A Koch's Case
NATIONAL JOURNAL OF HOMOEOPATHY 2001 Jan / Feb VOL III NO 1.
Dr Sushma Metkar
Dr Ram Subramanian
'Sil / Calc-phos / Ars

This case has been selected from Dr Ram's children hospital, Mulund where Dr Dilip is consultant. Case was initially taken in Feb 97 where the simillimum arrived was Calc-Phos and intercurrent was Tub-b. Patient was managed for 2 year. The complete understanding of the totality and the overall assessment of the follow ups are given on next page.

Current Situation
Review: 21/04/99
Date of birth: 6/5/91.
Age: 8y. Sex: male
Occupation: Student 3rd std
Status :single. Religion: Maratha. Diet: Nonveg.
Fa: 55, Estate agent. Mo: 45, housewife.
Sister S1 =20, SYBCom. / S2=15 SSC /S3=12 7th
Res Address: Bhandup.

Chief Complaints

Associated Complaints

O/E: Temp+ Throat - N. Chest - Crepts +
P/A : L2 ½ Finger palpable (FP) , (Lt) lobe 2 FP SNP
(1) CBC MP (2) Urine (3) SG PT
(4) Widal (5) MT (6) X RAY CHEST-X RAY
CHEST-haziness LLL with effusion
Hb - 11.5 gm% , WBC- 8700,
M62, L36, MP-No
Urine -NAD, SGPT-36
Widal- O-1:20, H- 1:20

Patient as a Person
Lean ++, Fingers Long, skin clear, wheatish complexion
Perspiration; Moderate², Neck², upper lip² Odor -socks², offensive2
Craving: sweets², tomatose², Av: milk³

Development And Growth
BIRTH WT 3.2 Kg, Milestones-within normal limit
THERMAL MODALITY: C3H2
F/H: Koch 's -MGM and PU. Allergic Rhinitis - Fa: MI-PGF
P/H: recurrent RTI-Pt(self).
SLEEP: eyes remain half open during sleep.
DREAMS: Ghost², cricket².

Life Space
The patient is an 8 year old, male child belonging to a Hindu Maratha Family. He is the youngest in the Family with 3 elder sister: SI =20y, S Y BCom, S2= 15 y -SSC, 12 y 7th Std. Father is an estate agent and a loving and caring person while Mother is a house wife caring, anxious2 and co-operative by nature.

He studies in 3rd standard. Always stand 2ndin his class. Very particular about his studies, and will not sleep till his homework is complete. Mother finds it very difficult to convince him as she is not educated and hence keeps awake to help him out. Mother has never to bother, as he does his work well. While writing if he makes a mistake, he will erase it nicely and re-write things. He is very friendly and obedient; hence he is the pet of the class teacher. He likes to wear new clothes but will never make a fuss about it. The reason given by him was that if I wear different clothes whenever I come to doctor, she will think I am a good boy. As soon as he comes from somewhere out, he will immediately change his clothes. He wants others to play perfectly with him. If a boy drops a catch, he will immediately go and explain him how important it is to play nicely. Keeps awake till midnight watching cricket on TV when studying, but the moment the channel is changed, he sleeps.

He starts weeping if scolded. If teacher scolds their entire class, he will come home and repeatedly tell the incident to his mother. Though she will try to convince him otherwise, he will reply that it was definitely their mistake and they should not behave in this manner. While playing also he dose not like colleagues misbehaving. If he finds no one is listening to him, he will come back home.

While walking, if he finds small photographs of gods, he will immediately pick them up and keep them in his book. If in case, it is dropped by anyone, he will immediately start scolding them-will keep the photograph to his chest. If he sees a Mandir, he will join his hands, and ask his mother to do the same. He says: everyone in the house performs pooja but none of us has such religious feelings.

He will take money from parents but not spend a single rupee for buying a chocolate for himself. He likes out side food but does not eat it, as it is bad, text books say. He obeys everyone, shares a good relationship with his sisters, often fights with his younger sister, but most of the time scolds her for eating chocolates etc.

He gets anxious and restless before exams and if anybody is unwell at home.

Our Approach And Chronic Totality after review:
As we had many qualified mentals, Kent's approach was selected.

Differential Remedies
Lyco was ruled out on the basis of sensitivity, behaviour and conscientious and physical hard data.

Understanding Of Intercurrent
FM: Tubercular
DM: Tubercular

·         Tubercular constitution: Lean, long fingers.

·         A Hypersensitive response which is now unpredictable.

·         A rapid progressive pathology can go into complication.

·         Anal itching.

Understanding Of Clinico-Pathological Co-Relation
Initially hypersensitive response to food allergens has been noted where the inflammation has been restricted to the level of Bronchus, Pace has been rapid and duration of 1-2 days Now since 11/04/99

Inflammation in the Lungs  exudation  pressure effect. Hepatomegaly, Clinical impression being: Koch's with pleural effusion.
Susceptibility: low pace-rapid characteristics++
Pathology - deep seated and progressive
Sensitivity - High
Management: Specific

Homoeopathic Planning And Programming

A) Remedy Selection
Silica was chosen since we were dealing with deep-seated progressive pathology.
Was Silica the simillimum force - according to R T (Reportorial Totality)
Indication of the constitutional - because characteristic and structuralization acute form was absent.

(B) Potency - 30 was chosen because:
(a) of clinico-pathological dimension,
(b) cautious approach as the sensitivity is high and we do not know how this system will behave.

(C) Repetition - 1 P  7 P
Cautious repetition as we have combination of low susceptibility and High sensitivity.
A hypersensitive response of the system and deep seated pathology
Totality of Calc-phos in Feb 97
Fearful child - fears of crackers, dogs, ghosts
Affectionate² -when anyone is sick in the family will go and inquire.
Mixes easily with everyone
Likes to go out and play³
Irritable if demands are not fulfilled but calms down quickly.

Observation: Patient: delicate look with long eyelashes This case was the 1st case taken by the physician on the 1st day of her posting. Only father was interviewed. Overall assessment after 2 years of treatment from 97-99. Tub-b 1 M followed by Calc-phos200 weekly. Initially for 2 months and then once in 15 days. After 1 year Calc-phos 200 (3p) once in 15 days, interspersed with Tub-b in the 2nd year. In allthe patient Acute- Allergic Bronchitis, URTI or viral fever, the picture which emerged was of Arsenic-alb. Therefore Arsenic-alb 200 QDS was prescribed for 2 days and patient was > 3 in Acutes. In 1997: child has 2 episodes of viral fever, 1 episodes of URTI. In 1998 - 1 episode of all Bronchitis and 4 episodes of URTI. In 1998 - 1 episode of all URTI and I episode of Allergic Bronchitis Until Feb 99. The last episode in Feb 99 of Allergic Bronchitis required Ars-alb 200 QDS x 2 days for a complete response. C/o and itching had a fluctuating response C/o skin Urticaria came up once when they went to Sangli >3 with allopathic Rx in 5-6 days.

Learning achieved by team after the follow-ups

1. Retrospectively the understanding of the totality defined in Feb'97 was inadequate.
2. Calc-phos was a partial similar force which has shown response in the reduction of the frequency of allergic Bronchitis.
3. The question arose was, why should Koch's with Pleural effusion come up if Calc-phos was the similimum. Therefore a review was conducted.
4. In an 8-yr old child with H/O fever for 8-10 days, liver 2 FP especially Lt. Lobe with crepts on chest examination, how fast we seek an urgent x-ray and 2nd opinion of the chest physician. Learning was how an opinion taken at the right time enhances our clinical knowledge.
5. Pleural tapping was advised for diagnostic as well as therapeutic purpose to relieve the pressure effects.
6. How a clear understanding of susceptibility and sensitivity helps us in Planning and Programming.
7. In 24/04/99 night Sil (30)3rd dilution has been used.

S/by Dr Rupwate-Advised Tapping Done at 2pm -200ml of transudate removed-straw colored.

On 20/4 night AKT was started because of parental anxiety up till 21/4 night after which father decided to take homoeopathy Rx.

Adenosine Deaminase (Pleural) - 86.90 Pleural fluid: Poly 04, RBC - 26.00 L:90 M: 6 WBC - 1.580 Glucose: 63 Protein 5.54.

XRC=small effusion left side (smaller than before)