My Experience with Gun Powder in a Septic Gangrene Case (An evidence based clinical story)

Abstract:  Septic gangrene is a rare and life threatening condition  which needs   immediate  and proper  treatment.  Modern medicine goes for higher antibiotics, analgesics, antipyretics and sedatives  along with  proper dressing  and maintains hygiene  around  the wound. If this does not respond within a short time limit, immediate amputation of part/ nearby  parts are mandatory to save the life of the  victim. To manage this type of case with Homeopathy is really a challenge.  The situation of the     case presented was  quite  different  as  the patient and her  family members  were  illiterate with no  proper medical  facility, even for dressing near their  tribal village. Above all, they had  no affordability to high cost of medicines. Only two internal Homeopathic medicines- Pyrogen & Gun Powder with haphazard external  application of  Calendula-Q  in dressing  helped   to save the life of the patient  from been handicapped. In this case, a   rarely  used  drug -Gun Powder  played  a major role in  curing the patient  and its  high value   needs  to be well  exposed  scientifically. Proper documentations with snaps of the case at each stage of consultation has been given as an evidence.
Definition of Septic  Gangrene 
Gangrene is a term that describes dead or dying body tissue(s) that occur because the local blood supply to the tissue is either lost or is inadequate to keep the tissue alive. Gangrene has been recognized as a localized area of tissue death since ancient times. The Greeks used the term gangraina to describe putrefaction (death) of tissue.
Types of Gangrene
There are two major types of gangrene, referred to as- dry and wet. Many cases of dry gangrene are not infected. All cases of wet gangrene are considered to be infected, almost always by bacteria.
Common sites in Gangrene
The most common sites for both wet and dry gangrene to occur are the digits (fingers and toes) and other extremities (hands, arms, feet, and legs).
Causes of Gangrene
● Dry gangrene can result from conditions that reduce or block arterial blood flow such as diabetes, arteriosclerosis, and tobacco addiction as well as from trauma, frostbite, or injury.
●Wet gangrene can result from the same causes as dry gangrene but always includes infection. In some cases of wet gangrene, the initial cause is considered to be the infection.         The case described here is of wet type of gangrene due to infection in the foot.
Septic Gangrene
When wet gangrene is infected severely by bacteria, it discharges toxins into the blood stream resulting  in  Sepsis. It is a life threatening condition.
Epidemiology
There are more than 1 million cases of total sepsis found each year, according to the Centres for Disease Control and Prevention (CDC). This type of infection kills more than 258,000 Americans in a year. But   particularly septic gangrene cases are very less in number due to good & prompt medical facilities now a days. The chances of diabetic septic gangrene are somewhat more due to negligence of diabetic patients.
Symptoms of Septic  Gangrene:
● Discolouration of the affected Skin
● Extreme offensive smell & discharges from infected skin.
● Oedema of affected & nearby areas.
● High fever above 101ºF.
● Heart rate higher than 90 beats per minute
● Breathing rate higher than 20 breaths per minute
● History of probable or confirmed infection
● Loss of Appetite
●Extreme weakness
 
Introduction:
It was a  hot  summer  month  of 4 ^th  May-2007. Around  1.30 P.M.,  at  Maharana  Pratap Homeopathic  Medical College, Raipur, Chhattisgarh,  I   found  some  people  carrying  an old  village lady   of around  68 years age. They entered into the college attached hospital O.P.D and were searching  the  doctors  for the treatment  . Due to lunch time, the O.P.D was  up .One of them saw me  there and requested for the treatment of the patient. At that time, I was the   Lecturer of Materia   Medica  in the  college. I accepted their request  and  thoroughly  saw  the patient. This lady patient was  from a rural village  about  60 kms away from Raipur &   extremely poor .
Case taking and First Prescription – 4 th May, 2007
On seeing and taking the detailed history of the patient, it was found,

                                                  PLATE-1
Mrs. X, Aged about-68 years, Hindu  Female

1. She  had   a  big injury  by a poisonous  thorn (which probably  remained  inside) over  the left  foot   while  going  to  the forest   10 days back.
2. Just after one day of injury, the leg swelled with pain.
3. She tried to remove the thorn  but could not  do it.
4. Next day, she dipped that  foot  into  boiled oils  for removal of  the thorn  to decrease the swelling  as  advised by a relative.
5. Immediately, there were  a number of  large blisters on the foot  which burst to produce ulcer  and it became  difficult  for her to walk.
6. Due to illiteracy, she ignored the case, moved with bare foot and did not take any medical treatment.
7. The ulcer went on   increasing rapidly day by  day with  high  fever  and rigour, huge swelling of left leg up to the  knee,  loss of appetite,  weakness, much  offensive  discharges  from  the ulcer of foot, Colour of skin-white , stool-irregular, Urine-decreased, thirst-decreased.
8. She was  treated  with Antibiotics, Antiseptic ointments   & Analgesics for the wound  but without any result.
9. Consultations by different  Surgery specialists at Raipur   advised  her for  immediate Amputation of  Left leg below the Knee.

On Examination
1. Left Foot- Swollen hugely upto the  knee, big ulcer in left foot,  Skin-white with gangrenous condition,  Smell- very offensive  from ulcer, Discharges- watery &  profuse.
2. Temp – 103 ^oϜ
3. Pulse-118/minute
4. B.P-150/90 mm Hg.
5. Breathing rate- 26 breaths per minute
 
Prescription

1. Pyrogen–200/ 1 dose ,

To be taken  immediately  in empty  stomach.

2. Gun Powder- 3X (Tablet  form)  , two tablets  thrice daily in empty stomach.
3. Dressed  with  Calendula  -Q  .

  Advised- for complete bed  rest, dressing of the foot with Calendula  -Q    every day
  &   consultation  after  3 days.
 
1 ^st Follow-up – 7 th May 2007
 
The condition of the patient had  improved a little. There was no dressing of wound  due to lack of trained person  in their village.

1. Leg swelling- decreased  10%.
2. Pain- lesser
3. Discharge  from the Ulcer- lesser and  offensiveness  remarkably  decreased.
4. Skin  colour of Ulcer- more red than before
5. Body Temp-101 ^oF
6. Pulse-100/minute
7. B.P-144/90 mm Hg.

8. Breathing rate- 22 breaths per minute
9. Appetite- Same as before
10 .Stool & Urine-regular
11. Thirst- decreased
12.Weakness- much and persist as before
 
Prescription
Gun Powder-3X  continued as before.
Dressed with  Calendula  -Q 
Advised –  complete bed rest,  to drink plenty of water,  simple food  and for dressing of the foot with Calendula  -Q  regularly.
To  consult  after one week.
 
2 ^nd Follow – up – 15 th May,2007
 

Condition of the Patient- Much more improved and encouraging.
There was again no dressing of the foot done.
1.Leg swelling- decreased  40%, healing of the Ulcer started from sides of the foot.
2.Pain- decreased
3. Discharge  from the Ulcer- little and non offensive
4. Skin, colour of Ulcer- more reddish
5. Body Temp-100 ^o F
6.Pulse-94/minute
7.B.P-140/88 mm Hg.
8. Breathing rate- 18 breaths per minute
9.Appetite- improved
10.Stool & Urine-regular
11.Thirst-Normal
12.Weakness-persist but feels better than before.
Prescription
             1.     Pyrogen–200/ 1 dose ,
To be taken tomorrow  in empty  stomach
      2.     Gun Powder -3X  to be continued as before.
      3.      Dressed  with  Calendula  -Q 
Advised for complete bed rest, drinking plenty of water, simple  food   and dressing of the foot with   Calendula  -Q  regularly.
Consultation  after 15 days.
3 ^rd Follow – up – 6 th June, 2007

PLATE-3
 
The Patient was much better. All  things  had  improved.
1. Leg swelling- decreased  80%, healings of ulcer from all sides in a rapid way.
2. Pain and soreness- little, on pressure only
3. Discharge  from the Ulcer- completely stopped
4. Skin, colour of Ulcer- little red, scaring of tissues found
5. Body Temp-Normal
6. Pulse-Normal
7. B.P-136/86 mm Hg.
8. Breathing rate- 18 breaths per minute
9. Appetite- better
10. Stool & Urine-regular
11.Thirst-Normal
12.Weakness-less.
The patient started walking and carried on with her routine work.
 
Prescription
 
Gun Powder-6X  to be continued as 2 tablets twice daily in empty stomach.
Advised not to do much pressure work and to avoid water contact. Dressing to be continued  with Calendula  -Q  regularly.
Consultation after 15 days.
4 ^th Follow –up – 17 th June 2007 

PLATE-4
 
 
Now  the  Patient  was quite all right.  Healing of the ulcer fully  completed. Only white spots were there. No more pain and swellings  . The appetite, stool, thirst were normal. Weakness -no more.  Patient was doing  her  work smoothly.
            In this case, the medicines  –  GUN POWDER , PYROGEN & CALENDULA had done excellent work. They  saved  the life of a lady  from a situation  of been handicapped.
                                  Let us discuss  in detail about the role, nature and other utility of   the homoeopathic drug  GUN POWDER , which  played an important and major  role in the above case.
GUN  POWDER  REMEDY:  AN  ILLUSTRATION
This medicine can be called as  a HOMEOPATHIC  ANTIBIOTIC  due to its multifarious  effects in wound healing.
Dr. John  Henry Clarke: The Prover of Gun Powder
It  is a lesser  known remedy but very  useful in  clinical practice. This is a sure, reliable and quick acting medicine which never fails if applied in proper way. Dr.  Henry Clarke, M.D. has extensively described its characteristics & usefulness in his book – GUNPOWDER as a War Remedy in 1915.
 
Gunpowder is a black or brown explosive substance. In previous days, it was used by the soldiers in wars. It  was the first and only explosive used in gunnery and blasting, until it was eventually replaced by more powerful organic nitrogen compounds. It is now used primarily to detonate other explosives.
Colour- Traditional Gun Powder is Black in colour.
Composition
 This is a three-in-one remedy. So, it is much  more powerful. This type of  remedy combination is rarely found in  any other Materia Medica drugs.
It contains – Sulphur, Carbon/Carbo veg. (Charcoal) & Potassium nitrate or Saltpetre.
Proportion-(by weight)-Approx-70-80% Potassium nitrate-10-15% each Charcoal/Carbo veg and   Sulphur.
 
Actions
•         As Gun Powder contains three important constituents like Sulphur, Carbon & Saltpetre, so it has  powerful and effective  action on skin problems like that of  Sulphur(Inflammatory process in boils, eruptions, suppressed impurities & Sepsis, Blood poisonings), Charcoal-Carbo veg.(Disinfectant properties) & Kali Nitrate(  powerful action on skin as suppuration, oedema ,opening pores etc.  ).
Carbon and Sulphur with Kali nitrate are very potent antiseptic and germ destroyer. So, Gun Powder acts on blood as to render it antiseptic, or to assist/ increase its normal antiseptic action.

2 .Boericke, William.(1996), . Pocket Manual of Homoeopathic  Materia Medica & Repertory, Reprint ed., B. Jain Publishers(P) Ltd., New Delhi
 3. www.medicinenet.com/gangrene/article.htm ,Gangrene infection causes, symptoms & treatment.
4. www.healthline.com, reference library, sepsis: symptoms, effects & causes- healthline.