A 7-year-old girl developed slimy nasal discharge. cough, vomiting and fever (104F). In addition there were occipital headache worse from motion, vertigo and nausea when standing, general aggravation from noise, light and motion. Bryonia 200. in water, a teaspoonful every two hours for five doses, repeated after five hours, was prescribed.
There was no improvement at the end of 24 hours; in fact there was general aggravation. A new symptoms appeared in the form of sticking pains in the right chest and the tip of the right shoulder, worse from motion. The pains were intermittent, coming and going suddenly, and though worse from motion were not brought on by it. In addition there were red face, circumoral pallor, hot skin. Veratrum viride 200. was now given in water, one teaspoonful every two hours for five doses, repeated in five hours.
Again there was no improvement. The symptoms remained the same except for an increase in the frequency and severity of the pains. There was thirst for sips of water, a feature present since the onset of the illness. Vomiting at intervals continued. Treatment: Belladonna 200 in water, a teaspoonful every two hours for five doses, repeated at the end of five hours.
The result was nil, all symptoms remaining the same with the exception that the vomiting seemed to appear sometime after water had been ingested. This was interpreted as indicating Phosphorus of which the 200. was prescribed in water, a teaspoonful every two hours for five doses, to be repeated after five hours.
Again the results were nil. A review of the situation showed a right lobar pneumonia with chest pain involving the whole right chest but now frequently centering at the angle of the right scapula. Not other remedy but Chelidonium seemed to apply. This was given in the same manner as described for the previous remedies, but the results were disappointing. There was not only no improvement but new symptoms seemed to be present. The patient would be woken from sleep by pain or cough; lying down seemed impossible, the patient would sit upright or bent over on the edge of the bed which position relieved the pains and made coughing easier; there was aversion to being covered.
Lachesis 200. was prescribed now but with no help to the patient. Conditions at this time (one week after first visit) now were.
1) Right-sided lobar pneumonia.
2) Sticking pains in right chest, worse lying, better sitting upright or bent forward.
3) Motion aggravated the pains, as did coughing, but the pains came on independent of motion.
4) Aggravation in general after one. A. M.
5) Paleness of face previously flushed.
6) Temperature 104.F, pulse 140, respirations 40.
These symptoms indicated Kali carb., particularly the character and modalities of the pains. Kali carb. 200. was therefore given, one powder every three hours, six doses. The first of these doses was given at 6 P.M.
When seen the following day, it was evident that the little patient was much improved. For the first time since the onset of the illness she had slept relatively well, being awake for short intervals only four times. The mother reported that two hours after the second dose of Kali carb. the temperature had apparently begun to drop since the child felt cool to the touch instead of hot as previously. The temperature at 10 A.M. was 96.6 F. At 2 P.M. when I visited, the pulse rate was 104, respiratory rate 24, as compared to 140 and 40 twenty-one hours earlier.
Twenty-four hours later, on the 9th day of the illness, the temperature, pulse and respiration were all normal, cough was decreasing, pain in the chest at a minimum. My final visit to her was made on the 14th day after the onset. At this time the chest was clear, no cough was present, appetite and sleep were normal. There still remained occasional sticking pain in right chest. One dose of Kali carb. 9M. was given.
This case is reported because it well illustrates the dangers inherent in “hunch” prescribing coupled with too little knowledge of the Materia Medica as well as too little analysis of the patient. In reviewing the case after the patients recovery, it became obvious that Kali carb. was indicated from the second visit; yet it was not prescribed until the seventh day. Although the result was cure, yet the poor prescribing which preceded the administration of the similimum detracted from the complete satisfaction ordinarily experienced following the successful termination of a serious illness.
All the remedies given were prescribed on “hunches” with the exception of Bryonia and Kali carb. “Hunch” prescribing differs from intuitive prescribing in that the former is based on pseudo knowledge of drug pathogenesis, while the latter is founded on the subconscious recollection of pathogenetic details acquired by study and experience. Intuitive prescribing is a gift, a natural talent; “hunch” prescribing is an attempt to hit the target with the eyes of the mind closed.
The strange and peculiar character of the pain pointed directly to Kali carb.; yet none is so blind as he who will not see, as this case amply demonstrates.
Sometimes something of this sort is required to jolt one out of ones feeling of self-sufficiency, bringing one to a level where one can analyze and learn from ones mistakes. This case has taught the writer a much-needed lesson; may it serve to prevent others from falling into similar errors of judgement and self- satisfaction.
80 Main Street, Brattleboro, Vt.