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May 16, 2017

Observations of Acute Pharyngitis

Observations Of Acute Pharyngitis
Dr. Casez (Annecy, France)
Translated* by Roger A. Schmidt, M.D.,
San Francisco, California
 
 
A Case Report
 
We have examined the patient's throat and observed a number of interesting symptoms; in fact these symptoms are not essential. An angina is at the most a localized infection, but it soon reacts over the whole body. Its main general symptom is temperature.
 
This temperature - as well as pain, when intense - is going to produce definite reactions: general, even mental, and particular or local. We know that for the right hierarchy of the symptoms, these general and mental symptoms - as well as desires and aversions that might occur - are more important than the local symptoms. In this domain many manifestations are essential and characteristic.
 
That does not mean that local symptoms are valueless. An angina which is not serious or malignant will fail to produce peculiar mental symptoms or definite general symptoms. You will be pleased to have examined carefully the patient's throat to determine the local symptoms. I am stating this for the beginners. I have told you that angina, when commonplace and simple, the benign acute pharyngitis types, are the perfect practice ground for a beginner. Don't jump to the conclusion that Homoeopathy belongs only to the cases that recover spontaneously.
 
I would like to present the case of diphtheria that I have treated - I am rather proud of it! I took care for many years of a lady now 67 years of age who had been treated for the last four years for a very deficient general state due to a right nephrectomy caused by a traumatic rupture of the right kidney. Besides, she was suffering from a chronic nephritis. She had a heavy proteinuria and a blood pressure around 240/150, evidently as a consequence some myocardiac damage with a total arrhythmia and some degree of decompensation. I studied her case rather well. She was an extremely kind patient. I finally gave her as a constitutional remedy, Calcarea, which helped her to live a normal life without any cardiotonic. Calcaera was indeed her ideal simile.

One day in November 1960 she phoned (as she lived pretty far from Annecy), telling me that she had the flu, was feeling bad with aching limbs and a little temperature. What was her main trouble was a terrible neck pain. I remember prescribing on the phone Gelsemium 7 H. The next day she rang again telling me there was no improvement, not only the same symptoms but in addition she had a sore throat, with adenopathy of the neck and a horrible pain in the right ear on swallowing.

What worried me was not the pain in the right ear but mostly the fact that she had only one damaged kidney with chronic nephritis, a severe hypertension, and a marked proteinuria with a sore throat starting - on top of it all. I insisted that she see a colleague who practiced a little Homoeopathy. Forty-eight hours later, in the morning, her son came to see me with a prescription and the results of the tests. The lab test; throat swab: "short Loeffler bacilli with Streptococci." The Rx of my confrere suggested local treatments, Streptomycin, penicillin, plus anti-diphtheric serum. The patient's son was worried about using the serum with such a bad kidney and decided to see me.

I then phoned my colleague to ask him to follow a Homoeopathic treatment and he answered: "Please understand, I have already given Belladonna and Mercurius without results. I don't wish to be accused of having refused the serum in a case of diphtheria!"
Of course, one should be free to do as he thinks best; so I asked him to let me take over and went to see the patient that evening.

As I entered the patient's room, she started reproaching me for coming so late. I was rather surprised because she was always so kind and considerate. So she asked me: "Why didn't you come earlier?" She was pale possibly due to her renal condition. I started to examine her, pulled out the blankets. She got angry, saying: "Can't you see that I am going to catch more cold? As soon as you pull out the sheets I shiver....." I tucked in her bed and had her put on a wool garment and finally she was reassured. I examined her throat. She really has false membranes, worse on the right tonsil, extending to the palate. She then mentioned the pain in the ear, dreadful when swallowing, and added: " I also have this neck pain." But she meant not the neck but the occiput. The false membranes had started on the right, spreading towards the left.

Generally speaking, she was worse at 4:00 p.m., a very definite symptom. Such were the symptoms I noticed and I classified them as follows: (Page numbers refer to Kent's repertory.)

1. Irritability, excessive during fever, p.59
2. Chills as soon as moving the covers, p. 1265
3. Aversion to uncovering, p. 1292
4. 4:00 p.m. aggravation, p.1342
5. Occipital headache during fever, p. 163
6. Pain in the throat extending to the ear when swallowing, p. 460
7. False membranes, gray, on the right side, p.455
8. Extension from right to left, p. 455

Her blood pressure was the 240/150, and I believed that she would have been seriously aggravated with the serum.

The remedies coming out of the repertorization were:

Lycopodium  with symptoms 4,7,8;
Nux-Vomica with symptoms 1,2,3,5, and 6;
Hepar sulfur with symptoms 2 and 3.

Of course I was much worried and pondered for quite a while before administering the remedy. The Repertory does not mention Nux-Vomica neither for diphtheria nor for false membrane! The 4:00 p.m. aggravation, the extension form right to left, prompted the choice of Lycopodium, which a well known remedy for diphtheria; whereas Nux-Vomica was fitting the patient but not the diphtheria. Honestly, if the patient did not have such a bad kidney, I might have given Lycopodium.

Because of the kidney condition I solved the question, giving first Nux-Vomica, waiting until the morrow to administer Lycopodium in case Nux-Vomica would fail because Lycopodium is always dangerous in renal disturbances.

So I gave Nux-Vomica, the one I had with me, i.e., one globule of Nux-Vomica XM. Getting back home that evening, I was worried about the outcome. Arriving at Annecy, I opened my Herring and read the following:

"Diphtheria starting on the right side of the throat and extending to both tonsils; strong diphtheric odor; complete prostration; acute pain in the back and extremities; roughness and soreness of the throat; deglutition almost impossible due to an extremely violent pain when swallowing; chilliness, worse on the least motion; worse 4:00 a.m. and 4:00 p.m."

"Gray spots on the right tonsil; red throat; sudden pain in the ears while swallowing; patient much worried about himself; very chilly when uncovered; perspiration has a horse urine odor; worse 4:00 p.m., diphtheria."

I knew nothing of all that, and after reading this I was able to fall asleep quietly. The next day I was called on the phone: "It is most extraordinary, the patient is transformed, she is quiet, no temperature, no more sore throat, the neck pain completely gone, the throat almost free." On the third day she has another bacteriologic test which showed no more streptococci, just a few Loeffler's bacilli. Later she had three more tests for peace of mind and all three were negative! Twenty-one days later gave Diphtherinum 200 and later went back to Calcarea, her constitutional remedy. I saw that patient again during her convalescence. She is now perfectly well. I am certain that this patient owes her life to Homoeopathy.

Now we have a delicate problem to solve. What should we think of a doctor conversant with Homoeopathy yet wanting to prescribe serum and antibiotics to that patient? I believe that each one should judge according to his possibilities, and it is clear that those of my confrere were rather limited. But what should be the duty of a physician who knows his Homoeopathy pretty well when confronted with such a severe case of angina? I believe that we have to differentiate as there are two different kinds of severe anginas: the diphtheric angina and the hemolytic streptococcic angina. These two categories differ greatly.

Regarding the diphtheric angina, I want to say that this was not my first case of angina, but the fourteenth, and the twelfth handled homoeopathically. When I was practicing in Chamonix and was taking my first steps in Homoeopathy under the guidance of Dr. Pierre Schmidt, I recall a little blonde girl about eight whom I took care of and who had a nasty angina with gray false membranes on both tonsils and a terrible halitosis and temperature over 38 C degrees, however without prostration and not as in malignant diphtheric cases with a picture of adrenal insufficiency, so common in such cases. Looking in the throat I inferred that this was probably a diphtheria. I tool a swab and sent it to the lab. Because this looked to me so typically Mercurius Corrosivus (one of the rare remedies I was familiar with at that time), I gave the patient the 200th while waiting for the lab report. Sixteen hours later the results came back: "Diphtheria, medium bacilli." I went to see the little girl again with the intention of giving the serum but found her up playing, The mother said: "You know, she is very well, there is nothing wrong with her." When one is a beginner in Homoeopathy he needs such a case to convince him of its efficacy. This was a child prone to urticaria, so we have an added reason not to administer the serum.

As I came back home, I cogitated and decided that from then on in a case of diphtheria I would proceed as follows:

First make the test, give the indicated remedy, and give the serum later if the patient is not definitely improved by the time I get the answer from the lab. from then on I treated 13 cases of diphtheria, all take care of Homoeopathically without serum. Eleven cases were cured in 24 hours. Among these was one case of croup. The two cases that received the serum were two croups: One was a patient who had received sero-therapy already, the other one came as I was leaving for my vacation and my substitute could not be trusted with homoeopathic drugs.

And now I wondered what I would do if the patient was not cured at the time I got the lab result. I studied the most recent classic therapy of diphtheria and observed that there was nothing new since 1936 - just the anti-diphtheric serum. Yes, the serum works sometimes and I was grateful to have been cured myself of croup by the anti-diphtheric serum. Yet, one is also impressed by the many accidents produced by the serum. I believe that one who is well versed in Homoeopathy has better chances to cure with it than with the serum. In any case the serum can cause severe side effects. The problem is therefore rather delicate, being a personal problem; but with my experience, as far as I am concerned, I am convinced that Homoeopathy is far superior provided you find the right remedy.

Regarding the streptococcic anginas, this is a different problem. Whereas if the anti-diphtheric serum is not the weapon of choice, on the other hand allopathy is very effective against the streptococcus hemolyticus, which responds very well to penicillin. We all know that the streptococcus is a serious danger for the kidneys and the heart. I wonder to what extent one has the right not to give penicillin in such cases. Personally, when confronted with a patient affected with a hemolytic streptococcus with joint involvement or renal or cardiac risk, I give the classical treatment.

In fact, isn't the streptococcus the occasional cause to be removed? Because without streptococcus there is no angina. If we can remove the cause with penicillin aren't we following the rule? Yet, such a comportment should not be generalized, nor should we believe that antibiotics are homoeopathic. One has to evaluate each individual case, and this justifies the idea that diagnosis is indispensable, even more so for the homoeopath than for the allopath.



Note:- Commentary on this presentation By Dr. Pierre Schmidt will be posted in next Post.

* Translated from the "Groupement Hahnemannien de Lyons, 8 Serie, No. 10, 1971". From "Journal of The American Institute of Homeopathy", Vol. 65, No. 3, September 1972.

1. Here it is taken from "The Layman Speaks", A Digest of Homoeopathy, November 1972.

2. Antibiotics such as Amoxicillin, Cephalexin, or Penicillin are used to treat Streptococcal Infection in Allopathy these days.