Dr Gheorghe Jurj, MD, DScCourse: Visual Semiology

XXIX Brazilian Congress of HomeopathySão Paulo, 2008

• 6 year-old girl, consults with fever (39.4 oC) and erythematoustonsillitis.

• Frequent colds with running nose and inflammation of the throat.

• Nasal obstruction, cannot breath at night and sleeps with open mouth. Cough “from the throat”, as if trying to eliminate a lump. During consultation, coughed rarely, dry cough.

• NET doctor has suggested adenoidectomy.

• 2 or 3 episodes of middle ear infection.

• In the past year took ATB 10 times.

• All along theconsultation, tossingon the chair.

• Notice her posture

• Every time, beforeanswering a question, turns to her mother

• Cannot breaththrough the nose, the mouth is open allthe time

• Dry lips, cracks onthe angles. On theleft side, eczematization

2 Gestures

Licks the corners of the mouth Bites the lower lip

• Red tongue, papillaeincreased in anterior part, whitish coatingin the posterior part; Crack on the middleline and transversally(“cross-like”)

• Pharynx congestive; large tonsills(touching in themiddle line); whitespots of suppuration

• NATRIUM: dry lips; nasal obstruction; well-behaved, quiet... But, usually with much secretions, thirst, suppurated tonsillitis is lessfrequent, congestion is not as intense.

• CARBON: perspiration of the scalp, wet hands, cold-blooded

• MERCURIUS: important remedies of suppurated tonsillitis in children, high fever, copious perspiration, thirst, copious yellow-whitish suppuration in tonsillsc

• REMEDIES OF ACUTE INFLAMMATION (Phyt, Bell, Acon, etc.): presentation is more dramataic, much more congestion

1 MOUTH - CRACKED - Tongue fissured - Centre

2 MOUTH - CRACKED - Tongue fissured

3 FACE - CRACKED - Lips

4 FACE - CRACKED - Lips - Lower

5 MOUTH - DISCOLORATION - Tongue - white - heavily coated

6 THROAT - DISCOLORATION - redness - Tonsils

7 THROAT - DISCOLORATION - redness - Uvula

8 THROAT - INFLAMMATION – accompanied by - cough

9 THROAT - INFLAMMATION - Tonsils

10 FACE - DRYNESS - Lips - licks them frequently

11 FACE - DRYNESS - Lips

puls. sulph. merc. nit-ac. bapt. apis cham. mez. nux-v. bell.

10/17 8/15 7/15 7/15 7/14 7/12 7/12 7/9 7/8 6/14

1 - 1 - 2 1 - - 2 - -

2 1 2 2 3 2 2 2 1 1 2

3 1 3 2 1 2 1 2 2 1 1

4 2 1 - 2 - 1 1 1 1 -

5 3 - 3 - - - - 1 1 -

6 2 2 2 2 3 2 2 - - 3

7 2 1 1 - 3 2 - - - 3

8 1 - - - - - 2 - 1 -

9 1 2 3 3 2 2 2 1 1 3

10 1 - - - - - - - - -

11 3 3 2 2 1 2 1 1 2 2

• Calm, quiet, “perhaps too quiet”

• Cries easily; always asks permission to do anything

• Thirstless, esp during fever

• Sleeps rolled up or on the back, with the handson the head

Pulsatilla 30x e/6-8 hours until resolution of tonsillitis, then 200CH for 1 month.

No further recidives appeared; tonsillectomy was ruled out

1. “Mental atmosphere”, reflected also in her posture: sitting on the edge of the chair, with fixed hands; turning always to look for her mother

2. Nasal obstruction, esp in the night – constant of Pulsatilla in children. Although a generic sign of adenoidism, according to the context its value may increase.

3. Licking the lips – its value is increased by the local context (lips, tongue, pharynx)

4. Although tonsillitis is suppurative, secretion is white, in relatively welll delimitatedareas, on a background of intensely red congestion, but not as in Bell, Lac-c, Merc orLach. Moreover, as in Apis, tonsills are swollen, touching each other on the middleline (Bar-c) but no other symptoms of these remedies are present.