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Case Study

The Weak but Intelligent Child
Dr B G Daptardar

Master AK aged 2 yrs, was referred on 27-3-98 by a colleague for high fever- 101 of that did not respond to Ferr-phos for two days. I saw a weak, almost emaciated child, moaning and thirstless with cold feet. I gave him Puls 200, 3 doses & fevers subsided the very next day but cough & cold continued. I waited for 1 day with sac-lac. Next day fever rose again & the child became dull and irritable with greatly reduced activity. Hell 200, 3 doses brought no change within 36 hours. Then his parents remarked that child was passing involuntary stools & urine; this coupled with fever continuously for 6 days - pointed to typhoid like state. The added weakness and irritability pointed to Muriatic-acid 200-2 does 8 hours apart brought good improvement.

Now after this acute episode was over. I wanted to know the chronic complaints of the child. Why did such a small child reach a state that called for a drug like Muriatic acid? So I called the parents after 4 days for a detailed history. The referring doctor also briefed me before the interview.

The patient was a premature child; born in 7th month of pregnancy- 30 weeks gestation. Birth wt 1.3 kgs. Kept in premature unit for 45 days. Icterus on 10th day. Septicaemia-Blood transfusion.

Wt. at discharge-2kg.
Mother had Hypertension during pregnancy-LSCS done.
H/O Recurrent nasal congestion, sneezing, cough; chest congestion twice.
Born with excessive hair on cheeks, arms & abdomen. Stretches often, specially after feed. Restless hand & feet.

Cries before urination or stool.
Starts during sleep.
Needs human touch to go to sleep; will not sleep in cradle.
Loves bathing.
H/O- Trembling of one lower limb.
Lies with lower limbs abducted- one or both or in knee-chest position; curled up on sides.
Shrieks in sleep.
Likes rocking very hard. Restlessness.
Fear: of balloons, whistle of pressure cooker, but not afraid of crackers.
Thermal- wants fan, does not like covering or even to wear sweater or cap in winter. In sleep also throws off covering.

12-1-98- Phyctenular conjunctivitis. During acute attack of cold & fever, he becomes dull, irritable, restless, wants to be carried, will stick to mother or aunt. Startles from sleep during fever.

He is very timid, cries if dog barks loudly, if a pigeon comes near or even on hearing a duck quack. Earlier he was fond of slides; once he fell down, so now he does not use slide. Does not mix around or plays with kids. He wants one of the family members to be there. Plays alone. He will play a shot & will turn around & will say "mamma".

Anything attracts his attention for some time & immediately it goes back to his mother. Restless; does not sit in one place, & play for more than 5-10 min. Likes to read books. Computer fascinates him. Wants to be carried; Aunt should carry him while cooking. Good memory picks up words very fast.

He talks, plays with toys but is not mischievous.
Basically his problem is with strangers. Does not even look at strangers, clings to Mother. Does not wear dirty shoes. Likes playing in water, stones, mud. Quite stubborn at times. Does not allow his mother to carry any body else's baby.

DESIRES- Fruits, Curds+++; cold drinks, ice creams.
F/H- Diabetes; IHD

19-1-98 Oral polio- followed by recurrent diarrhoea, continuing till now. As soon as her narration was over I got answers to a few of my questions & I told so to the doctor. But she was not satisfied. So I decided to interview the parents & the following things came up apart from the information provided-

AK was a weak child from beginning. He suffered from cellulites, bad infection of toes. He had a hot vertex for which Calcirol-D injections were given. He suffers from cough & cold very frequently. He passes stools & urine without giving any indication for it. If taken to toilet he will not pass it but anytime he will pass & without being aware. He is sometimes very stubborn. Once he saw plastic grapes hanging in a taxi & he cried a lot for grapes; so much so that the shopkeeper had to buy grapes for him. He does not play with children of his age & does not like outdoor games. He likes to sit the series of pictures in his computer program Power Point. His thirst is less & he likes fruits. A sudden but drastic change occurred in him after the last medicine (Mur-acid). - for one full day he cried for his "papa". He had never done this before. He was always attached to Mother. His appetite increased greatly. This confirmed my prescription. The doctor had given Sulph & Lyco previously without much effect.

Now I knew the answer to my first question- what is the chronic state & the remedy. Now I wanted to know the answer of the second question. So I questioned the parents about their health in general & mother's history in particular.

Mother's History: polyhydramnios in the early weeks of pregnancy & doctors had suspected twins. She suffered from hypertension during pregnancy. She had placenta praevia. She takes things too personally i.e. if work is not completed she is not comfortable. She is irritable before menses. She also is very obstinate, anxious & conscientious about trifles. Theirs was a love-marriage. Her parents, especially father did not agree for it initially. She wanted to marry only after parents approved. Father suffered from heart attack & was operated- during that period she was with her father all the time & later father gave consent. The main reason to oppose was that she was more educated than her husband & earned more. This was not an issue for her. From childhood there was discrimination in the house to wards her; she was refused many things but the same were given when asked by her sister. She got the feeling- "this is not right". & she never retaliated. But when same thing started happening for her younger brother, she fought for him.

I asked "what did you like most abut your husband?" She laughed shyly & said "his caring nature". Rubrics taken are given in the chart.

For Child

For Mother

Mind active
Starting from sleep
Cares & worries full of Emaciation
< Warmth
> Bathing Head,

A/F Rudeness of others

Looking at the evolution of child: premature delivery, septicaemia, cellulites, all are zymotic states, low grades of inflammations. With every condition he becomes dull, irritable, physically weak but mentally well developed. No control over stools & urine. We all are familiar with Muriatic-acid in typhoid like fevers. Hahnemann gives it in his antipsorics. So if we expand our idea of the drug & apply it to the case, Muriatic acid is very difficult to miss. What I mean is that, if we know a drug is useful in say typhoid like fevers but that drug is, very deep acting one; than the central idea or theme or whatever individualising aspect of that drug is, that will be seen in a case of typhoid like fevers as well as in chronic case. Only the expressions will be differing in pace & pathology. Now take the case in hand. We know very well Kent's description in his Lectures. He describes paralytic weakness of Mur-ac vividly. He says "with this great muscular exhaustion, with jaw hanging down & patient sliding down in bed & soon the involuntary stools & urine, this remedy is forced upon the mind has been stronger than could be expected". All these coming up in a typhoid fever in a rapid manner, where there is a great physical weakness & mind is not that weak or is rather irritable we easily point to Mur-ac. Now when we see these features coming up in a chronic case will they be manifested with such rapidity? On the contrary we see slow progressive muscular weakness, where mind is active or irritable. The characteristics of muscular weakness will be manifested according to the pace & pathology. Involuntary stools & urine will be present but the pattern may be different.

If Jan Scholten's idea of muriates & acids is used, then also this case can be understood. From his analysis the theme of muriaticums is "Care & Nurturing: Mother; Attention; Self awareness". All these themes are clear in our case specially from mother's case. Her expectations from her parents, her taking care of her father during his illness, her not being ready for marriage without consent of parents, all collectively point to that. The final stamp was put when she replied to my question: "What did you like in your husband:" & she shyly replied "his caring nature". Though her father mainly opposed her marriage she always had problems with her mother. Now Acid theme is "Exhaustion; Active, hurried; Lively, fresh, extrovert; Aggression, fighting; Desire for unification; Isolation & apathy". Now when we combine the themes of two i.e. Acids & muriates what we get is following themes: Exhausted as a mother or by care & nurturing; Active or even aggressive as a mother or in asking for care & nurturing; desire for unification by or for care or nurturing; isolation & apathy as a result of failure in giving/receiving care, nurturing, attention. We see that most of these themes are present in mother of the child. The relation between mother & child also is once again seen clearly.

Follow Up:
Slowly his fears became less, he started going on slides and playing with balloons. He regained control over his stools & urination. He gained wt. He did not have any acute episode like before.