Homoeopathica February 2008
By P. N. Pai
Diarrhœa may be defined as a sudden and abnormal increase in the frequency and change in the consistency of stools. Acute diarrhœa is usually associated with dehydration and electrolytic disturbances, which are often severe in children.
In India diarrhœa is the second leading cause of death in children and it accounts for about 20% of hospital admissions and 7% of deaths. [This was written in 1964 - Editor.]
Homœopathy has a good deal to offer in the treatment of diarrhœa, even in the moribund stages, but probably its efficacy has not been demonstrated well so far.
It is necessary to pick out a few remedies and their infallible indications since almost all the severe cases in the advanced stages present very similar pictures and few children are in a condition to narrate the symptoms. No time can be lost in studying and selecting remedies.
With a desire to verify the efficacy of our remedies, simplify the treatment of such cases and if possible, add a useful chapter to our existing literature, a study of 500 cases of acute diarrhœa in children was undertaken in collaboration with my friend, Dr V. B. Athavale, a senior and reputed paediatrician of Bombay.
METHODS AND MATERIAL
Severe cases of infantile diarrhœa are seldom treated in private practice and all such cases are admitted in allopathic hospitals even by the best prescribers. Most of these cases have a sudden onset and a severe and rapid course, and it is not possible to say that early treatment can stop the progress, because this has not happened in the best hands in a number of cases.
Correction of fluid and electrolyte balance in most of these cases is as important as medicinal treatment. It is worth mentioning here that a three year old child with severe diarrhœa and dehydration recovered completely with intravenous fluid therapy only and no medicines were given. This may be a chance cure, but it underlines the value of the therapy.
All severe cases of diarrhœa were admitted in private nursing homes for the purpose of efficient management and homœopathic treatment was carried out in all the cases.
This study covers a period of five years from 1958 to 1962. All the interesting findings and the method of treatment are discussed in this paper.
CAUSES OF DIARRHOEA
Causes of diarrhœa are said to be infective, dietetic and parenteral, but practically all the cases of acute diarrhœa with dehydration and electrolyte disturbances are infective in origin. The causes of diarrhœa as given in the history are in fact predisposing factors. These are listed in Table One.
Table 1
| Causes of diarrhoea | No. of cases | Percentages |
| 1 Teething | 177 | 35.4 |
| 2 Starting bottle feeds | 120 | 24.0 |
| 3 Starting solid food and allergy . | 53 | 10.6 |
| 4 Eating earth, coal and mud | 31 | 6.2 |
| 5 Colds and cough | 52 | 10.4 |
| 6 Measles | 13 | 2.6 |
| 7 Worms | 36 | 7.2 |
| 8 Change of residence | 18 | 3.6 |
| Total | 500 | 100.0 |
Dentition and starting of bottle feeds were the causes of diarrhœa in 297 (59.4%) of the cases as is seen from Table 1. In spite of these various predisposing factors, the presenting pictures were similar and the symptoms in all cases were covered by one of three remedies, as will be discussed later. An appreciable number of children were suffering from recurrent diarrhœa and the cause of the attack in none of those cases helped in the selection of the remedies
Thus an inference can be drawn that the causative factor may not guide one to the selection of a remedy in the desperate stages of acute diarrhœa and the acute exacerbations of chronic diarrhœa. It is surprising to note that out of the 177 cases of dentition diarrhœa in the advanced stages, not a single case had the symptoms of Chamomilla, Podophyllum, Calcarea phosphoricum or Silicea. It is worth mentioning here that the period of primary dentition extends from the age of 6 months to 2 years and it is not correct to describe any diarrhœa occurring during this period as dentition diarrhœa.
Dentition itself generally gives rise to mild moderate diarrhœa not associated with dehydration. Therefore, in the above cases, dentition has no role as a causative factor.
Hence, remedies like Cham, Calc phos, etc, recommended for dentition diarrhœa, are likely to fail in these cases as confirmed by our experience in the above cases. These remedies, however, act very well in mild to moderate cases not associated with dehydration.
FAMILY HISTORY
Definite and relevant family history could be obtained only in 110 cases as detailed in Table Two:
Table 2
| Allergy | No. of cases |
| Allergy to milk | 15 |
| Allergy to fats | 11 |
| Allergy to pulses | 9 |
| Recurrent diarrhoea in other family members | 32 |
| Tuberculosis | 43 |
| Total | 110 |
The high incidence of tuberculosis and undernourishment in India is reflected in Table Two, as also the history of recurrent diarrhœa in an appreciable number of families. This explains why Tuberculinum and Psorinum are extremely useful as intercurrent remedies in the treatment of chronic diarrhœas but they were not used during acute stages.
THE FEEDING BOTTLE
The study of the problem of diarrhœa should embrace all the possible causative factors. Particulars regarding boiling of the feeding bottles and vessels were collected in 439 cases in the age groups from birth to 5 years and these details are given in Table Three.
Table 3
| No. of cases | Percentage | |
| Not boiled | 342 | 78.0 |
| Boiled once a day | 41 | 9.3 |
| Boiled twice a day | 23 | 5.2 |
| Boiled thrice a day | 15 | 3.4 |
| Boiled four times a day | 12 | 2.7 |
| Boiled with every feed | 6 | 1.4 |
| Total | 439 | 100.0 |
It is seen that in 78% of the cases the feeding bottles and vessels were never boiled at all. Nearly 40% of these bottles were not of the conventional type and therefore could not be washed thoroughly. This resulted in the creation of small colonies of bacteria in vitro. This is an important cause of recurrent diarrhœa in our children and must be carefully looked into when treating such cases.
VITAMIN DEFICIENCY
Malnutrition and recurrent diarrhœa form a vicious circle, one giving rise to the other. Chronic diarrhœa leads to multiple deficiencies, marasmus and kwashiorkor, especially in poorer classes. Table Four illustrates this point.
Table 4
| Deficiency | No. of cases | Percentage of total |
| Severe anaemia | 56 | 11.2 |
| Vitamin A deficiency | 44 | 8.8 |
| Vitamin B deficiency | 30 | 6.0 |
| Vitamin C deficiency | 18 | 3.6 |
| Vitamin D deficiency | 15 | 3.0 |
| Marasmus and kwashiorkor | 60 | 12.0 |
| Total | 223 | 44.6 |
The table illustrates the condition of our children suffering from chronic diarrhœa. Unless the deficiencies are treated with suitable diet or multivitamin and iron preparations our remedies do not act well. Ideally these children should get a natural and balanced diet, but owing to the poor economic conditions this is not possible or practicable in a very large number of families in our country. It is therefore essential to supplement the poor diet with concentrated tonics. This is just like supplying enough food to a hungry child and giving vitamins, etc, to children with gross deficiencies, at least till they are brought to the normal optimum level is a logical, natural and ideal method which cannot offend the homœopathic method of therapeutics. In fact, this method was found to be unavoidable to achieve good results.
DIARRHOEA AND FEEDS
All artificial baby foods are forbidden by many homœopaths who insist on feeding babies on fresh cow or buffalo milk, both of which are difficult to obtain in the “natural” form. With a view to finding out the facts in this respect and also about the general belief that diarrhœa occurs less frequently among breast-fed babies, factual information about feeds was collected in 212 cases. This is shown in Table Five.
Table 5
| Type of food | No. of cases | Recovered | Died | Percentage |
| Breast milk | 91 | 81 | 10 | 11.0 |
| Breast and other milk | 73 | 68 | 5 | 6.8 |
| Powdered milk | 8 | 7 | 1 | 12.5 |
| Buffalo’s milk | 32 | 29 | 3 | 9.4 |
| Toned milk (equal parts skimmed milk & buffalo’s milk) | 3 | 3 | 0 | 0.0 |
| Cow’s mlk | 5 | 4 | 1 | 20.0 |
| Total | 212 | 192 | 20 | 9.4 |
It is seen from the table that the incidence of diarrhœa is not high in children fed on artificial and other types of milk as compared to those fed on breast milk. Further, there is no significant variation in the mortality rates.
PRESENTING SYMPTOMS AND REMEDIES USED
Table Six contains presenting symptoms and remedies used.
Table 6
| Symptoms present | Cases covered by | ||
| STOOLS | Ars alb | Verat alb | Calc phos |
| 1 Large and watery | 0 | 106 | 15 |
| 2 Small | 164 | 0 | 0 |
| 3 Rice water | 0 | 0 | 0 |
| 4 Diarrhoea ceased | 210 | 0 | 0 |
| 5 With frank blood | 29 | 0 | 1 |
| 6 With mucus | 14 | 0 | 1 |
| 7 Without blood or mucus | 331 | 111 | 13 |
| 8 Foul smelling | 81 | 7 | 11 |
| 9 Sour smelling | 42 | 39 | 4 |
| 10 Without abnormal smell | 251 | 65 | 0 |
| 11 Yellow | 53 | 61 | 6 |
| 12 Brownish | 321 | 1 | 0 |
| 13 Green | 4 | 49 | 9 |
| 14 Black | 86 | 0 | 0 |
| 15 Acrid | 15 | 3 | 0 |
| 16 Not acrid | 359 | 108 | 15 |
| 17 Gushing | 3 | 111 | 15 |
| 18 Worms | 36 | 3 | 0 |
| 19 Vomiting small quantities | 60 | 20 | 0 |
| 20 Vomiting large quantities | 36 | 108 | 0 |
| 21 No vomiting | 98 | 0 | 0 |
| 22 Vomiting ceased | 108 | 55 | 15 |
| 23 Irritability | 111 | 4 | 14 |
| 24 Drowsiness | 210 | 8 | 0 |
| 25 Convulsions | 4 | 3 | 0 |
| 26 Cold extremities | 39 | 15 | 0 |
| 27 Cold sweat on forehead | 0 | 3 | 2 |
| 28 Cold sweat all over | 2 | 1 | 0 |
| 29 Desire to be covered | 16 | 2 | 0 |
| 30 Desire to be uncovered | 9 | 7 | 0 |
| 31 Sensation of burning | 3 | 0 | 0 |
| 32 Oliguria or anuria | 83 | 6 | 0 |
| 33 History of colds or cough | 52 | 0 | 0 |
| 34 History of bronchitis | 14 | 0 | 0 |
| 35 History of pneumonia | 3 | 0 | 0 |
| 36 History of measles within 15 days prior to the attack | 13 | 0 | 0 |
| 37 History of partaking of cold drink | 11 | 2 | 0 |
| 38 History of exposure to the sun | 8 | 1 | 0 |
| 39 Desires cold drinks | 5 | 2 | 0 |
| 40 Desires warm drinks | 8 | 4 | 0 |
| 41 Vomits soon after drinking | 142 | 62 | 0 |
| 42 Distension of abdomen | 0 | 0 | 15 |
| 43 Severe dehydration | 251 | 0 | 0 |
| 44 Fever | 80 | 41 | 11 |
The following are the important deductions from the table.
Arsenicum album
The general indications for this remedy have been confirmed. However, certain aspects need some comment. Ars has characteristically foul-smelling stools with blood and mucus whereas in 331 cases the stools contained neither, and 251 cases did not have foul stools. This was probably due to the fact that these children had been treated by others with antibiotics prior to admission to the nursing homes. The nature of stools at the onset prior to any treatment, of course, would be useful but in a majority of cases it is not possible to get the correct history in this respect. This again adds to the difficulties in obtaining the simillimum. In 42 cases stools were sour smelling and stools were not acrid in 359 cases, but these factors did not contra-indicate Arsenic. In 36 cases worms were present in the stools and this confirms the indication for Arsenic in “complaints from worms”.
Further, it will be noted that Arsenic cases had vomiting of small as well as large quantities and also no vomiting.
Convulsions were seen in 4 cases, “desire to be uncovered” in 9 cases, symptoms which are not generally expected under Arsenic.
It is interesting to note that all the cases of parenteral diarrhœa occurring in bronchitis and pneumonia were covered by Arsenic.
In 8 cases “exposure to the sun” was the precipitating factor and 5 cases had “desire for cold drinks”. Both of these do not generally suggest Arsenic at least in acute conditions.
It was not possible to get a simillimum in most of the cases and after studying the first 100 cases, the following simple indications were selected for Ars alb, which have proved to be nearly infallible. These indications are very useful in the absence of a simillimum.
1 Irritability or drowsiness
2 Small stools with or without blood or foul smell
3 Severe dehydration
4 Oliguria or anuria
Veratrum album
All the 111 cases treated with this remedy had large and watery stools, including 5 cases with “rice water stools”. Vomiting also was present in all the cases.
However, only 3 cases had “cold sweats on the forehead” which is said to be an important characteristic of this remedy. Fifteen children had “cold extremities”. In 61 cases stools were yellow and in 49 cases they were green.
The following simple indications were selected and followed in all the cases after studying the first 50 cases:
1. Large watery stools with or without foul smell
2. Stools greenish or yellowish
3. Severe vomiting or history of severe vomiting
4. Mild to moderate dehydration
Calcarea phosphoricum
One does not generally think of this remedy in acute and severe diarrhœa.
In all the 15 cases stools were large and watery, vomiting had ceased and the children were irritable.
These were the cases where Verat alb had acted partially and foul diarrhœa persisted. All of these cases had distension of the abdomen, which is contrary to its usual indication “sunken abdomen”.
The following indications were selected for Calc phos in severe diarrhœa:
1. rritability
2. Stools large, watery - may be foul smelling
3. History of vomiting
4. Distension of abdomen
Table Seven illustrates why the above indications were selected for the respective remedies.
The percentages in this table are worked out on the total number of cases covered by each of the remedies out of the total of 500 cases in order to show the frequency of occurrence of different symptoms under the respective remedies. Out of the total of 500 cases, 374 were covered by Arsenic, 111 by Verat alb, while Calc phos was indicated in 15 cases. It is also necessary to compare the frequency of occurrence of symptoms under different remedies with the total number of cases in which the respective symptoms appeared.
Table 7
| Symptoms | No of cases | Cases covered by | |||||
| Ars alb | % | Verat alb | % | Calc phos | % | ||
| 1 Irritability | 129 | 111 | 29.7 | 4 | 3.6 | 14 | 93.3 |
| 2 Drowsiness | 218 | 210 | 56.1 | 18 | 7.2 | - | - |
| 3 Stools small | 164 | 164 | 43.8 | - | - | - | - |
| 4 Stools large, watery | 241 | 120 | 32.0 | 106 | 95.5 | 15 | 100.0 |
| 5 Stools foul smelling | 105 | 87 | 23 | 27 | 6.3 | 11 | 7.4 |
| 6 Stools without abnormal smell | 316 | 251 | 67.1 | 65 | 58.6 | - | - |
| 7 Stools yellow | 120 | 53 | 14.1 | 61 | 54.9 | 6 | 40.0 |
| 8 Stools green | 62 | 4 | 1.0 | 49 | 44.1 | 9 | 60.0 |
| 9 Stools with blood | 30 | 29 | 77.5 | - | - | 1 | 6.6 |
| 10 Stools with mucus | 15 | 14 | 37.4 | - | - | 1 | 6.6 |
| 11 Stools without blood or mucus | 455 | 331 | 88.5 | 111 | 100.0 | 13 | 86.6 |
| 12 History of vomiting in large quantity | 144 | 36 | 29.6 | 108 | 97.2 | - | - |
| 13 Distension of abdomen | 15 | - | - | - | - | 15 | 100.0 |
| 16 Oliguria or anuria | 89 | 83 | 22.1 | 6 | 5.4 | - | - |
| Out of a total of 500 cases - each remedy covered | 374 | 111 | 15 | ||||
EMPLOYMENT OF REMEDIES
All the remedies were administered in the form of solutions. 20 pills (No. 20) were added to 1 ounce of distilled water and 4 drops of this solution constituted a dose. In severe cases remedies were administered every half-hour, and in mild to moderate cases the repetition was 2-hourly on the first day. A rough routine had to be laid down because of many practical difficulties of nursing and management in nursing homes. In all the cases remedies were repeated 3-hourly on the 2nd and the 3rd day, 4-hourly on the 4th day and were then gradually omitted. No aggravation or harmful effects were observed in any of the cases. In fact, on the first and the second day it was noticed that frequent repetition was absolutely necessary to bring about a rapid recovery. With less frequent repetition, reaction was poor in severe cases and recovery was comparatively delayed. A majority of the cases were completely cured in 4-5 days. Malnourished and marasmic children lingered and could be discharged after 10-15 days’ treatment though the diarrhœa was controlled in 3-4 days in these cases.
THE POTENCY
Ars alb was used in the 10M and 50M potencies, the former in mild cases and the latter in moderate to severe cases. Verat alb was found to be effective in the 50M potency. Calc phos, which was always used after the diarrhœa had been partially controlled always acted in the 200M potency.
Very high potencies and frequent repetition MUST be the rule in acute and severe diarrhœas according to our experience.
OTHER REMEDIES
Seven cases were in a severe state of shock and Ars alb, Verat alb and Carbo veg failed to elicit any immediate response. With considerable reluctance I had to give these children hydrocortisone and noradrenaline in addition to intravenous fluids which were administered in all the third degree cases. Ars alb also was administered along with the above in drop doses. Administration of remedies through olfaction and implantation of pills under the eyelids and the tongue did not have any effect in these cases. After the first 24 hours only homœopathic remedies were administered in all these cases. Two children died and five recovered. These results are comparatively good in this group; all the five children who recovered had received the combined therapy and the two who died were under homœopathic remedies alone. Further, with modern therapy alone the mortality in such moribund cases is higher. The inference is clear. However, the fact remains that 493 out of 500 cases of severe diarrhœa could be managed with homœopathic treatment alone.
COMPLICATIONS AND TREATMENT
Paralytic ileus or severe distension of the abdomen was a serious complication in 8 cases and was caused by toxaemia or electrolytic disturbances. Opium 1M and 10M selected in one case on the symptom totality did not act and the child died. Carbo veg 200 and 1M also similarly disappointed and the second child was lost. A combination of Ars alb CM, Opium 1M and Calc phos 200 - 20 pills of each to 3 ounces of water - 2 drops every hour, saved 5 children and the mortality in this group came to 37.5%. Unconventional methods may be essential in many such conditions where a simillimum is either absent or not available. Homœopathy can be developed in many ways and orthodoxy should not come in the way.
Toxaemia, high fever, hypernatremia or various effects of dehydration on the brain were the causes of convulsions in 7 cases. One child died though the indicated remedy had stopped the diarrhœa and vomiting. Cuprum met 1M failed to save one life and Bell 1M another. In the remaining 4 cases, Bell 1M was mixed with the indicated remedy the moment convulsions appeared and out of these 4 cases 3 recovered and 1 died. Thus, the mortality in this group stands at 57.1%, which might have been much lower had the mixture therapy been employed in all the cases.
Table 8
| Degree of dehydration | Recovered | Died | Total number | Percentage of total | ||
| No. | % | No. | % | |||
| I | 36 | 100.0 | - | - | 36 | 7.2 |
| II | 125 | 92.6 | 10 | 7.4 | 135 | 27.0 |
| III | 307 | 93.3 | 22 | 6.7 | 329 | 65.8 |
| Total | 468 | 32 | 500 | 100.0 | ||
| Overall mortality: 6.4% | ||||||
Some of the 2nd degree cases were on the border line of 3rd degree and this explains the higher mortality in the former group.
Table Eight shows that 7.2% of the cases were mild, 27% moderate and 65.8% were severe and the overall mortality is 6.4% which compares very favourably with the mortality rates in general hospitals in the best centres, which vary from 8% to 11%. It may be possible to bring down the above mortality with the above methods in a well-equipped homœopathic general hospital.
INVESTIGATIONS
In spite of a strong desire it was not possible to do all the necessary investigations. However, stools were examined in 140 cases and Escheridia coli found in 119 cases (85%); the next most common infective agent being E. freundii, 18 cases (12.8%). Serotyping of E. coli was done in 25 cases and the results are shown in Table Nine.
Table 9
| Type | No of cases | |
| E. coli | 020 | 7 |
| E. coli | 086 | 1 |
| E. coli | 0111 | 5 |
| E. coli | 0112 | 5 |
| E. coli | 0127 | 7 |
| Total | 25 |
At the present time, these investigations do not appear to be useful for homœopathic prescribing. However, by good observation we may be able to develop definite indications based on pathological findings. At present we are using only macroscopic indications such as presence of blood and mucus of Merc sol and Merc cor and while comparing these remedies, we even stress the presence of more blood in favour of Merc cor. Similar indications can be developed further on the microscopic findings such as red blood cells, etc.
After some years it may be possible to establish homœopathic indications based on the positive organisms in relation to modalities, characteristics, etc, which may be very useful.
COMMENTS ON PROGNOSTIC POINTS
Fever: In nearly 74% of the cases, fever was absent on admission to the nursing homes, although diarrhœa is presumed to be infective in origin and infection should give rise to fever. In the newborns (babies up to the age of one month), it is a general observation that fever may be absent even with severe infections like pneumonia but in older children with diarrhœa the condition of collapse was probably the cause of absence of fever. Soon after initial treatment, the temperature shot up in many cases and this was considered as a good reaction and not an “aggravation”. In cases with high fever the mortality was slightly higher.
CNS Signs and Oliguria: Mortality was also higher among children with oliguria, drowsiness, irritability, convulsions and cold extremities.
Cold, Cough, Measles: In cases where recent history of measles or cold and cough was present, the mortality was slightly lower. This may not have any significance.
Vomiting: In cases with vomiting, the mortality was slightly higher.
SUMMARY
500 cases of acute gastro-enteritis in children are presented. All the cases were treated with homœopathic remedies in private nursing homes during the period from January 1958 to December 1962.
The chief causes and precipitating factors of acute diarrhœa, frequency of recurrent attacks in children and deficiencies in the victims of chronic diarrhœa are discussed.
Presenting symptoms under all the cases are classified under respective remedies used and a few simple and definite indications in acute diarrhcea for each remedy have been established.
The problem of dehydration and the importance of its treatment with intravenous or oral fluids has been thoroughly discussed. All the cases have been classified and discussed under different degrees of dehydration.
All the cases have been treated with homœopathic remedies. Seven cases in the series were in a state of severe shock and only in these cases noradrenaline and hydrocortisone had to be used in addition to the indicated remedy.
Common complications and their treatment and certain prognostic points have been discussed.
A method of administration of two or three remedies in combin¬ation under exceptional circumstances has been discussed and advocated.
Results of examination of stools in 140 cases and their possible relation to homœopathic indications has been discussed.
The overall mortality is 6.4% which compares very favourably with the mortality in other hospitals.
- Greatly condensed from the British Homœopathic Journal, Vol.LIII No.1, January 1964