Two with one pansy - W. Taylor

 Two with one pansy (W. Taylor) 

Case 

 Eczema 

 Viola tricolor 

 Case 
 4 month-old girl 
 Presenting complaint: eczema.
 This is the worst case of infant eczema I have ever seen. The face and scalp is entirely covered with thick damp yellow crusts, like a draught-cracked mudflat. If you happen to have the dermatology text Color Atlas and Synopsis of Clinical Dermatology by Fitzpatrick, Polano, and Suurmond (McGraw-Hill, ISBN 0-07-021197-3), this child looked worse than the photo on p. 17 of "infantile atopic dermatitis." Incidently, reflect seriously on the following comment from that text: "Since the advent of topical corticosteroids, the problem has lost much of its seriousness." Seriousness to the dermatologist, perhaps-to the wholeness of the person, quite the contrary could be said.
 The following history was obtained principally from the mother of this child. Both parents are present, and the father is also very attentive and involved. The mother is 19, the father is 21.
 "She has this terrible eczema. The doctor wants to give her cortisone, but we just don't feel comfortable with that. We-at least I-don't think that really addresses the issue, does it? Like, her face was OK when she was born, OK, but she had this cradle cap stuff in the first week. We comb it and put baby oil on it, but it hasn't ever really gone away. We first saw the eczema behind her ears. It was flaky, not like it is now though. It's been real bad on her face like this since she was like about a month old. She gets all this junk in the corners of her eyes. We have to wipe it out after a nap or when she's nursing. I think she has yeast. [Note: Everybody thinks they have yeast because they've read William Crook's book, The Yeast Connection.] She gets this discharge from her vagina. And her diapers just smell awful, worse than the cat."
 When I ask her just what the diapers actually smell like, she replies, "Just like cat urine. You'd think a cat had peed in them."
 I observe that this is a round-headed baby with big open fontanelles. She is rather quiet and likes to be held and nursed. It's very tempting to shoot from the hip and give Calcarea Carbonica!
 Analysis 
 A standard totality repertorization yields the repertory sheet in Figure 1.
 This confirms my gut feeling for Calc-c as a possibility here, but also brings up the small remedy Viola Tricolor, which edges ahead of the pack, principally on the intriguing keynote symptom of "urine smelling like that of a cat." Mezereum also comes up high for a small remedy (eczema starting on the scalp), as does Dulcamara. And there are some "larger" "skin" remedies here: Staphysagria, Mercurius, Sulphur, Graphites, Hepar, Petroleum. It's also interesting to see Cicuta here, and to read about its skin symptoms-not the first thing we think of when we reflect on Cicuta!
 One thing we can say for certain when looking at this field of possibilities: this is not a case of eczema that we would wish to suppress. Reflecting on the more central pathogeneses of these remedies, there are some potentially pretty nasty outcomes if we deny this disharmony its superficial expression on the skin.
 If we weight the repertorization in favor of small remedies, we get the analysis in Figure 2.
 Fig. 2-Small remedy repertorization Fig. 1-Totality repertorization
 This brings up Vinca Minor (an important differential, with severe eczema of the head and face and strong-smelling urine); Melitogrinum (a nosode prepared from eczema capitus); Juglans Regia; and Iris Versicolor, all worth reading for consideration in this case. Ernest Farrington, in his Clinical Materia Medica (p. 167), says of Vinca Minor:
 "In these skin symptoms, you may compare Vinca minor with several remedies; first with Viola tricolor. This is useful in crusta lactea, when the exudation is very copious. Like Vinca, it mats the hair together, but there is this peculiarity which always enables you to distinguish between the two, namely, Viola has urine with a peculiar pungent odor, which has been aptly compared to that of cat's urine."
 This is a perfect illustration of the benefits of reading up on all those small remedies that come up in a differential!
 Now, none of the possibilites brought up so far, except Calcarea Carbonica, are in the rubric "FEMALE; LEUCORRHEA; girls, in little; infants." But we could look at the following larger rubric:
 FEMALE; LEUCORRHEA; girls, in little (25):
 asper. 8, bar-c. 3, bufo. 1, Calc. 3, calc-p. 3, cann-s., carb-ac. 8, carb-v. 3, caul. 1, caust. 535, cina. 2, cub., hydr. 8, kali-p. 1, mang. 76, med. 7, Merc., merc-i-f., mill. 2, nat-m. 2, puls., senec., Sep., syph. 7, viol-t. 2
 Note that viol-t. is an addition to Kent via Knerr, from Hering's Guiding Symptoms. Thus, of the remedies we've encountered thus far, we find Calcarea Carbonica, Mercurius, and Viola Tricolor in this rubric. If we now take the two most unusual symptoms of this case and repertorize, we get the analysis in Figure 3. Viola Tricolor comes through clearly.
 I now feel confident that I have a strong case here, with a well-described presenting symptom, supported by three concomitants (eye discharge, leucorrhea in a child, and cat-odor urine), of which this last is a keynote for Viola Tricolor.
 Rx: Viola Tricolor, 30C in water (1 pellet in 4oz water);
 6 succussions, and 1/2 tsp daily to the nursing mother.
 In The Chronic Diseases, Hahnemann recommends treating infants-at-the breast routinely by giving the remedy to the nursing mother or the nurse-maid; I've adopted this practice, and find it works very nicely, as you'll see below.
 Followups 
 The child experienced gradual resolution of the eczema over six weeks. At the four-week followup visit, there was only some roughness behind the ears and a bit of flakiness to the scalp. The vaginal discharge cleared up within a few days of the first dose, as did the odorous diapers. The remedy was discontinued at six weeks. With some minor return of eczema behind the ears, Viola Tricolor was repeated briefly, in the same manner, at 8 months, and directly to the weaned child at 14 months (4 and 10 months after the initial visit, respectively). There has been no subsequent return of symptoms now for over three years.
 It is interesting to note that, at the six-week visit (which she made without her husband), the mother remarked:
 "You know, like, you asked like if I had this stuff when I was a baby, so like I asked my Ma, and she asked why we didn't just use cortisone, 'cause it worked fine for me. I guess I was almost as bad."
 Later in the visit she said:
 "I was having a lot of, like, wondering if I should even like stay with her father, you know. Like I couldn't trust him all that much, to keep a job, to take care of me and the baby. But I stuck with him 'cause I didn't feel like I was able to do this just on my own. But I'm feeling more confident, like doing this mother thing. And I think he's coming around."
Remark 
 Figure 4 presents a repertorization that suggests Viola Tricolor for the mother herself.
 Obvious, the remedy also had a beneficial effect on the mother! I see this so incredibly often with mother/infant pairs. I suspect the influence can go strongly in either direction. A severe maternal fright can bring about an Aconite or Stramonium state in the child; or carrying a child with Viola Tricolor disharmony may bring about a Viola Tricolor disharmony in the mother. Perhaps this mother's cradle cap and eczema as an infant, suppressed with cortisone creams, resulted in a more central expression of her Viola Tricolor disharmony, manifesting as a life-long lack of self confidence and suspiciousness, "erupting" in her during her pregnancy, as well as in her infant.
 ...This is not a case of eczema that we would wish to suppress. Reflecting on the more central pathogeneses of these remedies, there are some potentially pretty nasty outcomes if we deny this disharmony its superficial expression on the skin.
 Fig. 3-Minimal repertorization
 Fig. 4-Viola case's mother
 In any event, "Two with one pansy!"
 Viola tricolor was one of the 59 medicinal substances mentioned in Hahnemann's 1796 landmark article, "Essay on a New Principle." He wrote of it: "The pansy violet (viola tricolor) at first increases cutaneous eruptions, and thus shows its power to produce skin diseases, and consequently to cure the same effectually and permanently." Hahnemann subsequently performed the first proving of this remedy, published in Stapf 's Archives. 
 Many of these early remedies were introduced on the inspiration of their occasional clinical success in empirical use. Viola Tricolor was employed in ancient Greek medicine in asthma, epilepsy, and chronic and obstinate cutaneous diseases. It was reintroduced to the old-school medicine of Hahnemann's day in the 1770's by Starck, and described in his monograph De crusta lactea infant. It was empirically employed by the old-school medicine of Hahnemann's day in crusta lactea (cradle cap), impetigo of the scalp and face, acne rosacea, favus (ringworm of the scalp), articular rheumatism, and gout.
 Will Taylor has a practice devoted to classical homeopathy in a small coastal community in downeast Maine. His own intractable case of shingles led him in desperation to homeopathy and to the discovery of his own "true and highest calling" as a homeopathic practitioner. His web site is www. simillibus. com.