THE FALLACY OF ROUTINE AND EMPIRICAL PRESCRIBING


THE FALLACY OF ROUTINE AND EMPIRICAL PRESCRIBING. At the age of four years he developed an attack of acute rheumatic fever which left him with a mitral systolic lesion. About five months after this attack, he developed a severe case of tonsillitis with the usual symptoms of fever, sore throat and difficult swallowing.


The following case has always been of great interest to me because it illustrates the fallacy of ordinary routine prescribing.

Master J.A.F., 8 1/2 years old, was brought to me in January 1950.

Chief Complaint-Recurrent attacks of tonsillitis.

Family History-Both parents living and well.

Past Personal History-Normal birth; dentition delayed; always timid and bashful. At the age of four years he developed an attack of acute rheumatic fever which left him with a mitral systolic lesion. About five months after this attack, he developed a severe case of tonsillitis with the usual symptoms of fever, sore throat and difficult swallowing. A relative in the family, who was a homoeopathic physician, told the parents to keep on hand Belladonna 2x and Mercurius iodide rubrum 2x.

During the winter and spring he developed attacks of tonsillitis about every six weeks. After two winters of similar recurrent attacks, it was recommended that the tonsils be removed. But at the hospital the anesthetist felt his cardiac condition would not warrant deep anesthesia, so he was allowed to drift along for two more years with constant attacks of tonsillitis until he was brought to be in January 1950. He was then at the age of 8 1/2 years and in the first grade of school.

On his first visit to me, I made a complete physical examination. He was a poorly developed, emaciated boy who did not seem to comprehend my questions. His throat presented two very large tonsils with open crypts and a well-developed adenopathy, particularly on the right side of the jaw and neck. These glands always became greatly enlarged with every attack of tonsillitis. He also had an enlarged heart. The apex beat was in the fifth interspace within the nipple line. Also there was a harsh systolic murmur over the mitral area and an occasional early systole. The myocardial tone was poor, the lungs were negative and he only began to walk at the age of three years. As I took his symptoms, I enumerated them as follows:

(1) Inflamed and enlarged tonsils with pus in the crypts.

(2) Liability to tonsillitis after every slight cold.

(3) The right tonsil was much larger than the left and was suppuration.

(4) Submaxillary glands were swollen and tender and were part of his regular attacks.

(5) Complained of smarting of the throat; much worse on empty swallowing and was only able to swallow liquids during an attack.

(6) Night cough with difficult breathing, due probably to the enlarged tonsils and adenoids.

(7) He seemed chilly and sensitive to changes in the atmosphere.

My first prescription was Baryta carb., the 30th, a dose four times daily. According to the mother this remedy gave him more prompt relief and, in fact, reduced the distress in the throat and the swollen glands more quickly than the former treatment, which was Belladonna 2x and Mercurius iodide rubrum 2x, alternately.

His next attack of tonsillitis came on ten weeks after this attack, with the same clinical picture.

I prescribed Baryta carb. 200., twice daily, and, according to the mother, the attack was cured in three days. The attack occurred in the middle of March (1950). During the summer he seemed to improve, taking only an occasional single dose of Baryta carb.

His next attack occurred the following Thanksgiving Day with the same clinical picture. Three doses of Baryta carb. 1000. broke it up in a day and a half, and the mother remarked, “I did not find any swollen glands in his neck during this attack.”.

On January 1, 1952 he developed fever, pains in the chest and knee joints just as he had suffered at the age of four years during the attack of rheumatic fever. On this last occasion he during the attack of rheumatic fever. On this last occasion he had intense soreness over the cardiac region; the heart lesion was quite loud with some dyspnoea; there was swelling and tenderness and some redness of the finger and knee joints. I prescribed Lithium carb., the 30th, which, inside of one week, removed all the rheumatic symptoms except the soreness over the cardiac region.

Lithium carb. 200. was prescribed and in one weak all the soreness and symptoms pertaining to the heart were ameliorated. He would sneak out of bed, which was forbidden; but, strange to say, by Easter at the conclusion of my physical examination there was absolutely no sign of any heart lesion. However, I advised the was absolutely no sign of any heart lesion. However, I advised the parents to take him to a cardiac clinic where a cardiogram and an X-Ray picture were taken. The cardiogram was absolutely normal and he was discharged with a clean bill of health.

During the spring and summer of 1952 enjoyed good health. About the end of October he developed an acute upper respiratory infection accompanied with much debility and sweating. I prescribed Tuberculinum in the 1000th potency. Since then, and up to the time of this reporting, January 1954, he has been gaining in weight, apparently perfectly healthy, has been out without a hat and has had no further attacks of tonsillitis. He has now joined the Boy Scouts connected with the parochial school he attends.

To me, this case has proved the value of individualization

1326 NORTH TWELFTH STREET

PHILADELPHIA, PENNA.

WANTED: Contributions to The Editors Discretionary Fund. Checks payable to the international Hahnemannian Association, 80 Main Street, Brattleboro, Vermont.

William B. Griggs