseases are the study of a life-time and should never be neglected in present-day medical work. Rather than talk about the principles of chronic disease and of miasms, I prefer to take up a particular group of disease conditions and approach it in the light of Hahnemann's genial philosophy. The theme I have chosen for today therefore is leukaemia and other malignant haematological disorders. These have been known for quite some time and are recognized as diseases of modern times. The one basic question being asked again and again by both laymen and medical practitioners is: 'What has hom0eopathy to offer in conditions like leukaemia?. It is not easy to give a simple answer to this, but perhaps an answer will gradually emerge in the course of this paper.
History of leukaemia Cases of splenic enlargement accompanied by purpura and swelling of lymph glands have been described in the earliest medical records. Ayurvedic medicine has records going back over 2,000 years. The history of medicine on the other hand does not tell us much until the middle of the 19th century, which is regarded as the time when present-day leukaemia was first recognized. A paper entitled 'Observation of Abdominal Tumours and Intumescence Illustrated by Cases of Diseases of the Spleen' by Richard Bright of Guy's Hospital, Physician Extraordinary to the Queen, makes clear the position of advanced medical opinion on the subject in 1836. It is interesting to note that by this time clinicians were close to the idea of the disorder of'sanguification' involving the spleen; pathologists and microscopists had been surprisingly slow to exploit and extend the microscopic study of blood and recognition of white corpuscles initiated by William Hewson in 1774. Definite recognition of leukaemia came with the marriage of clinical and microBased on a paper presented at the 35th LMHI Congress in Brighton in 1982.
96
The British Homoeopathic Journal
scopic evidence which was brought about independently in several centres between 1839 and 1845. The introduction of differential staining methods developed and expanded by Paul Ehrlich from 1877 onwards greatly facilitated advancement of knowledge relating to leukaemia. Cases of leukaemia, with clinical, post-mortem and microscopic findings, were later independently published in Paris, Edinburgh and Berlin. It was Virchow who in his description of further similar cases published in November 1845 identified the abnormal corpuscles in the blood as WBC and in 1847 proposed the name leukaemia for the disease.
Classification Various forms of leukaemia are distinguished according to the anticipated acute or chronic course of the disease, and the predominant type of cell involved. A detailed clinical classification would go beyond the limits of this short paper.
Pathology The basic pathological changes in leukaemia are related to primary proliferation of leukopoietic tissue and to secondary changes consequent upon disturbed functions of involved orgasns.
Clinical manifestations Clinical manifestations are varied, but some of the important and common manifestations are principally due to: --hypermetabolism associated with rapid growth and destruction of leukaemic tissue. - - b o n e marrow dysfunction. --abnormalities in organs involved in leukaemic proliferation. The increase in metabolism is manifested by fever, weight loss and fatigue. Bleeding and easy bruising are associated with thrombocytopenia. Deficiency in normal granulocytes is associated with extensive infections. Leukaemic infiltration may cause enlargement of liver, kidneys and testes.
The homQeopathic view The classical clinical and laboratory evidence in a case presenting for the first time as leukaemia is only of secondary interest in homo~opathic medicine. We must grasp the diseasse symptomatically before considering pathological evidence.
The miasmatic basis of leukaemia It is true that Hahnemann never made or gave a classification of any particular disease category such as leukaemia. He had no interest in doing so. As a thinker, he was far ahead of his time, and his work on chronic diseases, with special reference to miasms, includes every aspect of disease, not only past and present, but also those to come in future. The study of miasms has been a very rational and interesting study, but confusion has arisen from time to time. We should be very clear concerning the basic idea that Volume 75, Number 2, April 1986
97
no specific pathological condition results from a particular miasm. All three miasms can lead to any pathological condition, and leukaemia may therefore arise from any miasm or combination of miasms. The age at which the disease occurs is a measure of the number of miasms involved. Let us consider two patients with leukaemia. Patient A develops leukaemia at the age of 70, after a lifetime in good health. In this case it is probable that only the psoric miasm is involved. Patient B' develops leukaemia in childhood, and there is a likelihood of more than one miasm being dominant. This is easily determined by taking the full history. It is of interest to consider the views of von Grauvogl in this respect: 'The glandular enlargement and accompanying cachexia described by Virchow were familiar to older physicians under the name of sycosis.'
Von Grauvogl admits an infection of the system by gonorrhoeal poison and its accompanying condyloma as only one of the exciting causes and believes the essential condition to be one in which the blood contains too much water. The patient feels worse from cold, damp weather and from rain, and complaints are aggravated by bathing, drinking too much fluid, etc. 1 have personally observed these again and again in cases of leukaemia, suggesting dominance of the sycotic miasm.
Management Before we enter into the world of management it must be clearly understood that the basic principle is to manage not merely the leukaemia but the patient as an individual with leukaemia. It is not enough for us to know that it is a case of leukaemia or even a case of acute lymphocytic leukaemia. What we need to know is how this individual person differs from every other person presenting with this disease. This is our basic philosophy, and at no time can we afford to neglect it. It is the first important hurdle for us to cross. There can be no compromise at this basic primary stage, and we must proceed with an open, unprejudiced mind. Despite the advances in radiotherapy and selective chemotherapy, leukaemia still remains an ultimately fatal disease. Palliation may be achieved, but basically the course is set. Clinically, patients may be divided into three categories:
Patients presenting with features suggestive of leukaemic disorder but no pathological evidence of the disease. This is the field where we can be most effective. Such patients as a rule show derangement more marked in the mental sphere. Green (1949) reported studies on twenty males and thirty two females with leukaemia and concluded that the majority of patients suffered from various types of personal loss or separation from a key object or goal, with resulting sadness, depression, hopelessness, weakness and anorexia persisting for months prior to onset of the clinical syndrome. Here we have to individualize the patient, considering both the mental and the physical sphere. We have to determine the dominant miasm and go directly for the appropriate similimum.
Patients presenting with a definite leukaemic pattern supported by pathological 98
The British Homoeopathic Journal
evidence. Generally speaking, these patients do not come for homceopathic outpatient or inpatient treatment but prefer to go for the more popular chemotherapy and radiation. Yet appropriate homceopathic treatment has time and again relieved suffering at this stage. Established cases, where the patient has had adequate radiation and chemotherapy. These are cases one often sees on homceopathic wards when the last ray of hope has gone. Homoeopathy still has something to offer at this stage, and palliation in these terminal cases presents a real challenge to the homceopathic physician. These patients will as a rule show a good temporary response to the acute remedy which has to be changed constantly to match the ever changing totality. With patients who have already had adequate steroids and chemotherapy, it is a great problem to exhibit deep-acting chronic remedies. Time and again these evoke a reaction in the body from which it is difficult to arouse the patient. In my experience it is best to see these terminal cases of malignant haematological disorder daily, changing the acute remedy constantly and timing the dose according to the ever changing totality and severity. Finally there is the dying patient. Our role as homceopathic physicians still consists in minimizing suffering at the time of death. As the time of death approaches, the role of homeeopathy changes from the process of cure to the goal of offering the patient a maximum degree of awareness with a minimum amount of suffering.
Important homceopathic remedies The main remedies recommended by yon Grauvogl are
Nat. sulph, and Thuja
Lilienthal in a study of leukaemia recommends consideration of
Nat. tour.
Richard Hughes in his Principles and Practice of Homceopathy sees a promising remedy in
Picric ac.
W. Boericke in his Pocket Manual refers to
Arsen., Picric ac. and Thuja occ.
Kent's Repertory (p. 1370) lists the following as first and second grade remedies under 'leukaemia'
Julian in his Materia medica Homoeopathic Remedies refers to
of
Calc., Calc. phos., China, Nat. ars,, Nat. mur., Nat. phos., Nat. sulph., Picric ac.
New X-ray and Sulphanilamidum
These are some of the important remedies recommended by the older generation of homeeopaths. They do of course in no way limit the number of remedies to be used, with the similimum remaining the final goal.
Volume75, Number2, April 1986
99
Clinical cases Mr J., age 38, first sought medical advice in March 1978 on account of enlarged lymph glands in the neck. Examination revealed gross lymphadenopathy in all palpable sites, the glandular masses measuring up to 7 cm in diameter. The spleen extended to 10 cm below the umbilicus. Sternal marrow aspiration and lymph gland biopsy confirmed the diagnosis of chronic lymphocytic leukaemia. Irrespective of the clinical diagnosis, I preferred to consider the symptomatic picture. Mr J. was asking for Bryonia alba in every respect, hie was always wanting to lie down. Feeling a little better lying on the enlarged spleen when sleeping. A dry spasmodic cough, hard, dry stools and dryness of lips added further weight. Bryonia 30c was prescribed t.d.s., along with Ceanothus americanus 5 drops b.d, The patient responded well, with marked reduction in the size of palpable lymph glands and spleen and a general feeling of well-being. I was aware at the time that Bryonia on its own would not cover the case and was on the look-out for a deep-acting chronic remedy. On repertorization, Phosphorus and Calcarea shared equal honours. Phosphorus was decided on, as the patient had a tall cylindrical appearance and his mother reported that he used to be afraid during thunderstorms. A single dose of Phosphorus 1M was prescribed. It was followed with several doses of placebo and other acute remedies. The patient was feeling better all the time. Complete investigation done exactly six months later showed spectacular improvement: hgb 12.2 g.m1-1 platelet count 350,000 per mm 3 total WBC 4,000 per mm 3 spleen not palpable Full remission was maintained for almost two years, then recurrent lymphadenopathy, hepato- and splenomegaly developed in April 1980. This time the patient and his family preferred to go for chemotherapy which was given for about two months, with the patient's condition getting worse. It is important to note that the patient never felt well mentally. He was brought to me again, but in spite of repeated efforts did not respond and died two months later. Comment. One basic difference observed time and again between well selected homoeopathic remedies and chemotherapy is that with hom~eopathic remedies patients are all the time feeling better mentally. They feel happy and cheerful, which is most important. A boy of sixteen coming from a middle-class Indian family was first seen in early July 1977. The chief presenting complaint was loss of appetite and a painful, hot, swollen stiff right knee joint. On examination a moderate splenomegaly and lymphadenopathy was found. Laboratory investigation revealed primitive ceils in the peripheral blood, 90% of lymphoblasts in the sternal marrow 1O0
TheBritishHom~eopathicJournal
B e l l a d o n n a 30c was prescribed b.d., as this was a typical B e l l a d o n n a case. Whole blood transfusion was given in support. Laboratory investigation on the twelfth day revealed normal bone marrow and pheripheral blood cytology. After a two-month remission, a severe relapse rapidly developed, with gross splenomegaly and lymphadenopathy in all palpable sites. The acute condition called immediately for R h u s tox., which was prescribed in the 30c, again b.d. The patient did not improve, getting a little more restless. R h u s tox, 200c was prescribed to ameliorate his condition. This helped to improve the acute situation. It was followed with other acute remedies, namely C o l c h i c u m , B r y o n i a and F e r r u m p h o s . Whilst the acute condition was to some extent relieved 1 was on the look-out for a chronic remedy. A strong family history of tuberculosis, the patient's habitus, emaciation and ever-changing symptoms found their similimum in T u b e r c u l i n u m which was prescribed in the 1M potency. The patient made a good recovery and was able to resume his day-to-day activities two months later. Laboratory investigations done in mid-October 1977 showed
hgb platelet count total W B C
11.4 g.100 ml -~ 80,000 per mm 3 8,000 per mm 3
The only abnormal physical sign was a just detectable splenomegaly. The patient was discharged and asked to come for follow-up every month and later every two months, Later we did not hear from him for eight months, as he felt in normal health. He again reported to the out-patient department with a severe relapse in early November 1979 and died three days later with severe bronchopneumonia and cerebral haemorrhage. C o m m e n t . We have a number of patients who are doing extremely well. I particularly wanted to present this case to show that we could not do much in this instance because the patient did not come for regular follow-up examination. The good response seen with numerous patients depended on regular follow-up. It is important to note that patients who have not had chemotherapy respond fairly well to the well selected remedy, BIBLIOGRAPHY HayhoeFGJ. Leukaemia Research and Clinical Practicepp. 1, 2 and 6. London:J. & A. Churchill. Nelson WE ed. Textbook ofPaediatrics 8th edn. Price. Textbook of Practice of Medicine. HughesR. Principlesand Practiceof Homceopathy (1878)3rdedn. pp. 6, 11-12.Calcutta:C. Ringer& Co. 1983. BoerickeW. Pocket ManualofMateria medica (1927),withrepertoryaddedbyBoerickeOE. NewDelhi:B. Jain 1984. KentJT. Repertory of the Homceopathic Materia medica p. 1370.New Delhi: WorldHomceopathicLinks 1983. Julian OA, Materia medica of New Homoeopathic Remedies tr. V. Munday, p. 601. Beaconsfield Bucks,: Beaconsfield 1979.
Volume 75, Number2, April1986
101