Acute Tonsillitis Case Study

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Case 1:

Case description: A twelve year-old girl, whom I was treating for chronic complaints, got acute tonsillitis with the following symptoms:

The disease had been lasting since the previous day and the complaints developed gradually within several hours. She had a fever 38,2°C (101 °F). It has to be noted that she was one of the cases with lower physiological temperature – for all her life, she had had body temperature in between 35-36°C without having any thyroid related problems or other pathology which would explain this phenomenon. So we have to think as if the fever was 38,7°C. The fever was of typical remittent type.

  • pains in throat (3) worse on the left side (3) (from the beginning significantly worse on the left side)
  • swollen tonsils (left tonsil significantly more) (3) with yellowish-white coating (3)
  • white coated tongue (2)
  • burning in the throat (3) and a sensation of heat there (3)
  • the pains were better by warm drinks (3) and worse from swallowing (3), more on empty swallowing (2)
  • swelling of cervical glands (2)
  • red cheeks (2)
  • in general, she felt hot and wanted to be uncovered (3)
  • headache in temples (2)
  • vertigo when rising from bed suddenly (1)

That was all I managed to get. There were no other modalities concerning fever, generals, mental or emotional symptoms. (This is quite common because children usually find it difficult to give clear information.)

Note: the numbers behind the symptoms mean their intensity2

Selection of symptoms:

In this particular case, we have a difficulty finding rare and peculiar symptoms. I was able to find only two such symptoms: the left sided pain (we cannot explain why it is just the left side) and the amelioration of the pains from warm drinks (when there is an acute inflammation or abscess, the pains are usually worse from heat and better by cold). We might consider the burning character of pain peculiar as well because in tonsillitis, it is not so usual and not every patient with this diagnosis will have such type of pain. What I have usually seen in patients with tonsillitis, was sharp, cutting or stitching type of pain. Because some colleagues could oppose me in this subject, I will put this symptom among the intense ones for the sake of correctness, but since the patient reported it very clearly and intensely, we definitely have to use it.

Peculiar symptoms:

  • left sided throat pain and inflammation of tonsils (3)
  • throat pains better by warm drinks (3)

Intense symptoms:

  • burning pains during tonsillitis (3)
  • sensation of heat in the throat (3)
  • throat pains worse from swallowing (3), esp. empty swallowing (2)
  • yellowish-white coating on tonsils (3)
  • general sensation of heat with a tendency to uncover (3)

I did not use symptoms like red cheeks, swelling of cervical glands or white coated tongue because they are pathognomonic symptoms and are not either peculiar (with regard to the pathology), or very intense. Vertigo when rising is quite common during high fever and in this case, it is not intense either.

Note: it is not always necessary to repertorize acute cases, but for the sake of completeness, I will state the relevant rubrics from the Synthesis repertory:[1]

THROAT – PAIN – left
THROAT – PAIN – warm – drinks – amel.
THROAT – PAIN – burning
THROAT – HEAT
THROAT – PAIN – swallowing – agg.
THROAT – PAIN – swallowing – empty – agg.
THROAT – SUPPURATION – Tonsils
GENERALS – ABSCESSES – pus – yellow
GENERALS – HEAT – sensation of
GENERALS – UNCOVERING – desire for

What I found very peculiar in this case was the fact that the patient felt warm in general, wanted to be uncovered and had the sensation of heat in the throat with burning pain and yet, the pain was better from warm drinks. So I was looking for a remedy which has left sided throat pains (or general left sidedness) better from warm drinks and is warm-blooded in general.

Differential diagnosis of the most relevant remedies:

Sulphur has left-sidedness, burning pains, sensation of heat in affected parts and a general sensation of heat (esp. in bed) as keynotes. Redness of face is quite normal in fevers but it is also in favor of Sulphur as plethora is a keynote of this remedy. We can find it in the second degree in the rubric THROAT – PAIN – warm – drinks – amel. in the Synthesis repertory and in the original Kent’s repertory.

Chamomilla is a warm blooded remedy which has amelioration of most local complaints (except toothache) from warm applications. It has throat pain better by warm drinks. There are no other confirmations and none of the mentioned symptoms are keynotes of this remedy.

Lycopodium is an important remedy for tonsillitis with pains better from warm drinks and it can be worse from heat in general, although it is not a keynote. However, right-sidedness is a big keynote of this remedy and it is therefore a contraindication. We could have thought about this remedy if the inflammation had originally started (or had been worse) on the right side and then moved to the left side, but it was not so in this case.

Arsenicum album has local and general amelioration from heat (except for headaches) as a keynote and it is valid for throat pains as well. Burning character pains is another strong keynote of this remedy, but it has two contraindications in this case, mainly its general aggravation from cold, which is a keynote, and also right-sidedness.

Hepar Sulphur also belongs to main remedies for complaints ameliorated by heat – it is its general and local characteristics and it is often indicated especially in suppurative forms of tonsillitis. As was the case with Arsenicum, Hepar Sulphur is also generally worse from cold. It is one of the chilliest remedies in the materia medica.

Sabadilla has left sided throat pains which are better from warm drinks, but this remedy has general chilliness as a keynote.

Alloxanum is a small remedy which has left sided burning pains in throat better from warm drinks, but this remedy is generally chilly.

Rhus toxicodendron covers throat pains better from warm drinks and is a left sided remedy. It is contraindicated by general chilliness.

Lachesis is one of the main remedies to think of in left sided tonsillitis. It covers the aggravation from empty swallowing (together with Kali Carbonicum, Mercurius, Lac Caninum and other remedies) and it is generally worse from warmth. The problem is that throat pains of Lachesis are worse from warm drinks.

Choice of the remedy:

The remedy which has the most keynotes (namely five) in the case is Sulphur. There is no contraindication for it and we can find a lot of confirmation for suppurative tonsillitis with swollen cervical glands in materia medica from J.T.Kent[2], J.H. Clarke[3], C. Hering[4] or S. Hahnemann[5]. The amelioration of the throat pains from local heat can be found in Hering’s Guiding Symptoms of Our Materia Medica.6

Prescription: Sulphur 30C every 2 hours

Outcome of the treatment:

After 3 doses of Sulphur 30C the patient felt significantly better, so the dosing was stopped. She did not report any initial aggravation but this is not an uncommon thing in intense acute cases where the symptoms are at their peak. The remedy was correct because in a few hours, the fever went down, the pains diminished considerably, she felt much better in general and the swelling of tonsils gradually subsided during the next 24 hours. From my experience, in tonsillitis, swelling usually goes away more slowly than pains or fever. I advised her to be careful and rest for a few more days in order to avoid a relapse which can occur when a patient starts feeling much better quickly after a homeopathic remedy and starts exerting herself. She has had no other episode of tonsillitis for 18 months now, but during the course of her chronic treatment, she has had some episodes of colds.

Discussion:

This case was interesting from several points of view. First of all, it reminds us that homeopathy is not a mechanical thing and it is not possible to make routine prescriptions (apart from a few exceptions). Sulphur is not a remedy that most of us primarily think of in cases of tonsillitis. But what the law of similars tells us to do is to simply find a remedy that covers the most characteristic symptoms of the case and if possible, such symptoms should be keynotes of the selected remedy (characteristic symptoms of the remedy). In homeopathy, a diagnosis usually plays a very small role in the choice of the remedy. It is important as far as the prognosis and case management are concerned and in some cases, it is helpful to know what is behind the symptoms, what is the origin of the pathology. For example, we know that Sulphur also belongs to important remedies for abscesses in general. But what is the most important is to match the most characteristic (unique and individual) symptomatology of the patient with a remedy, for which this set of symptoms is also unique and characteristic, regardless of the diagnosis. Somebody might oppose that Sulphur does not have the most peculiar symptom of the case – the amelioration of the throat pains – as a keynote, but it is a local symptom, whereas the other keynotes (the general aggravation from heat, sensation of heat, burning pains and left sidedness) are generals which are always more important than local symptoms.

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