I was called to visit a patient on 14.6.48- a child of 2 years at a place 4 miles north of Calcutta. It was about 20th day of the disease.
On Set:-About 20 days back the child was attacked with an acute cold and cough and abrupt rise of temperature with diarrhoea. 6 or 7 days passed without any amelioration. Patient was all along under local homoeopathic treatment. On about the 8th day convulsion started. The following were the symptoms when I saw the case.
(1) Continued fever for 20 days. Temperature varying from 102*C to 104*C.
(2) Signs of Meningeal inflammation.
(a) Feet tonically extended with flexed toes.
(b) Attacks of convulsion, stretching and stiffness of all the limbs-coming off and on.
(c) Both the eye-balls are turned towards the right and fixed.
(d) Kernigs sign present.
(e) Stiffness of neck present.
(f) Occasional side to side rolling of the head on the pillow.
(3) Constant involuntary moanings.
(4) Abdomen distended.
(5) Fits of cough with loose sound-Rales and Rhonchi found on auscultation, scattered here and there in the Lungs-Pulmonary Engorgement.
(6) Movement of Alae Nasi.
(7) 3 or 4 loose stools in 24 hours-green and offensive- Cadaveric Odor.
(8) The question of thirst was determined in the following way:- A spoon of water was led before his mouth and the lips were touched by it, the child at once opened his mouth and swallowed the water with utter eagerness, reopening the mouth for more drink-Unquenchable thirst.
(9) Automatic up and down movement of left arm.
(10) It is reported that the patient had automatic motion of the mouth as if chewing or swallowing something for which Bell., Bryo., Helle., etc., had been given by the attending doctor but during my first visit of the patient these were not so marked.
(11) Grinding of teeth.
It was obviously a case of Meningitis, developed either primarily or as a complication of Typhoid fever. The mode of onset speaks in favour of primary meningitis. No important informations were obtained from the previous history and family history of the child-excepting a few months back he had a kind of eruption of the skin, the nature of which was told to be Scabies like.
Treatment:-Of the above symptoms pulmonary engorgement with unquenchable thirst, movement of Alae nasi, distension of abdomen attracted my attention most and Phos. 30, 4 doses, one every two hours were prescribed.
The patient was seen towards the afternoon the attending doctor phoned me at about the mid-night-the temperature rose to 103*c, it was a little below 102*c in afternoon, convulsion aggravated, I studied the case with deeper attention. Pulmonary engorgement is a very common complication of Meningitis but green diarrhoea with cadaveric odour is rather an un-common symptom of Meningitis, so it is very characteristic with the present case. Repertory was consulted- Arsenic, Carbo-Veg, Kali Phos, Lachesis, Rhus Tox were found to be among the important drugs put under Cadaveric Stool.
Under Meningeal Inflammations:-Apis., Bell., Hell., Hyos., Rhus. Tox., Stram., Zinc. are among the important remedies. My attention was drawn towards Rhus. Tox. for the following reasons:-
Firstly, seasonal influence-It was August and the atmosphere was quite damp. The onset of the disease was ushered in by an attack of cold and cough in a damp cold day. It will not be out of place to say a few words about the influence of seasons on diseases. Epidemic diseases, however, are always found to occur in particular seasons but it is surprising that diseases which are not Epidemic in nature, are also much influenced by seasons, the latter producing in them a train of symptoms common to particular season-no matter whatever be the disease, They all may then demand for the interpolation of the remedy of the season which modify the course of the disease even if it be a chronic one.
Secondly patient was reported on enquiry to be all along restless and even when unconsciousness prevailed the child had side to side rolling movement of head and automatic movement of the left arm. These I took to be indications of residual restlessness. In the Repertory Alum., Apis., Bell., and Hell., are the drugs that are put under Automatic Movements of one upper limb but of these drugs one gives a full totality, Hell. is indicated in a more sensorial depression-Complete unconsciousness.
Patient was opening his mouth whenever water was offered to him, so the sensorium was not utterly depressed and he was not completely unconscious. Cadaveric stool, is absent in Bell. These two drugs were therefore left out. Both Kent and Knerr put Rhus Tox under Meningitis in the general rubric, Phos having more pronounced action on the brain substance than on its serous covering-Meninges.
Now if all the individual symptoms of the patient had been referred to in the Repertory at random it might have been possibly seen that Phos or some other drug to be covering more symptoms than Rhus Tox; but totality does not mean merely a numerical strength. That drug is only similar to the patient which covers more of the characteristics-peculiar symptoms of the patient. Rhus Tax 1M. was advised and given at midnight (14.7.40).
15.7.48. (evening)-After Rhus Tox temperature gradually, came down to 99*6c in the morning 15.7.48 which remained so till evening.
16.7.48-Temperature began to rise from evening 15.7.48 and in the morning of 16.7.48 it was 102*C, at noon it again came down to 100*6C. Now another dose of Rhus Tox 1M was given at noon. At 9.P.M. it was reported:-(1) Urine is more free (2) Drowsiness same. (3) One stool, less offensive (4) Moaning much less. (5) The right upper and lower limbs are still periodically stretched and made stiff. (6) Temperature 100*6c. Patient was kept on Placebo.
17.7.49:-Patient was seen again in the evening. (i) Temperature at 6-30 P.M. is 99*6c. Last night temperature began to rise after 9 P.M. and became 102*6c to day morning then it gradually came down to 99*6c when I examined the patient in the evening. (ii) Thirst much (iii) Neck and feet are still but convulsive movement much less. (iv) No moaning. (v) Eyes always turned up as before (vi) Pulse better (vii) Chewing and swallowing motion are present. (viii) Sensorium brighter, but no intelligent response. (ix) Occasional movement of the upper arms, the left more: sometimes the arm became stiff. (x) Flow of urine better. (ix) Condition of the lungs much better- Left lung being free completely only some occasional rattling cough being present. (xii) Respiration not so hurried as before. On the whole patient looked to be improving.
Now from the above result, it was evident that Rhus tox was rightly selected. Immediate amelioration of temperature may be argued to be the effect of previous doses of Phos., but its coming down to 99*c again, after the 2nd. dose of Rhus tox and the definite amelioration of other Symptoms on the 17.8.48 evening-all clearly show that the effect was due to Rhus tox.
Now though Rhus tox did a great work in putting a check to the fever, lessening the offensiveness of stool, also reducing its frequency, stopping the moaning, making the urine more free and lastly clearing off the engorgement of the lungs yet tendency of rise of temperature and symptoms of Meningeal irritation were not ameliorated to any appreciable degree. The above fact together with history of skin eruption a little before the onset of the disease made me administer one dose of Sulph 30.
18.7.48.-(Morning) After taking Sulph 30 (evening 17.7.48) patient gradually closed his eyes which he had not done for the last few days, and slept. Temperature came down to 98*C at 9-30, P.M. (17.7.48), which again rose to 100*8C at 1-15 A.M. In the morning, to-day at 5 A.M. it was again 99*2c and at 10 A.M. it again rose to 100*5c. Now this is the first remission of fever after a long time and it took place 3 hours after the administration of Sulph 30. No stool since last afternoon, flow of urine better, slight tympanitis in the upper abdomen; eyes not so upturned, stiffness of leg and hand some, thirst less than before, slight moaning again, chewing and swallowing motions are continuing. Reported at 5-30 P.M.”-condition much the same, only the temperature rose to 102*c at 2-30 P.M”.
19.7.48-Two doses of Bell. 30, were given when the temperature was above 101*c. The temperature fluctuated between 99*c and 100*c through out the whole of last night. From 3 A.M. Temperature began to rise, at 9 A.M. to-day it is 101*4c. In the evening the condition of the patient was as follows.
(i) Temperature was pretty under control.
(ii) The symptoms of Meningeal irritation were still persisting with all their intensity:
(a) Eyes turned upwards for the most part of the time.
(b) Limbs made stiff in frequent intervals.
(c) Movement of the head from side to side.
(d) Another important information was given that during each rise of temperature the vessels of the forehead become very much engorged and throb.
Prescription:-Bell 1M.-2 doses in the course of 48 hours.
21.7.48:-The temp. is brought down still further and it is varying between 97*C and 98*4c. The other symptoms are reported to be the same another new symptom is reported to have developed The child is trying to bite his own hand.
23.7.48:-Stramonium-1m was given-No change.
24.7.48:-Another dose of Stramonium 1m.
25.7.48-Reports to-day that, the patient, for the last 3 days, is having good sleep at night and the stiffness of the neck is softer, and no stiffness during sleep, but during waking hours and during the rise of temp, which is now varying from 98*c to 100*c, the symptoms of meningeal irritation are persisting though in a milder form; among which the constant motion of the upper limbs is very prominent. The condition of the patient is now somewhat peculiar-meaningless staring look, opening and closing the mouth in a peculiar way-all these are stimulating an insane mind-a hysterical manifestation.
26.7.48:-The automatic and constant motion of the upper extremities are also very peculiar with the patient and it is present from the very beginning, so its importance can not be neglected. It is as found in the Repertory, covered by Bell. and Ars. Alb. But attaching more importance to the above hysterical attitude of the patient Ignatia 200 2 doses 1 every 4 hrs. is given. This is given in the morning and in the evening (26.7.48) it is reported that the patient is in a little better condition. Another dose Ignatia 200 is instructed to be given in the next morning.
27.7.48-(11-30 A.M.) The child is reported to be much better. Eyes, have normal look, movements of the upper limbs much less. Another dose of Ignatia 200 is given in the evening.
28.7.48:-Condition is further improved. Signs of returning sense are observed, responds to calls by opening the eyes and stretching the arms as if asking for being carried up. Temperature about 99*c. No medicine till 1.8.48.
1.8.48:-No further improvement, one stool deep green in colour and a bit offensive. Temperature is normal for the most part of the time. Movements of the mouth is still persisting to some extent. Ignatia 200, 1 dose.
4.8.48:-Patient is practically alright. Stool has become yellow, responds people intelligently; but the patient can not yet speak excepting that he can only utter the word “Ma” mother).
14.8.48:-Patient has been improving all the time, but no speech as yet. Cicuta 200-2 doses one to be taken every alternate day. Cicuta is indicated in “speech lost in meningitis”. Speech gradually returned.
In conclusion I want to say a few words about the use of Ignatia in Meningitis. I was wonderfully benefited in one more case of meningitis by Ignatia I have often found in cases of meningitis, that patients develop certain peculiar nervous symptoms particularly towards the period of recovery- symptoms which are very difficult to account for by the meningeal condition alone. Patients temperature is quite under control, the general condition pulse and respiration, quite satisfactory, yet the patient is showing some symptoms indicative of derangement in the functions of higher centres of the brain-the psychic centres. In these cases I have often found Ignatia to be highly useful.