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This is the case of a small girl of 8 years old, tall, thin built, pale, with sharp features, who came to me with redness, itching and pain in left eye, with watery discharge, specially on reading books. There were small eruptions around the inner canthus of the eye, which used to itch and discharge serum on scratching. She found no relief even by constant itching and rubbing her eye. Her mother informed that she could not open her eyelid in the morning due to presence of sticky, gluey, thick, white discharge and her eyelid had to be cleaned everyday with warm water, before she could open her eye properly. Small eruptions were also present in the junction of left alae nasi and face. There was also a watery discharge from nose.
One of her most peculiar features was craving for chilled drinks, ice and spicy things.
She grew angry easily, was very afraid of darkness, desired company of people, and made friends easily.
In childhood, she had suffered from recurrent loose motions, appendicitis and typhoid. Last year she had jaundice. Since then, as her parents informed, her height had increased surprisingly.
Family history revealed that both her paternal grandparents had suffered from tuberculosis.
ON EXAMINATION: Small pinkish white nodules were found in the bulbar conjunctiva, with much redness of the surrounding area.
ANAMNESIS: Craving for ice, chilled drinks, spicy food; Left sided complaints; Sudden increase in height since jaundice; Tuberculosis of both paternal grandparents.
DIAGNOSIS: Phlyctenular conjunctivitis.
MIASMATIC ANALYSIS: Inflammation in eye, itch (3 +), desire to rub eyes (3 +), cannot open eyes in morning (3 +) - Psora. Pain, more in morning; white, sticky discharge; desires really cold (3 +) - Pseudo- psora. Therefore the case is of predominantly psoric miasm.
PRESCRIPTION: Phosphorus 30, 9 doses, three times daily for three days, followed by placebo.
FOLLOW- UP: The redness of her eyes slowly decreased for the first 4-5 days, but all her complaints relapsed by the end of the week.
Phosphorus 200, 9 doses, three times daily for three days was now prescribed.She slowly recovered, with the redness, itch, lachrymation, eruptions and nasal discharge gradually becoming less and less. After 15 days, there was occasional, mild pain and lachrymation on reading. Some of the eruptions persisted.
There was no itching. Her appetite had decreased slightly. She was kept on placebo.
After 7 days there was reappearance of some of the eruptions with itching and redness. Now some eruptions could be seen near right canthus also. Phosphorus 200, 1/11 was given, 1 spoon three times daily for 4 days.
After one day of Phosphorus 200, there was marked improvement. Redness and itching disappeared and the eruptions dried up.
She is still under observation.
CASE APPRECIATION:
Phlyctenular conjunctivitis is an allergic inflammatory reaction of the conjunctiva to some endogenous toxin, which is bacterial in origin. It occurs in children who are prone to tuberculosis. The exciting factor is usually tuberculo-toxin, but toxins from other organisms like staphylococcus may also be responsible.
In this case, the little girl with family history of tuberculosis and tubercular physical built viz- tall, thin, pale, with sharp features had great tendency to tuberculosis. The two severe illnesses that she had suffered from- Typhoid at first and then Jaundice, had led to the awakening of the latent tuberculosis in her, which surfaced superficially, in mucus membrane, but in the mucus membrane of the very important organ- Eye. All her symptoms- left sided complaints, tall, thin built and sharp features, craving for ice and chilled drinks, friendly nature, fear of the dark and her history of Jaundice, indicated the drug- ‘Phosphorus’.
Phosphorus, a deeply antipsoric drug, is suited for frail, delicate people with the stigma of tuberculosis in them, who show rapid growth in height, causing malnutrition, anaemia and premature decay. Administered at proper time and at a proper potency, Phosphorus puts a check on such abnormalities. Also, Phosphorus is a great local irritant of the mucus membrane. Even the fumes of Phosphorus may inflame exposed mucus membrane of the eye, mouth and respiratory tract.
Phosphorus is usually given with much caution in the deep seated cases of T.B. But in this case, the clear cut indications, and the fact that the expression of the inherent deep seated T.B. had taken the acute form of expression as phlyctenular conjunctivitis in a superficial part of the body, i.e . in mucus membrane, removed all doubts and hesitation.
Why other seemingly indicated drugs were not given:Other seemingly indicated drugs were Belladona, Apis, Argentum nit., Euphrasia, Silicea, Sulphur.
Belladonna: The conjunctiva of the patient was red but not as intensely red as demanded by Bell, also the intense heat of Bell was absent. Belladona would not have covered the deep-seated tubercular diathesis of the patient as did Phosphorus.
Apis: Apis though covered the inflammation of eyes but the patient did not have the stinging, biting pain of Apis and nor the relief by cold water, rather she was averse to application of water on her eyes, as verified by her mother.
Argentum nit: Patient did not have purulent discharge from eyes, nor the splinter like pain of Argentum.
Euphrasia: Euphrasia, though did cover the itching, watery, inflammed eye and coryza, yet it did not cover the tubercular diathesis of the patient and the acute left sidedness of the complaint and desire for cold and spice like Phosphorus.
Silicea and Sulphur: Both the drugs covered the inflammation, and left sidedness of the complaint along with being strong anti- psoric remedies, but they do not have the intense craving of cold and spice as found in the patient.
CONCLUSION: Phosphorus, a deeply anti- psoric drug suited for tubercular diathesis, was prescribed on the basis of the acute presenting complaints of the patient accompanied by chronic concomitants of her physical and mental make up. Its prescription in this acute phase of the chronic psoric miasm of T.B., expressed as phlyctenular conjunctivitis, rooted out not only her phlyctenular conjunctivitis, but the latent lurking proneness to T.B. Had she been left without treatment, the conjunctivitis would have healed by granulation but with very little scar formation, and the lurking and untreated miasm would have found expression in some other organ, or there would have been recurrence of the conjunctivitis, finally leading to phlyctenular keratitis or involvement of cornea (fibrous tissue), leading to corneal ulceration. If the child would have been wrongly treated, it would have led to suppression of the miasm, also leading to metastasis to some other deeper seated important organ. Timely treatment removed the above three possibilities and made the child resistant to future diseases, as will be evidenced by a long term follow up of the child.
