Mary was an a thin, athletic 11 year-old child with chronic asthma. Her asthma had started at five months old, and had been severe for the next two and a half years. She was a forceps delivery. She was never breastfed, and was put on soy formula at birth. Solid food was introduced at 4 months. She had had chickenpox twice, once at four months and again at age 9. She had had fever and irritability after a DPT shot. She had had one wart on her elbow. Her 19 year-old sister had developed asthma after Mary.
Mary’s asthma had continued since infancy and now was of particular concern because she played sports. She was a very competitive swimmer and soccer player. Whenever she would get a cold, it went into asthma. Her lungs would tighten up and she would develop loud, squeaky wheezing. The wheezing was worse on inspiration.
Attacks were induced by viral illnesses, pollen or exercise. She was very reactive to grasses, mold, wool and rabbit dander. Her asthma was very definitely worse from being exposed to cold, damp air. Her typical pattern was to get a runny nose or ear infection which would proceed to a cough, sore throat and wheezing. Then she would be treated with prednisone or antibiotics, which would relieve the symptoms for a while.
Mary was a popular child with many friends. She liked music and being social. She always pushed herself to be the best, and doing well at sports was very important to her. She could be irritable at times. She denied anxiety, but she had a long history of fingernail biting.
She desired candy, spicy food, hamburgers and pizza, and was averse to eggs.
Her body temperature was normal, but she could get cold at night. Her hunger and thirst were average.
The remedy that was given was Natrum sulphuricum 6C, T.I.D. This remedy is one of the main remedies for pediatric asthma that is worse from cold, damp weather, indicating the presence of the sycotic miasm, which originates from an ancestor having had gonorrhea. Mary took the remedy for four weeks and returned for follow-up. She had had two weeks of increased congestion after the remedy, but her asthma had decreased markedly. She had only had one incident of slight wheezing the day before the visit. While at camp she had fallen on her back and bruised a rib. She had some residual back pain which was resolved by a dorsal spinal adjustment.
Mary continued the remedy once a day and stayed well for two months until mid-September. Then she developed increased congestion in the middle of the night, or morning which caused her to expectorate thick yellow mucus. This had come on after swimming in Lake Washington. She was not wheezing. She was given Dulcamara 6C, TID, which is useful for autumn colds that are brought on from getting wet. The Natrum sulphuricum was discontinued. Two weeks later, she returned after becoming worse. A runny nose with thin discharge had started after the Dulcamara and she had developed wheezing and coughing. She wheezed much more at night between 2 and 3 A.M. Ice water helped the wheezing a lot. Her wheezing would improve from exercise now, rather than becoming worse. She continued to desire sweets and pizza. She was feeling very sensitive to the cold. She was still biting her nails, but not anxious. Dulcamara was discontinued and Kali carbonicum 30c at bedtime was given acutely because of the severity of the nighttime attacks, the chilliness and the time of aggravation. The nightly asthma attacks ceased within a few days on Kali carbonicum and Natrum sulph was begun again in 30C potency, once daily. The Dulcamara had apparently caused a relapse, and Natrum sulphuricum was needed again to finish its work.
After two weeks on Natrum sulphuricum, Mary was only wheezing slightly in the morning on waking, with some coughing at 6 A.M. She was still very chilly at night in bed. She complained of sinus congestion at the root of the nose, and had a thin nasal discharge. Her wheezing was better from exertion. She had a desire for ice water and candy. She was not worse from damp weather now. She was sleeping well. She was continuing to be quite competitive in sports and band. Her irritability was worse, especially in the morning. She did not like drafts of air. She was getting cramps in her side during exercise. Natrum sulphuricum was discontinued and Nux vomica 6C, TID was begun because it fit her symptoms and was expected to be her constitutional remedy which would finish the case. Six days later she developed a red, itching rash on her face after exposure to cat dander. Her face was puffy. She had some wheezing on exhalation. Her sinuses were not congested now. She wasn’t as chilly and had no cough. Within a week, she complained of nasal discharge that was yellowish and clear, a barking cough which had come and gone. Her wheezing was only in the morning and not severe. She was paler than usual and felt tired. The rash had disappeared. During sports she had been knocked down several times and had the wind knocked out of her, which gave her a fear of suffocating. At this point, the remedy action was unclear with the skin eruption and discharge possibly indicating signs of cure.
Three weeks later, Mary’s asthma was much better. She coughed up a little clear mucus in the morning. Her runny nose had stopped. She had broken out in itching hives on her knee for 25 minutes after icing it. She was able to be around a dog without reacting to it. She had a rash on her forehead once for a few hours. Mary was sleeping well now, but still somewhat chilly at night. She had a sore throat for a few days which didn’t develop further. Her energy for sports was a little less than usual. At this point it looked like Nux vomica was working.
Nighttime wheezing at 2-3 AM returned, however, several weeks later. It began after slight cold symptoms. Kali carbonicum 30C, given acutely, relieved her. Hives after exposing her body to the cold returned. She felt cold after drinking ice water. She would get a blotchy discoloration on her face if she touched cat fur. There was no family history of tuberculosis which might have indicated the nosode, Tuberculinum. The allergy to cats might lead to its possible prescription in the future, even though she did like cats, rather than hate them. She went to Arizona for a soccer camp and while there, wheezed a little during practice. She still desired sweets and ice cream. Nux vomica was continued at this point, although in retrospect, the fear of suffocation, her chilliness, and hives from cold applications were beginning to point to the next remedy.
Two weeks later, Mary was not much better. Her toes would break out in blisters and swell after exposure to the cold. She had occasional nasal congestion, but much less in general. She had had one episode of hoarseness. She would sometimes wheeze at night now and clear out mucus, but no severe attacks.. There was not much coughing. Her eyes itched a little. She was having some difficulty writing complex sentences, similar to her difficulty in second grade.
At this point, the case was reviewed and seemed to be off track. Nux vomica had not given as much relief as expected, and Mary was still not as well as she had been after the first remedy. Asthma and congestion were continuing, although in a reduced way. The initial success of Natrum sulphuricum had not continued after Dulcamara was given.The major symptoms now were nightly aggravation of asthma and aggravation and skin eruptions from the cold. Since the focus had shifted to skin eruptions with asthma, aggravated by cold, and at night, Kali carbonicum and Arsenicum album were considered. Arsenicum 6C TID was begun.
After two months on Arsenicum, all of Mary’s wheezing had stopped. Her endurance had increased markedly. Only slight congestion had occurred. She was not having any anxiety. She was sleeping well. She still reacted to cats, but only slightly and could have a cat around now. Now she was not sensitive to the cold at all. She had had no hives. She still desired sweets, however, which is not unusual in children.
In reviewing the entire case, we can see that Natrum sulphuricum was correct as the first prescription and produced considerable benefit. Dulcamara definitely caused a relapse, probably because it’s picture is close to Natrum sulphuricum, and it ruined much of what had been accomplished by the previous remedy. Kali carbonicum was quite helpful in the acute nighttime aggravation, and prevented further allopathic intervention. Nux vomica, however, was prbably not correct, even though it fit her chilliness, her competitiveness and irritability, and is listed for children’s asthma in the repertory. Nux vomica may still have usefulness in the future as what Dr. Eizayaga calls a functional remedy. The increasing aggravation from cold, nighttime aggravations and the new development of anxiety about suffocation finally led to the successful prescription of Arsenicum album. Arsenicum had never been considered before due to Mary’s complete lack of anxiety with the asthma, which is uncharacteristic of Arsenicum cases. Some cases, however, do not have mental or emotional pathology, and must be prescribed for based on the physical symptoms alone.
This case shows the evolution of the case towards the prescription that was most effective, but which was not obvious at all at the beginning. It also shows the necessity for careful follow-up to evaluate the results of each prescription, and how a case with two wrong prescriptions may still be treated successfully if the correct remedy is found.