Case Of Empyema And Homoeopathy

Mr. S.M aged 18 resident of mangalore , 27^th September 1998 was suffering from fever of the remittent type for the last 34 days with aggravation in the considerable dyspnoea , on examination the whole of the left side of the chest was dull on percussion

There was just a slight respiratory murmur at he apex of the left lung . the intercostals spaces were as it were filled up and almost bulging as if from fluid pressure from with in , there was much cough but no rales in the right lung heart beats exaggerated and visible , considerable bulging of the skin , but no enlargement of the liver tongue slightly furred

I diagnosed the case to be one of pleuritis of the left side with effusion filling up the whole of the pelural cavity causing shrinking of the whole of the left lung and probably pericarditis with effusion . I gave broyona 200 , report was that the patient was better and cough and dyspnoea were less continued bryonia 200 , follow up report was brought in the morning that the cough was worse , but in the other respects much the same thinking the increase of cough was due to an aggravation of bryonia 200X gave bryonia 200X , report of strong fever yesterday sent aconite 200X

Fever less but cough worse , bryonia 200X next patient brought in the morning

A swelling about the size of a small orange with distinct , fluctuation , was observed about 3 inches below left nipple. the dullness of left side was the same as before , fever was less but cough no better , the swelling appeared to me to indicate Pulsatilla and not watery fluid as I had at first

I prescribed sulphur 200 in the hope of the causing absorption of the fluid what ever it was and also to allay the cough which was very trouble some follow up report came that the patient was better as respects the cough , otherwise much the same .

13^th report came that the patient was better aspects the cough , otherwise much the same , continued sulphur 200 . patients father reported that the swelling had increased and became more fluctuating . As my own health did not permit me to to visit the patient at his house and as I thought it too risky to bring over to mine .I asked the father to have the swelling explored by a medical friend of mine who resides in his neighbourhood and to make a small incision if there be pus

Follow up report was that the swelling was explored and incised yesterday as I had directed , with the result that about 4 pounds of pus had come out . stopped medicine

Next report that the discharge through the opening made is pure pus and about ½ pound daily patient brought to me in the morning found pus freely discharging in considerable quantity through the opening . patient was better in every other respect ; fever and cough were less and breathing easier . But respiration was not fully established . To check the suppurative process

I gave silicea 12 X which was continued till after which the improvement being stationary .I changed the dilution to 30^th centesimal which was continued , but no further improvement following I again stopped all medicines , report was that the patient was almost the same the slight fever hanging on still gave sulphur 200 from this day improvement became rapid the discharge  ceased and the opening through which it was flowing healed up in a day or two . the fever and the cough disappeared and there was great cry for more food than was allowed

Patient again brought that morning , I was glad to find him nearly all right , the fistulous opening quite healed , the respiration fully established in the upper and partially in the lower part of the affected lung , though still frequent being 28 in a minute , the swelling over the pericardial region quite gone continued sulphur and ordered a bath to be given tomorrow , patient brought again and I saw he was found better , still stopped medicine . It is difficult to say whether this was a case of suppurative  pleuritis from the beginning or of simple pleuratis from thr beginning of simple pleuritis with serous effusion taking on degenerative suppurative changes in the course of treatment when the patient was brought to me thirty four days after the commencement of illness , there was nothing to lead me to infer that there was pus in the pleural cavity . Taking the fluid which had filled the whole the whole of the chest to be ordinary serous effusion and having regard for the jaundice and the symptom that the patient could lie only on the affected side I prescribed bryonia . It did some , but not much good in the beginning .I had to use aconite for the strong fever which had come on while the patient was taking bryonia , under aconite though thre intensity of the fever abated , the cough became more trouble some and I had to use bryonia again , but this time in a higher dilution , though the medicine was used four days , the morbid process that was going on in the pleura went on unchecked and declared its true character by the matter with in pushing itself out through the intercostals spaces evidently the fifth and sixth and forming a fluctuating swelling

The fact of bryonia falling to cause absorption of the effusion shows that it was purulent and not serous at the time the patient was first brought to me , whatever it might have been in the beginning

If the diagnosis of empyema had been positively made at once , could we have used any medicine that could cause the absorption of so large a quantity as upward of four pounds of pus ? . My experience with hephar sulph , silicea and mercurius in such cases in the past , does not return an affirmative answer to the question and it is doubtful if any thing else , than what was done could have hastened the progress of the case , which , it must be admitted , was satisfactory , it is remarkable that sulphur should have played so important , a part in expediting the recovery . this shows that probably there was some constutional taint which this prince of anti psorics corrected , I must not omit to mention that I had to mention that I had to put the patient on a very restricted diet . I forbade all juicy and acid things . I kept him chiefly on milk and allowed him wheaten bread (chapathis)only when the fever had considerably abated . I have not yet allowed him rice , which I have found to be very prejudicial in fevers , dropsies and suppurations .