The infective hepatitis was previously termed as catarrhal or catarrh of the duodenum . Recent studies have tended to confirm that it is due to virus . As we all know that virus enters the body through the oral cavity ; the human faeces and urine are sources of infections < Direct personal contact with the infected person or carrier of the virus is responsible for the sporadic cases that we see in the clinical practice
Every year in about autumn or spring , I have come across a number of caes this type hepatitis and usually the children are affected . The only epidemic that I have seen is usually caused by the pollution of water supply . During the epidemic of the disease the majority of the persons affected are young adults rather than children .
We shall however continue to see sporadic cases in the population of the young . It is mostly with these cases that we are concerned . It is very difficult to locate the source of infection . Fortunately the cases are scattered and do not give rise to any wide spread incidence .
Most of us are quite familiar with the clinical features . This infection is that the onset is variable – some children start with sudden high fever while other have only a low fever or no fever at all . Very often patients starting sudden violent beginning , recover quicker where as those starting with an insidious onset take longer to recover . one must remember that ther are many cases which are non-icteric . I have treated a number of cases where they hardly developed any icterus , some of these were mild infections and in others the curative remedy was given early enough , but it must be remembered that some of the worst cases may not have any pre-icteric phase . In the pre-icteric phase the most annoying symptom that I have come across is the vague pains which they develop on the 2nd , 3rd day of the fever –refer to the epigastric region of the right hypochondrium . This is not a colic but a continous tormenting pain which makes the patient most miserable , this is usually aggravated by eating and drinking . Along with it may be present nausea and vomiting . these pains are due to stretching of the peritoneal covering of the liver , which is enlarging because of the inflammation . in this earlier stages one may not be able to find hepatic enlargement . few coupled with this pain plus nausea and lethargy have been enough to indicate to me the suspicion of infective hepatitis in the majority of cases .
I have been correct in nine cases out of ten , this pain was present in about 25% to 30% of my cases in children . the problem of relieving the pain and treating the patient at this stage is fairly difficult as the modalities are not usually marked . Remedies prescribed on the symptoms of nausea e.g., ipecac, arsenic album , do not usually relieve the pains which last for 24 hours to 72 hours . The patient usually keeps his hand on the hepatic region or rubs it . I prescribe if there are intermittent , sudden pains bryonia is often useful , when the patient would rather lie quiet and the pain is worse on motion . Ferrum phos and kali mur helps at times , a bio chemic combination of mag phos , kali phos and kali mur , especially when the pain symptoms are vague and do not lead to any other definite drug . in a particular case where the patient complained a sort of knot in the epigastric region and do not respond to a number of medicines ; ceanothos Q gives a prompt relief , just as this pain subsides I usually find the liver becomes palpable and even appreciably enlarged .
Nausea and some times vomiting are other important symptoms which are not uncommon . anorexia is marked for the first few days in almost all cases , during this stage I had to observe the patient very carefully before I could prescribe the correct remedy . the phosphorus case will demand icy cold drinks but the stomach will return the same after a few minutes ipecac or arsenicum album , nausea and vomiting are well known colchicum and sepia when odor or sight of food caused nausea . in one case of the most trouble some variety with prostration and tenderness in the epigastrium , I had to prescribe cadmium sulph , resistant anorexia , nausea and even vomiting may be present for quite a few days before jaundice appears pulsatilla and sepia have helped me when the high fever –there was no thirst , in some cases even nux vomica came handy . ars.album in its pattern of vomiting . In summer months I had to prescribe occasionally antium carb –the usual ant.crud tongue and history of excessive swimming was present by the time vomiting a hates a little , the jaundice makes its appearance and the enlargement of the liver is marked . now is the stage for me to prescribe according to the changed picture . in the previous medicine is still applicable and the patient has been improving , I let him continue it more often however there is a need for another remedy , often the symptoms are non-descript and one thinks of usual jaundice remedies like chelidonium chionanthus etc., here I have been guided , provided there are no other specific indications for a particular drug , by the location or enlargement of the particular lobe of liver if it is left lobe then the drug is card.mar and if it was the right lobe then chellidonium . in my experience card. Mar has helped me in more than 50% of my cases cardamus mar Q has a specific affinity for the liver as such and more specially for the left lobe of the liver
Card.mar as revived by the electic school and since then it has been a part of our materia medica , It is indicated even earlier in the picture i.e., pre-icteric stage when there is still nausea . in the proving there is intense nausea with painful retching , vomiting of sour greenish fluid marked want of appetite hepatic region sensitive to pressure paste like clayey stools without bilious coloring , urine scanty ; brownish in color and containing bilious color matter urine turbid golden yellow . general feeling adds comfort , lassitude and malaise very often this drug has helped me right form from the beginning of the case to complete recovery . chionanthus , chellidonium etc., are other common favorite drugs for the jaundice but I have come to the conclusion that cardumus is more often indicated in the infective type of hepatitis than any other drug . I have also observed that the liver is enlarged much more often transversely than vertically i.e., left lobe is more often enlarged , with the appearance of jaundice usually vomiting and nausea stop ; the appetite begins to return and the stool shows signs of whitishness . About this time I notice that the enlargement of liver is more pronounced ,the liver becomes firmer also occasionally the patients have loose motions whitish offensive stools , whenever they have loose and offensive , I give podophyllum which again is a grand liver remedy .
The patient wants to place his hand on the region of the liver and on rubbing it . even if the loose watery diarrhoea occurs in the earlier phase of the disease I use podophyllum unhesitatingly .
As many of you must have observed that in the matter of appetite patient swings from one extreme to another at this stage of sickness , he starts crying for more food . If the increase in appetite is moderate it should be considered normal and should not be interfered with . At time the appetite is inordinate . Here china to my aid . it promptly takes over the patient and usually accelerates the progress .
Other drugs that have been useful at this stage are pulsatilla , lycopodium , natrum sulph , kali mur , iod, is indicated, if I find spluttering , noisy and clay colored stools cina served me when there was inordinate appetite with great irritability , lycopodium was my sheet anchor when with this increased appetite there was irritability of the child on waking from sleep .
In my experience with children suffering from this infection I have come across pruritus rather infrequently . usually it has been mild . Dolichos is the drug which I have often employed and allayed the itching .
In my practice that period of illness i.e., from onset to the clearing of icterus has ranged usually from 8 or 10 days to 3 or 4 weeks . In the untreated cases the average range has been from 3 to 6 weeks . In a number of children , the enlargement of the liver subsides rather slowly . post hepatitis enlargement yields to the constitutional remedies . often I found that card,mar. reduced the enlargement in remarkably short time . in adults in one or two cases , I have met with what is known as post hepatitis syndrome and that too when they had already been treated by medicines other than homoeopathy . the patient suffers from great mental depression anxiety , anorexia , weakness and intolerance of fatty food . the liver continues to be palpable . in one case of a female , I was able to relieve her only partially . such case have to be treated constitutionally .
We must remember that in infective hepatitis sometimes the damage to the liver is so much that hepatic necrosis and cirrhosis can result . we can prevent the liver degenerating to necrotic or fibrotic changes . homoeopathy offers a very positive and dependable therapy for hepatitis .
A old aged 76 years resident of Chikmagalur town came to my clinic with his wife with blood report as under :
Blood examination: he was in an advanced stage of jaundice
Serum billirubin level was : 8.2mg%
Direct billirubin 6.5%
Urine examination : Bile salt –positive
Bile pigment –positive
As a last effort he decided take homoeopathic medicines . jaundice was the only sign and he did not describe any other symptom . the only thing which I could observe from his face was an expression , probably the patient was aware of the seriousness of his illness . I got a good history from the patient who was unwell since a month . The past history how ever revealed that he was under a lot of mental stress . He developed loss of appetite ,weakness , malaise and nausea , he also noticed that urine was turning dark yellow color , stool is white color , eyes are dark yellow color . He was reduced causing weight loss and nutritional deficiency . He was dull and timid , he received some treatment from a local doctor but in vain finding no relief . the patient was of a dark complexion , he had poor appetite , sleepiness , mild pain in fore head , excessive debility and conjunctive ,his tongue and especially his palate was strikingly yellow , suffering from pains and vomiting also ,constipation ,fever
Homoeopathic Treatment :
1.chelidonium 30 2.cardus marinus Q 3.natrum phos 6X 4.china 200
chelidonium30 was given for one week
nat phos 6X daily 4 doses
with in a few days the stool turned yellow , the skin and eyes and tongue ,palate resumed their natural color and after a week , the urine was devoid of bile salts and pigments . not once after the first dose of the remedy did he suffer from pain or vomiting .
I prescribed chelidonium 30 daily 3 doses reduced to 2 doses with in a week , no more nausea vomiting . the yellowness of skin disappeared gradually with urine test free from bile pigments and salts . The patient regained his lost weight and energy at the end of 3 weeks
Natrum phos 6X daily 4 doses with in a few days the stool turned yellow
After 3 weeks later the patient then recovered remarkably , good appetite and weight increase by 3 kgs , motion normal , no head ache , no giddiness .
The Australia antigen test was negative after one month . all liver function tests , also came normal and negative .
Blood examination :
Total bilirubin ………2.2mg%
Direct bilirubin ……..1.41mg%
S.G.O.T …………….28 IU/L
Uric acid …………….3.9mg%
Urine examination :
Bile salt …………….negative
Bile pigment ……….negative
THE ORIGINAL PATHOLOGICAL REPORT COPIES HAVE BEEN SENT BY POST – RELATED TO THIS TREATMENT OF THE PATIENT.