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
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
She is still under observation.
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
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,
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
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.