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Case Study

A Hopeless Case of Trauma
Dr S K Mamgain
'Alum / Nat-m / Cicuta-v

History of the case - A boy aged 11 yrs, fell from the roof about 15 feet high on 2/1/95, at 5 pm white flying a kite. He lost consciousness immediately and as such it could not be ascertained where was he hurt, yet it was sure that this was a bad Head injury.
His father gave the following details when he was brought to me on 30/1/95:
Shortly after the accident, the child was administered Inj. TT. His breathing was irregular, eyes fixed: whole body limp, slight bleeding from a bruise at right ear, no open injury anywhere in the body.
At 5.30 pm the child was examined by a Neurosurgeon at Dehra Dun who administered some injections. By this time a bluish discoloration had appeared at right mastoid process. The prognosis was very bad.
At 8.45 pm C T Scan was done.
The findings of the scan was:
Contusional haemorrhage right parrieto-occipital region with intraventricular leakage. The child was transported to Delhi under the supervision of the medico; and was admitted at Sehgal's Nursing Home and Neurological Research Institute. 

On 3/1/95 MRI of the brain was done:
The impression:
i] Bilateral multiple areas of contusion with left temporal and right parietal contusion haematoma.
ii] Suprarachnoid blood+
iii] Small fluid collection - both maxillary sinuses.
X ray chest NAD
X ray right shoulder on 5/1/95 - Dislocation right shoulder
The child had to be kept on ventilator in ICU for 13 days, when tracheotomy was performed. Father of the Child was informed by the Neurosurgeon that the hope of survival of the child was only remote. And, moreover, even if he survives he may become epileptic or insane.
After the fall the bowels were inactive; as such he had been given enema thrice till 24/1/95 and still [30/1/95] had no bowel movement. At this stage he had bouts of paroxysmal coughing with copious ropy mucus expectoration through the tracheostomy tube. It used to be ejected forcibly with each bout of coughing. Finally on 12th Feb 1995 an ENT specialist was consulted, who removed the tracheostomy tube. Cough ceased along with the expectoration overnight. 
Actually the child had infection which was confirmed by Sputum test, which revealed presence of Pseudomonas bacteria.

I was consulted on 30/1/95 to try Homoeopathy:
30/1/95- Apart from comatose state the following symptoms could be elicited;
* Paroxysmal cough with expectoration of tenacious mucus through tracheal tube coming out with force.
* Much rattling in chest while breathing
* Inactivity of rectum
* When called and stroked at face to arouse him he used to open his mouth, and used to swallow if some thing was put in his mouth.
He was prescribed 1. Kali-bich 200 1 dose and 2. Alumen 30 TDS

He passed ver hard stool in the night of 31/1/95 at 9.15 [it was the first stool passed naturally after he fell down on 2/1/95]. After sometime it looked as if he is straining to pass stool again. Little later he passed loose stool again. Little later he passed loose stools twice on 1/2/95.
* Phlegm aggravated last night, but it was thinner
* Subconsciously, time and again, touching his forehead as if there was pain.
* Rattling in chest was much with respiration.
He was prescribed 1. Conium 1M, a dose and 2. Ant-tart 200 2 doses with placebo TDS 

* There is some > in phlegm
* Has developed fever
* No stool after 1/2/95
* Again trying to touch his head often.Conium 1M, a dose Alumen 30 TDS 

* Passed stool in the morning.
* Sputum was sent for examination, which showed presence of Pseudomonas infection
* Temp. 99 F.
Alumen 30 TDS 

* Meanwhile an ENT specialist was consulted who removed the tracheostomy tube.
* After this the fever and infection along with phlegm all subsided overnight
Alumen 30 TDS 

* Passed very hard lumpy stool in the night of 16th and after that no stool.
Arnica 200 TDS and
Nat-sulph 200 once in 2 days.
skipping the dose of Arnica was advised. 

* Passed stool on 23/2/95
* Unconsciousness persisting, but responds to certain orders.
* He was now being made to sit up by his father in his lap, supporting in his arms.
* On trying to make him stand, he bends forward, lifting up his left leg.
Conium 1M, 1 dose - Rest as usual.
He was given some anti-convulsants but all except Gardenal were stopped by 18/2/95. From 28/2/95 even Gardenal was stopped.
12/3/95 His voice came back. Responses to calls came back to some extent.
For some days the child was put under the care of some other Homoeopathic practitioner [prescription not known] He was again brought back to my care.
* He felt reaction to light first time on 19/3/95 after the accident
* He started walking with lot of staggering on 22/3/95.
* 30/3/95 During this period partial consciousness came back.
* So far had no vision, but could differentiate light from darkness.
* Urging to urinate most frequent around the clock, though urine scant.
* Sleeplessness
* Occasional jerking in legs and right hand trembling
* Staggers-on trying to make him stand
* Twitching in some muscles
Arnica 1M 1 dose
Rhus-tox 30 once daily
7/4/95 It appears that his vision improved a little
* Trembling as usual.
Arnica 1M 1 dose 

* There is definite improvement in various symptoms
* Vision returning back, improving
* Started talking, though talks irrelevant and unconnected [Ioquacious]
* Sleepless
* Urination copious and most frequent but only when awake.
Hyoscyamus 200 every 3rd day. 

* Gradual improvement continues, in all respects
* Sleepless
* Loquaciousness persisting.
* Staggering walk, put it seems as if he is being dragged backwards while walking forwards.
* Feeling much itching on scalp.
* A tender bulge is noted at occiput.
Natrum-mur 1M dose
Hyoscyamus 200 as usual 

* Improving gradually in all respect
Arnica 10M 1 dose 

* Improving gradually but with a good pace in all respects.
* Concentration of mind still wanting
* Catches cold at slight exposure
Aconite 200 1 dose every 3rd day. 

* Gradual improvement continued
* Even though his vision had improved considerably, earlier he was unable to distinguish different colours, which now he can.
* Memory has much returned, but the memory for alphabets both English and Hindi, has not yet revived. When he was injured he was in class VIII.
Prescription as above. 

* Obstinacy in temperament. Cold aggravated.
* Feels lameness in left lower limb on beginning to move, especially in the morning.
Rhus-tox 200 every 3rd day 

* Memory weak for letters/alphabets
Lyco 200 every 3rd day 

* Memory - some more improvement
* Pain in neck, may be due to malposition in bed
Lyco 1 M a dose
Ruta 200once daily

* Further improvement
Lyco 10M 1 dose
Arnica 1M TDS, once in 3 days

* Complained of pain in chest after meals.
Symphytum 200 few doses at long intervals.

* Often staggers while walking.
* Cough with sensation of phlegm in throat.
Causticum 200 every 3rd day for 2 weeks.
After wards he gradually went on improving. Occasionally a dose of indicated remedy was given.
Nov '96 - child is almost normal, only memory for what he reads is still weak.
On 4th Dec '96 MRI of brain and EEG were done.
The MRI findings were suggestive of old encephalomalacic areas in the right frontal, left parietal, left temporal and temporo-occipital and parieto-occipital regions.
The EEG record is an abnormal record and shows:
i] Slow background rhythm for the age.
ii] Evidence of bilateral cerebral dysrrhythmia.
But the child never has any epileptic seizures. He had slight staggering in left lower limb while walking, especially in cold weather and weakness of memory for what he reads.
After receiving the above finding a few doses of Cicuta-virosa IM at longer intervals were given. The medicine worked like magic. The remaining staggering and the memory immediately started showing improvement after the first dose of Cicuta-virosa 1M. 

Jan '97. The child is steadily improving and under observation
Kent repertory has given under the chapter HEAD [PG 128] under the rubric - injuries of the head after. Under the chapter GENERALITIES [PG 1368, 1369], under the rubric-Injuries (including blows, falls, bruises), many remedies.
Apart from the above there are other remedies also contained in our Homoeopathic Materia Medica which are helpful in various injuries.
Editor: This was a difficult and irreparable case. And that is why probably as each phase presented remedies were changed. Since indication are not clearly given, it is difficult to learn from this case. But it has been included to show the efficacy of Homoeopathy in a near irreparable case.