Should the infection prove resistant, then an increased dose may be required. Occasionally it is necessary dose may be required. Occasionally it is necessary it shift from one drug to the other. With the sulfanilamide it is a good plan to give 10-15 grains of sodium bicarbonate three to four times daily. The time necessary to sterilize the urine may vary from twenty-four hours to a week or more. It is advisable to continue the medication for several days after sterilization has been accomplished. The tendency for relapses to occur must always be borne in mind.
If the case does not respond to treatment, it may be necessary to carry out a urological study during the acute phase to see whether a congenital anomaly exists. Generally it is best to postpone the study until the acute phase is over. The statement has been made that every case of pyelitis or of pyelonephritis deserves at least an intravenous urogram. With this statement most people are in hearty agreement.
As a whole it can be said that with chemotherapy there is usually a prompt drop in temperature with a corresponding improvement in the patients general condition. The usual precautions carried out when chemotherapy is used should of course be observed.
The question of where the use of homoeopathic drugs comes in when treating these infections should logically be raised, particularly at a meeting of this kind. In milder cases it may be possible to rely entirely on these remedies, while in the more severe cases the homoeopathic prescription can be used in conjunction with the chemotherapeutic drugs. When one is treating these cases, the first consideration is to sterilize the urine. For this purpose, it must admitted that chemotherapeutic drugs are by far the most effective.
Since a homoeopathic remedy is usually thought to act indirectly by stimulating the body to react, and a drug like sulfanilamide is thought to inhibit directly the micro-organism, it can be seen why sterilization can be more effectively accomplished by the latter type of drug. The writer feels that this is no criticism of things homoeopathic. Likewise, when a mechanical obstruction to the flow of urine exists, one is dealing with a state of affairs where the remedy is handicapped in its action. A congenital anomaly will frequently call for surgical correction.
On the other hand mere sterilization of the urine may not be enough. There still remains a patient ravaged by infection and requiring further treatment.
Here the homoeopathic remedy should certainly be considered. A number of drugs will be mentioned : Aconite–acute onset with a chill; Belladonna–an acute febrile condition with the usual Belladonna picture : Cantharis–probably the best indicated remedy for frequency and burning on urination; Terebinth–a picture similar to Cantharis, but with a bloody urine; Arsenicum Album–prostration, aggravation after midnight, marked burning, the characteristic thirst; Mercurius Corrosivus –tenesmus, sweating, albuminuria, urine scanty; Hepar Sulph. Calc.–pus that is not draining freely, a septic temperature,chilliness; Pulsatilla, Kali Bichromicum, Uva Ursi, Copaiva–are other remedies to be considered.
In the convalescent stages drugs like Chin. Ars. and Arsenicum Iodide are to be considered. In these cases remember Lyco. and Pyrogen before resorting to Chemotherapy. Hahnemann advised surgery in mechanical obstruction and congenital anomaly.–(Ed., H. H.).
Before closing I wish to illustrate briefly these infections with several cases: The first one is that of a new-born infant who was circumcised on the ninth day. Prior to this, things had been going along normally. On the day following the circumcision the infant nursed poorly and developed a temperature elevation of 102 by rectum. Along with this the infant looked toxic and was dehydrated. Physical examination was otherwise negative. A blood count and urine analysis were ordered.
The leucocyte count was 15,000 with an increase in the polys. The urine showed a trace of albumen and many pus cells. On culture the colon bacillus was obtained. The infant was given sulfanilamide by mouth and several hypodermoclyses of normal salt solution.+ + Without thinking of any simillimum ?–(Ed. H. H.). A prompt recovery ensued. Most likely this was an ascending infection related to the circumcision.
The second case is that of a white, female infant who was admitted to the hospital at the age of one year with the chief complaint of vomiting and fever of several days duration. The temperature ranged between 101 and 105 rectally. There was some abdominal distension, and the respirations were labored. Pneumonia and peritonitis were considered as possible diagnoses.
A catherized specimen showed a trace of albumen, an acid reaction and 6-12 pus cells per high power field. The culture of the urine showed colon bacilli. Other diagnoses were excluded by appropriate studies. During the time that these studies were in progress the temperature remained elevated and the patient was quite toxic. Bryonia and Hepar Sulph. had been prescribed on two different occasions.
Then the patient was put on sulfanilamide with a fall to normal in the temperature in 48 hours. After several days, the drug was discontinued and promptly the fever and the clinical picture returned. With the resumption of sulfanilamide the picture rapidly reverted to normal. An intravenous urogram was done and was found to be normal. The patient was followed in the clinic and has done very well.
SUMMARY AND CONCLUSION.
Urinary tract infections are a common occurrence in pediatric practice. Most of these infections fall under the headings of pyelitis or pyelonephritis. While there may be a variety of symptoms, the final diagnosis is obtained from care- fully performed urine analysis. Forcing of fluids and chemotherapy, supplemented with the indicated homoeopathic remedy usually produce gratifying results. The frequent relation of these infections to congenital deformities of the urinary tract must be born in mind. Hence the dictum that all of these cases should be urologically before being finally discharged has been propounded.
DISCUSSION.
Dr. Shadman discussed the paper during the absence of the stenographer.
DR. RABE : Dr. Agerty has provided an excellent homoeopathic paper, and in a field that is most important, as we all know.
What Dr. Shadman has said leads me to observe this in these cases where your symptomatology is purely diagnostic in character, symptoms do not as it were, reflect the patient as an individual, then homoeopathic prescribing is very difficult, then the solution may be, as Dr. Shadman has just suggested.
On the other hand, Dr. Agerty has brought out quite a number of our well-known homoeopathic remedies in this particular field.
Most of our prescribers are very deficient when it comes to drugs which affect the urinary tract; some of the symptoms we find in the materia medica are not reliable. On the other hand we can separate the wheat from the chaff and there are many little remedies which I think we often overlook.
Those little remedies to be sure are not very deeply acting, but they do fill in the chinks, they are useful on occasion, such remedies, for example as equisetum himala, and triticum repens and populus tribulatus, little drugs of that type that we are apt to overlook and which incidentally have rather partial provings, and sometimes no provings at all, their use has been based upon clinical experience, often of our friends the eclectics; we get useful hints from studying these old experiences of these men. Lycopus, in the American Indian lore, the homely remedies that helped the aborigines in these countries, some of those remedies are very valuable to us.
DR. GUTMAN : The excellent and comprehensive picture about these infant diseases has been most interesting. I would only add from the standpoint purely in remedies like Lycopodium benzoic acid, sarsaparilla, eucalyptus are of advantage in treating these diseases.
On the other hand, I noticed patients at the clinic of the Flower hospital who had been treated with sulphonamides in the wards, very slow recovery, unusually slow; it gives a definite impression that the vitality of these people was in some way hurt, and recently a doctor told me, from an autopsy where he had seen a case in which the kidney was filled with crystals of sulphapyridine. Of course these things do not happen with lycopodium, or other remedies like that.
DR. AGERTY (in closing): I appreciate very much the discussion. I think the comment along the therapeutic line is particularly important. I think we all have to admit as long as we restrict ourselves to homoeopathic drugs we are dealing with entities which are practically non-injurious, whereas when we step into the field of chemotherapy we are using very potent weapons, also weapons that may backfire just as Dr. Gutman has mentioned.
Otherwise I have nothing to add except my appreciation of the comments.
–The Journal of the Am. Inst. of Homoeopathy.
