Several Cases Of Pneumonia

SEVERAL CASES OF PNEUMONIA

Frederik Schroyens, MD, is a 1977 medical graduate of the State University of Ghent, Belgium, and a 1978 graduate of the one-year homeopathic training course at the Faculty for Homeopathy, London, England. Since 1981, Frederik has been the constitutive and continuing president of VSU, the largest and best-known school for homeopathic training in Belgium. He is also the constitutive president of the Masi Workshops in Belgium and Holland, has been homeopathic coordinator of the RADAR Project since 1986, and is a consultant for the Vithoulkas Expert System.

Introduction

In my country, we frequently have the opportunity to treat patients with pneumonia. Today, I will present seven pneumonia cases from my practice. Each of these cases will show you something different, either an instructive aspect of a commonly used remedy or the picture of an unusual remedy. I will emphasize the evaluation and assessment of each case, to show you different ways to approach a case. Once you have read and grasped the symptoms, then you must try to understand what is striking and characteristic about the case. This is how you can discover the true homeopathic symptoms and then translate them into rubrics, the language of the repertory.

Case Number 1

Female, Age 32

Initial Interview: November 21, 1989

She has pain in the left upper chest, near the shoulder. Yesterday, it extended into the shoulder.

A sudden onset, with a fever of 39øC (102.2øF).

The pain is much worse when she is lying on her left side (3); cannot breathe.

Her chest is painful when she coughs (2) and when she breathes in (2).

Frequent eructations.

She has pain in both ears, especially the right one; worse when she eructates and coughs.

She has pain in the chest from eructations (2) and laughing (2).

A kind of nausea occurs when she coughs.

When the pain becomes worse, it extends from the region of the left shoulder to the stomach.

The chest is aggravated as soon as she hes down, but especially when lying on the left side. She has been dizzy since yesterday evening (onset of fever).

She has a pain in her stomach from coughing, and she retches from the pain.

She is generally very pale, looks exhausted and sick.

For the past week, she has not felt "like usual." Has been tired with a sore throat. She weeps more easily.

Is not hungry at all, although she has a very empty feeling in the stomach.

She likes to be in the living room, to be with people, but quietly.

Analysis of Case Number 1

The choice is between Bryonia and Phosphorus. They both cover the general elements. At first glance, one might not prescribe Bryonia, because of its well-known keynote of amelioration from pressure (this patient is aggravated by lying on the painful side). It is good to know the general picture of a remedy and its keynotes, but it is also good to look for exceptions. Note that Bryonia is listed in the repertory, albeit in lesser degree, for chest pain aggravated by lying on the painful side. So, this is an exception for Bryonia.

In order to further differentiate between these two remedies, I did what is called a comparative extraction, using the RADAR computer program (from areHIBEL). This allowed for a more detailed search through the CHEST section of the repertory, comparing only Bryonia and Phosphorus. I often do this to develop clear-cut and very precise pictures of remedies. In this case, the comparative extraction made it very clear that Bryonia is much stronger for the right side of the chest, while Phosphorus is equally strong for the left side. This was enough for me to make the choice for Phosphorus as the prescription.

The same symptoms analyzed with the Vithoulkas Expert System (also from ARCHIBEL) show the following result:

The Vithoulkas Expert System (VES) analysis comes up stringly for one remedy, which is again Phosphorus. Thus, Phosphorus was prescribed with a considerable degree of confidence.

Plan: Phosphorus 200c, one close every two hours until a reaction occurs.

Follow-Up on Case Number 1

She took the remedy in the early afternoon. That night she could be down, but she still had a lot of pain in the chest. The fever was still present.

Day 1: The next morning she had some appetite and ate a little bit.

Plan: Stop regular intake of the remedy.

During that day, she felt the pain diminishing steadily. She coughed a lot, but it was less painful. By the evening, the fever was almost gone. She still felt very weak.

Plan: No remedy.

Day 2: Her weakness persisted. Her appetite returned. The pains and fever have almost disappeared. She is breathing more easily. She still complains about the pain in her ears.

Plan: No remedy.

Day 3: The pulmonary symptoms are now only in the background. She is still expectorating and coughing. The pain in the ears is worse; it can persist for several hours and then go away for a while.

Plan: No remedy.

Day 4: She is the same as before. Her ears are very painful.

Plan: Phosphorus 1M, one dose.

Day 5: All symptoms have disappeared.

Jacqueline Wilson: What did the ears look like on examination?

Schroyens: The exam was normal, no inflammation. So, when a remedy has produced improvement, we do not like to go away from it. I therefore gave a dose of Phosphorus 1M. The pain in the ears vanished within a few hours, and she made a complete recovery.

Audience: How many doses of the Phosphorus 200c did she take?

Schroyens: She started the remedy at I or 2 p.m. and then took it every two hours throughout the night. When I spoke with her the next morning, I felt that her ability to be down more easily and her slightly improved appetite were sufficient indications to tell her to stop the remedy, because the case was moving in a positive direction.

Case Number 2

Female, Age 34

Initial Interview: February 8, 1989

She has had pneumonia for the last ten days. She started with andbiotics (Cefadroxil and Duracef) but had no clear reaction, except that the fever disappeared. Another stronger andbiotic was started, but she reacted to it with repeated vomiting. Cefadroxil was then started again, at the maximum dose. Because there was still no reaction, hospitalization was recommended. She came to see me to try to avoid hospitalization.

She is very, very weak; walks in step by step, leaning on her husband's shoulder. She moves very slowly. She can barely speak; there is no power in her voice.

She still has a fever; 37.5 ?C (99.5øF) today.

Her ears feel closed by some pressure (for four days); she doesn't hear herself speaking.

SEVERAL CASES OF PNEUMONIA

She can barely breathe, speaks in whispers, avoids any respiration movements, pants slowly.

She has been sweating profusely at night. She had to change her nightgown three times last night.

Her skin is pale and shows some type of soft red-blue network, which is especially pronounced on the lower extremities and knees.

She is afraid to be alone. She believes she is going to die. She feels that at any moment she could suffocate and that she has to concentrate on how to breathe.

(She begins to cry silently.)

Her cough is worse at night. Regular paroxysms begin at about 4 p.m. and diminish at 4 a.m., after which she falls asleep.

She feels restless during the night and has confused dreams.

She has no hunger.

Her difficulty in breathing is aggravated by the coughing and by tobacco smoke. She is constipated.

When the fever was higher (40øC, or 104øF), she imagined that she heard thieves in the house.

She wants her husband to be with her and to talk to her.

Desires cold drinks, really cold, from the refrigerator.

During the pneumonia she had already received eight remedies, without effect:

- Arsenicum album

- Aconitum

- Belladonna

- China

- Bryonia

- Carbo vegetabilis

So, I began to reflect on Thuja. Do you know what Thuja is? Thuja occidentalis is the "tree of life." It is a very big, impressive tree. This is probably why it has such a name, because it was thought to demonstrate so clearly the idea of strength and the energy of growth. And, as you know, we homeopaths use Thuja to treat all kinds of growths --- warts, tumors, fibroids. What is equally interesting about Thuja is that it contains another aspect in its symptomatology that contradicts this idea of life and strength. This is the aspect of weakness, fragility, division, and death. It is a special fragility, a feebleness. Thuja makes a bridge between life and death, between strength and weakness, and between power and fragility. Both sides are encompassed in its materia medica.

The following is a list of some of Thuja's delusions that demonstrate this aspect:

You will not find very much information in our literature concerning Thuja and pneumonia. But this was a case where several of the more commonly used pnuemonia remedies had already been tried. The weakness of this patient was quite striking. It was as though I were sitting in front of a corpse. It was a situation where death was not far away. In addition to the extreme weakness, there was another symptom to support Thuja: worse from 4 p.m. to 4 a.m. (this is a repertory addition from Stauffer, in which Thuja is the only remedy listed). So, I decided to prescribe Thuja.

Plan: Thuja 200c, one dose every two hours until a change occurs.

Follow-Up on Case Number 2

She took the remedy in my office and called back the next day.

Day 1: She woke up the previous night and was perspiring very profusely (as she had done the previous nights). She started having a very foul and copious discharge from the nose that kept her awake for several hours. She fell asleep again toward the morning.

The physician, who knew she was seeing a homeopath, called her. She laughed, telling him "I am cured!" The fever had fallen completely, and she had her first breakfast in a long time, with a good appetite.

Her reaction was probably a bit optimistic; she was still very weak, with labored respiration.

Plan: Stop repetition of the remedy.

Day 2: Her appetite had returned and her respiration was easier, but she was still very weak.

Plan: No remedy.

Day 3: She was coughing more. She felt desperate again. Weakness. Some slight fever. Very painful in the fibs.

Plan: Thuja 1M.

Day 4: Her respiration was better, but the pain in the chest continued to upset her quite a lot.

Plan: Repeat Thuja 1M.

Day 5: The pain in the ribs had become the main problem; all other symptoms had decreased significantly. It was apparent that this pain was mostly in the right short ribs. In the repertory, I found the following:

- CHEST: Pain, sore, short ribs, right (Chelidonium, Lycopodium).

- CHEST: Pain, inflammation of lungs, after (Lycopodium is bold type).

Plan: Lycopodium 200c, one dose. (Remember that Lycopodium was strongly represented in the initial computer analysis.)

Day 6: Her chest pain had diminished; the respiratory problems continued to decrease.

Plan: No remedy. A complete recovery ensued.

Additional Remarks on Case Number 2

- Also consider the following two rubrics (both for Thuja):

- RESPIRATION: Difficult, sternum, from pressure on.

- RESPIRATION: Impeded, stitches in chest.

- The copious elimination from her nose on the first night was a very good sign.

- Borland mentions that Lycopodium is a remedy that typically comes in at the second stage of pneumonia.

Case Number 3

Male, Age 1

Initial Interview: February 10, 1979

The illness began two days ago with a green discharge from the nose and with some rattling in the chest, which was heard especially when crying. The next day, the green discharge reappeared, along with green pus from the eyes. In the evening, a high fever suddenly set in. The night was all right, but this morning the baby is really sick. His fever is now 39.1øC (102.4øF). His eyes are closed from the discharge, he has a lot of greenish discharge from the nose, and his breathing is very difficult.

His stool is green, papescent, and sticks to the skin (2).

His urine has a bad odor.

He is thirsty (2).

His appetite diminishes quickly.

He doesn't cough when he is quite, coughs a little when he is sleeping, and coughs more when he has been crying for a while (2).

Some swelling under the eyes.

The sudden appearance of the high fever in the evening is typical for many pneumonias-- a sudden onset, a high fever, and a general state of collapse. The baby had the marked difficulty with breathing that is usual for pneumonia. The right lung was more affected. The computer analysis suggests Phosphorus and Sulphur. In deciding between them, I took into account some "intangible" aspects. This was a beautiful little baby, surrounded by a loving family. The baby was quiet and relatively content as long as be was close to his parents, brother, and sister. There was a feeling that the child was surrounded by affection and clearly seemed to need and attract this attention. It was this aspect that led me to choose Phosphorus over Sulphur. Also, note that the stickiness of the stool suggests some concomitant liver involvement (due to an increased fat content in the stool), which is another point in favor of Phosphorus.

Plan: Phosphorus 2/50M, one dose every hour. (I was using the LM potencies more at that time.)

Follow-Up on Case Number 3

At 7:30 p.m. on the. day he took the remedy, he ate his normal amount of food.

Day 1, morning: he cried for three hours and coughed a lot, then slept 30 minutes, and again cried for a while. His urine and breath were very offensive. His fever was 38.2øC (100.8øF).

Plan: Continue remedy four times per day.

Day 1, evening: -The child was brought in to see me. His fever was 38.7øC (101.7øF). His skin texture was normal again. One eye was agglutinated. Auscultation: all symptoms in the chest had vanished.

Plan: Continue the remedy four times per day.

Day 2, evening: The fever had not been more than 37.5øC (99.5øF) all day. The child was playing again.

Plan: Discontinue the remedy. be made a full recovery.

Additional Remarks on Case Number 3

Phosphorus is often indicated for young children. This particular case is not especially typical of the Phosphorus pneumonia, so I would like to mention some of the key symptoms that occur more routinely:

- Dry air passages, with a burning feeling.

- Great thirst, especially for cold water.

- Yellow and diarrheic stools, sometimes blood-streaked (liver problems).

- Often the lower half of the right lung is involved (also pain in the left chest, aggravated by lying on the left side).

- Expectoration of mucus with blood streaks.

- Desires company; fears being alone.

Also consider the following rubrics:

- GENERALITIES: Mucous secretions increased, greenish (Phosphorus is italics).

RESPIRATION: Rattling (Phosphorus is bold type).

- NOSE: Discharge, crusts, green, masses (Phosphorus is italics).

Audience: Why did you continue to give the remedy when the child was improving?

Schroyens: Because at that time in my practice I was systematically using the LM potencies, and the rule in this approach is to continue administering the remedy, even after improvement has begun. As you probably know, this was described by Hahnemann in the later editions of the Organon.

Case Number 4

Male, Age 16 Months

Initial Interview: October 13, 1986

Bronchitis had set in on October 3. Two remedies were prescribed over the telephone. They were unsuccessful. The physician in charge told the parents that a pneumonia had set in and that andbiotics were absolutely necessary because the child's state had worsened considerably. Novabritine was given for one week, immediately reducing the fever but only slowly ameliorating the general symptoms. The day the andbiotics were stopped, the child grew worse within hours and his fever rose to 40øC (104øF) again.

He hasn't eaten much for several days; his thirst is moderate.

He is a very nice and lovely child. He caresses and holds his little puppet closely. He is also very nice to his brother.

He laughs when unimportant things happen and seems to be amused by what others do wrong.

Has laughed during his sleep for the past several nights.

He does not want his usual fruit compote; wants to eat what his parents eat (2).

Is afraid of noises, such as the vacuum cleaner; weeps.

Even though he laughs frequently when small things happen, he generally looks rather earnest, which is quite unusual for him.

What is initially striking in this case is the laughing. This symptom is not typical in a case of pneumonia, and it therefore qualifies as a "strange, rare, and peculiar" symptom. I interpreted his attitude toward food as envy -- he wants what someone else has. And then there is the serious, earnest look on his face. These symptoms strongly suggest Lycopodium. Lycopodium was given, with very good results.

Plan: Lycopodium 200c, one dose.

FoIlow-Up on Case Number 4

After taking the remedy, he was restless that night. He cried a lot. He had a fever the whole night.

Day 1: The child slept in the morning and woke up with only a slight fever. The fever increased again toward the evening. The cough diminished, and the child looked brighter and reacted more easily to contacts.

Plan: No repetition of the remedy.

Day 2: He was slightly better than the day before. Not much fever.

Plan: No repetition of the remedy.

Day 3: He was slightly better again. He slept through the night.

Plan: No repetition of the remedy. A complete recovery ensued.

Additional Remarks on Case Number 4

The following are other typical symptoms for Lycopodium:

- Earnest, including frowning of the forehead.

- Fan-like motion of alae nasi.

- Very serious, unresolved conditions.

- Loud rales, yellow and thick expectoration.

- Coldness of the right foot, with fever in children.

- Flatulence, a little food fills up the stomach.

- Fever is worse between 4 and 8 p.m.

Discussion on the Earnestness of Lycopodium

I would like to describe the earnestness of Lycopodium as it applies to adults. Imagine a person sitting there, looking so earnest and serious. He's looking off into the distance. He's thinking, wondering, and worrying: "Will I get there? Will it work out?" In the repertory under the rubric -- MIND, fear, of being unable to reach his destination --- Lycopodium is the only remedy listed. This gives the feeling of a kind of uncertainty, a kind of worry.

And then, in the SLEEP section of the repertory, we find Lycopodium in the rubric --- SLEEP, dreams, drowning :in a foundering boat. He can't reach his destination because he's rowing in a foundering boat. He has good reason to look so serious.

There is a third aspect of Lycopodium. Imagine him in this boat, ordering others around. "All right, you men over there must do this, do that...and you over there, bring me that oar and he quick about it. The captain is coming soon, and we must be ready to follow his orders." he becomes dictatorial, intolerant to contradiction, hard on inferiors, and respectful of superiors in order to get the others involved and to reach his destination. He makes everyone run, because the captain is coming. The captain represents power, and Lycopodium loves power.

So, taking all of this together, we get an idea of how life is for Lycopodium. He takes life very seriously. He has a deep inner feeling of insecurity that affects everything he does. This is the earnestness of Lycopodium.

Case Number 5

Male, Age 22 Months

Initial Interview: November24, 1989

He has had a fever of 39.2øC (102.6øF) since yesterday, and started coughing and having difficulty breathing.

He has one red cheek (2).

He doesn't sit anymore; he's been lying down since the onset of his inness.

He is very nervous. When playing, he gets irritated when the blocks in his game do not fit on each other.

Is not hungry, hasn't eaten since yesterday.

Has a very loose cough; you can hear the rattling (2).

Cold feet.

Didn't want to be left at his grandmother's place.

Wanted to eat some soup only if he could sit on his father's lap; wants to stay there.

Is angry and cross if he is forbidden something.

Is unusually thirsty, drinks one normal-sized glass in one stroke.

The child developed pneumonia while staying at his grandmother's house. The grandmother had developed pneumonia a few days earlier and was still sick with it. She told her daughter, "Quick, get the doctor to prescribe andbiotics. I'm very sick, and I don't want my little grandchild to suffer in the same way." But the parents called the homeopath.

As you can see from the VES analysis, the case is strong for Sulphur. The red cheek, the thirst for large quantities, the cold feet during fever, and the weakness during fever suggest Sulphur. I interpreted the child's attitude toward the blocks as anger about his mistakes, which is also a Sulphur symptom. One important characteristic of the acute Sulphur picture is an uneven distribution of blood, of body temperature. One part is very hot, and another is quite cold. Often the lips are bright red during acute innesses, or there is excess heat on top of the head. In this case, the feet were quite cold.

Plan: Sulphur 30c, one dose every 30 minutes until a change occurs.

Follow-Up on Case Number 5

Evening after the interview: The remedy was taken the same day at about 5 p.m. It was repeated two times that same evening. During the evening, he began sitting up again. By the time he went to bed, his temperature was 38.7øC (101.7øF). No other change.

Plan: Repeat the remedy once or twice today, then stop.

Day 1: All symptoms disappeared: No fever, he was eating again, and his usual, kind temperament had returned. His cough continued.

Plan: No remedy. Complete recovery followed. His grandmother was still sick and still taking andbiotics.

Additional Remarks on Case Number 5

The following are other typical symptoms for Sulphur:

- Especially the left lung.

- "Redness": face or lips.

- Heat: hot palms and/or soles; hot vertex.

- Many rales in the chest; mucopurulent expectoration; a lot going on in the chest.

- Coldness in one foot, especially the left one (Lycopodium, especially the right one --- Farrington).

Case Number 6

Female, Age 5 1/2

Initial Interview: December 12, 1988

She has had a fever for two days; today, it is 39.5øC (103.1øF).

Her sleep is restless, with perspiration.

She cries and feels annoyed because of the perspiration.

She has a deep, very loose cough.

Increasing mental restlessness.

She has some coryza and has definite pain in the ear when she blows her nose.

She asks for a drink when she wakes at night.

She Weeps easily, looks unhappy, and cannot hear to be contradicted.

The child was by nature lean, very thin. She appeared quite weak, as if all the strength had been taken out of her. I did not think of prescribing Stannum until I saw the RADAR analysis and realized it covered the case well. Stannum, of course, is well-known for having an affinity for the respiratory tract and for great weakness. So, I felt optimistic about the prescription. However, as you will see, the remedy did not produce any changes for the better. I probably persisted with Stannum longer than I should have. It was not until two new symptoms appeared on the third day that I saw the correct remedy.

Plan: Stannum metallicum 30c, one dose every two hours.

Follow-Up on Case Number 6

Day 1: No change. Her fever was still 40øC (104øF).

Plan: Continue Stannum.

Day 2: The child was worse. Her fever was sometimes more than 40.5øC (104.9øC); andpyretics were given. Her cough had worsened. Her general state was very weak.

Plan: Continue Stannum.

Day 3: New symptoms developed. She had cold feet with the fever (which continued to be more than 40øC, or 104øF). The child was very difficult to handle; she kicked, hit, tore the house apart, and wept at the slightest provocation.

Plan: Stramonium 30c, one dose every hour until a reaction occurred.

Day 4: Within 12 hours after taking the Stramonium, the picture completely changed. The fever had diminished, and the coughing was less severe. She experienced a gradual and steady improvement from that point on.

Additional Remarks on Case Number 6

The following are other typical symptoms for Stannum:

- Weakness in general, in the chest, and in the respiratory organs; weakness from talking.

- Gradual increasing and decreasing of the pains.

- Short, oppressive breathing, with stitches in the left side of the chest.

- Everything he does causes coughing.

But two new symptoms finally pointed to Stramonium:

- EXTREMITIES: Coldness, foot, fever, during.

- MIND: Destructiveness, kicks, strikes.

In retrospect, it seems that the restlessness in the initial case should lead one to prescribe Stramonium. The VES analysis based on the first set of symptoms had already shown a preference for Stramonium, but this advice was not followed! Stannum seemed the better remedy for a chest problem.

The following is the result of the VES analysis, showing Stramonium as the first possibility:

HELP IN INTERROGATION You can question about

stram.
stann. 3 ign.
apoc.
dig.
tarent. 7 hep.
coff.
ph-ac.
mang.
Case Number 7

Male, Age 10

Initial Interview: January 4,1988

He started coughing about a week ago; it had been going up and down, but now his cough is much worse.

His general state is deteriorating rapidly.

He vomited several times from coughing.

The cough increases whenever he hes down, is especially bad around midnight (2), and is better from warm drinks (1).

His fever is 39.8øC (103.7øF).

He looks very in and "spaced-out."

His movements are slower than usual, and he uses more movements than are necessary. This strange behavior worries his parents a lot.

This boy lives in another country, and a doctor there had diagnosed the pneumonia. I had successfully treated his chronic asthma problem during the previous two years. His constitutional remedy for the entire two years had been Bryonia. The computer analysis did not strongly suggest any one remedy for the pneumonia, other than perhaps Nux vomica, which was not a clear and obvious choice for me. Because no one remedy stood out for the acute symptoms, I prescribed Bryonia, his constitutional remedy. As you can see, Bryonia generally covers the acute symptoms. This is something I have often done in similar situations, with very good results. And, in this case, the constitutional remedy was able to bring about a rapid and dramatic resolution of the acute inness.

Plan: Bryonia alba 200c, one dose.

Follow-Up on Case Number 7

The remedy was taken the same evening. The next day, all the symptoms were gone. No other dose was needed.

The ConstitutionaI Picture of Bryonia

I would like present a picture of the constitutional Bryonia state. There are some key ideas to keep in mind. One is the idea of security. Security is very important to Bryonia people. They gather things around them and accumulate many possessions. This retention is even represented in their physical appearance, when they retain water during acute innesses and become puffy. They want to be left alone, not interfered with. The image of the baby in the womb is a useful one for Bryonia. The baby feels comforting pressure all around, and movement is limited. Everything is limited and safe. It is the security of being at home with the mother.

Without this sense of security, Bryonia people can become very anxious. The anxiety can appear in many different areas of life. When they think about health, they are anxious about losing their health. "When they think about money, they fear poverty. When they think about the future, they are anxious about losing their current stable situation.

It is interesting to consider the Bryonia alba plant. Above the ground, the plant is beautiful. Below the ground, the plant has a very large bulbous root. The plant stores food and water in this root, always ready for any trouble or disaster that might unexpectedly come along. It is always ready for any change, guarding against any danger or "motion" that might threaten to upset or destroy its world. This plant also has long tendrils, which grow so fast that you can see the growth with the naked eye! These tendrils Wrap around everything in a constant effort to consolidate the stability of the plant. In the same way, Bryonia people attach themselves to the surrounding environment, always seeking to anchor their lives and to make sure that nothing will change.

The second important idea in Bryonia is work. Bryonia people are quite focused on work. They are busy working all the time. Work is the way that home and security are maintained. The idea of work appears in many area s -- in dreams, delirium, and delusions.

So, we have two big themes: security and work. Many of the physical keynotes can be better understood if these themes are kept in mind. The constipation, for example, is a manifestation of the body keeping all the water, leaving as little to be eliminated as possible and resulting in a hard, dry stool. With a cough, the person holds the chest and tries to keep it still and secure, as if something were about to be lost. With a headache, the person holds the head, stabilizing it against the pain and unsafe situation. And with abdominal pain, Bryonia is better from drawing up the knees. Stretched-out legs produce a vulnerable, open feeling. Drawn-up legs produce a more guarded and protected feeling.

International Foundation For Homeopathy.

~~~~~~~~

By Frederik Schroyens

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