A Case of Ledum palustre, with Henny Heudens Mast

by Karen Cohen DC, CCH

Henny Heudens Mast stands poised at the white board and proceeds to guide a group of homeopathic colleagues through the thrilling unraveling of a difficult case. The case unfolds spontaneously for some time and then the process of tracking the expression of the vital force begins. Each symptom of significance is classified by miasm, with special attention given to symptoms that are strange, rare or peculiar. Henny’s teaching breathes life into the paradigm of miasms. A favorite miasmatic example: A group of homeopaths are attending a seminar when a fire breaks out across the street. The psoric homeopaths cannot even look at the flames and worry about the cost of repairs, the sycotic homeopaths remark “Oh how exciting—lets go over and investigate.” The syphilitic homeopaths secretly ponder how nice it might feel to set things on fire… Seminars in Florida and Oregon function like supervisions, and live cases are the focus.
Henny speaks directly to the child and immediately begins to engage him in the process.

The Case
(Names and certain details have been changed to preserve the confidentiality of the patient)

In 1999 a six year old boy “Jonathan” is brought to the seminar to have his case taken before the class. The middle child of three children, his chief complaints are eczema and hip joint pain. He is timid and slow to speak but his mother says that he is usually very talkative.

Henny speaks directly to the child and immediately begins to engage him in the process; He loves to investigate things that interest him and loves balls and balloons, but his mother explains that he cannot play alone and must engage someone to be with him. Someone else must be in his sight at all times.

His skin breaks out and doctors have diagnosed it as eczema or psoriasis. His skin becomes rough with tiny blisters and is cracked and inflamed. It begins in the lower part of the leg and moves up to the thighs and eventually covers the entire body.

His mother animatedly explains “This child had no skin on his body last July. The flesh just split all over. He looked like a disembodied thing.”
However, as soon as the skin begins to clear up he gets his other complaint: aches and pains in the joints of his legs. The symptoms alternate: when the skin is aggravated, the joints are quiescent. Emotionally he feels fine when his skin is a mess but when the skin is clear he has joint pains or hip inflammation that limit him significantly.

Henny inquires about the child’s early life: After being born he did not cry. He was very calm and breastfed for an hour. The mother did not want to separate from the child but the doctors mandated a four hour separation. When the baby returned he was given to his father and he began to sob. Not the crying of a newborn but a deeper sobbing and he sobbed for about five minutes and then it was over and then he was everybody’s dream baby. Later he would sob deeply in his sleep. The child has not been vaccinated.

The pregnancy with this child was difficult and included some trauma. The mother began vomiting and eventually was diagnosed with hyperemesis and needed to go to the hospital to be re-hydrated. Her insurance company insisted that she not remain in the hospital, but be released to home with a permanent IV line inserted so that she could be treated by a home health nurse in her own environment. The prescription was 50mg of Phenergen every four hours to stop the nausea. Paradoxically, instead of sedating or preventing it, the drug caused nausea and vomiting to increase to an awful degree. The home health nurse reported this to the doctor by phone who decided to administer scopolomine. Scopolomine is not usually used during pregnancy and when she was given the medicine she entered a state of confusion and did not even recognize her young daughter. Apparently she was given a series of drugs—she received nothing by mouth for five months and only one drug after another.

Aware of what the proper nutrition during pregnancy should be, she became very despondent. She despised the line going into her arm and tried to pry it out. At one point her husband found her searching the phone book to find a doctor who would perform an abortion and end her anguish. Finally her husband dragged her into the OBGYN’s office and confronted her doctor, beckoning him to re-read his wife’s chart. The MD discovered that she had been grossly overmedicated. After that rough start the rest of the pregnancy was unremarkable, and the baby was eight pounds at birth. The mother had not gained one pound for the first six months though she did eventually gain 35 pounds. Henny asks if there were any food cravings. “Anything ICE cold. My first meal was an iced down can of Ensure. It did not have to be sweet as long as it was cold.”

The child’s skin disorder began in November of 1997. He had never been ill—never sick, not even a cold. Around that time he was stung on the foot by a fire ant. Usually a stoic boy who did not express pain, he began to cry. In seconds a red finger of inflammation spread out from the bite. It was quite angry—more than what would be normal for an ant bite, so the mother, an aspiring homeopathic student, gave him a dose of Apis. The pain stopped and the streaks stopped, and he stopped crying. Fifteen minutes the foot again began to streak. She called a homeopath who recommended repeating the Apis one additional time. The sensation of heat and inflammation remained in the foot for a week.

At the same time a child of a friend of the family died. Jonathan then three and a half years old, asked. “Why do babies die?” He queried his mother who explained the family philosophy of life and death in simple terms, and then he left the room and asked his father the same question. At the funeral on the next day and the next week he said, “Mom I want to see where baby Stella was buried.” He really wanted to go there, so the whole family all went to the cemetery. The following Thursday and once a week every week—“ I want to go see where baby Stella is buried.” You could set your watch by him; he continued to ask to see the grave for a solid year. Soon afterwards, his mother noticed a small brown lesion on his leg—it looked like a bug bite. After five days it got bigger and rough like poison ivy and it had a red ring like ringworm. This was the beginning of the current problem: first the ant bite, then the death of the baby, and a week later the eczema-like eruptions on the legs began.

By the 24th of November it had become significantly larger like a bull’s eye. It was dry with a yellow crust around it. The mother thought it was ringworm. She waited. He said it never itched but he would scratch it at night in his sleep. It would fade and come back in one week periods—always creeping upwards. The eruption oozed watery discharge. It looked like it should smell really bad but it did not. A homeopath prescribed Sulphur and the eruption got worse and worse. He was wrapped in totally in gauze. He then got Sulphur LM. He was oozing pure blood. The skin was gone—and the blood would just seep through the gauze.

The Sulphur was stopped and in March he improved slightly, but in desperation the mother consulted with another homeopath who repertorized the case and decided to prescribe Arsenicum. Arsenicum 30X was given and four hours later the weeping stopped. Six days later he was out of bandages.

By summer he was asking to be carried. His legs hurt. His feet hurt and his hips ached. At first, the mother thought that the boy was just complaining, but eventually he was limping. That night he wet the bed for the first time in his life. He was screaming and he was pointing to his hip. The pain in his legs began at the lower leg and moved up. They sought an orthopedic consultation and the diagnosis was Perthe’s disease, osteochondrosis of the femoral head; a serious condition. Strangely when the skin erupted, the joint felt fine. Again there was alternation of these symptoms.

Henny now asks, “How is this boy?” She is asking about the temperament of the boy, his way of going through life.

He is accident prone. His mother dramatically says, “He sits and plans it out—not impulsive and then he’ll just about kill himself. It is like he attracts falling buildings.” He stepped on untied shoelaces while she was holding his hand and he fell so strangely that he cut himself and required stitches.

He loves sweets and sleeps well but sweats profusely in the first thirty minutes of sleep. He is restless, and we note that he has a tendency to sigh. He prefers his food and drinks cold. He loves the open air. He sweats easily but it doesn’t bother him—he likes being out in the cold. Even with the joint pain he wants to go out and play in the snow in shorts! Last winter they had no heat and the house was at 65—his skin would feel cold but he was fine. When he has the skin eruptions he doesn’t like to be touched or bathed. The skin eruption rarely occurs if it is cold outside.

Discussion of the case and remedy selection

Henny’s remarks on the case:

“When I start a case I am like a sponge. I put the strong characteristics on one side of my brain and at a certain point there will be four or five points there and it will be a picture of the remedy.”

In this case you have many syphilitic symptoms and certain prominent symptoms; A chilly child who is better going out in the cold and craves cold things. The mother even craved cold foods during the pregnancy.
Notable is the strong and immediate reaction to an insect bite. The reaction to one bite was awful. There are many syphilitic elements in the presentation most prominently the characteristics of the original reaction to the bite:

Oozing of blood
Loss of the skin
Destructive changes in the head of the femur

Some Rubrics of the case

RESPIRATION; SOBBING
EXTREMITIES; AWKWARDNESS
GENERALITIES; FOOD and drinks; cold; drinks, water; desires
MIND; COMPANY; desire for
PERSPIRATION; SLEEP; beginning of; agg.
GENERALITIES; COLD; amel.
GENERALITIES; PAIN; wandering
STOMACH; APPETITE; ravenous, canine, excessive; satiety, with easy
GENERALITIES; CHANGE; symptoms, constant change of

Ledum is a “small remedy” but it covers so much of the case.
Ledum has a specific sphere of influence:

Skin
Rheumatism
Blood

Henny warns, “Be careful of repertorization as, in many remedies, the proving is not complete. All of the symptoms of a remedy might not be recorded. What you have to find is what is really characteristic of the child. This child would go outside in the winter without clothes on—and if you would see him you would say he is a chilly child.
 
The child demonstrates a strong susceptibility. After the bite of one ant the reaction was awful! Henny remarks on the concept of susceptibility: “Who gets Lyme disease? The susceptibility must already be there. This is a clear example. The child receives a sting and it explodes all over the body in an eruption.”

“This brings to mind the IV that was stuck into the mother during the pregnancy. She was vexed! It was a total affront to the mother. It was a puncture wound. This child probably needed Ledum from the beginning of the pregnancy. His mother even craved the cold foods so typical of Ledum.”

Thankfully the child was never vaccinated. Imagine the possible result of vaccinating a child with this extraordinary sensitivity. Perhaps this is the kind of situation in which an immunization could result in autism.

Henny now instructs us to look up Apis in Boericke. It is a remedy that is inimical to Ledum. The administration of the Apis was wrong for this child and produced an aggravation of the condition. The prescription of Arsenic took the skin eruption away immediately! Why? Because it is very similar to Ledum in that it is a syphilitic remedy and touched the syphilitic elements in the child. Ledum and Arsenicum are similar in that they are syphilitic, but Arsenicum is better with heat and Ledum is better with cold. When the skin eruption was suppressed his organism produced the more serious destructive bone disorder.

What occurred when he got Sulphur? Sulphur is a warm psoric remedy and administering it caused the body to become strongly syphilitic—he began oozing bloody discharge. Here we have the dramatic effect of mistakes in prescribing. We will all make mistakes yet in homeopathy we have certain laws which stand. When we give a remedy and the patient reacts in a way that is not in accordance to the law of homeopathy then we have to learn from the mistake. You can never “fall asleep” in homeopathy—never do things by rote.

Differential discussion of some of the remedy suggestions of the class:

Pulsatilla
It is too warm a remedy
Pulsatilla likes to please, unlike this boy who clearly states his strong desires.

Opium
Opium is more confused.
Opium is known for its lack of reaction. Although the mother was exposed to drugs in the pregnancy the Opium picture is not strong in the case.

Mercurius
Mercurius individuals need to stay in a moderate temperature range. They would not like to play outside in the snow.
In Mercurius the problems come in the night—this child generally sleeps calmly all night. Maybe his father (we have some data to suggest this) needs a syphilitic remedy like Mercurius.

Radium bromatum
Could help the skin eruption but most likely it would suppress the skin as did the Arsenicum, and make the child worse. Radium bromatum does address the skin and joints but the modalities do not fit. Radium is better with hot baths and worse motion.

Ignatia
Even though the child has sighing and alternating states.
Where did the case start in the child? With the sting of an infant.
A hypothetical example of an Ignatia case might be: The mother goes through a very difficult period with the death of a child and her surviving child is still breast feeding. The pathology starts during this time. Then we could consider grief as an etiology. This is not situation as the pathology was initiated by the insect sting.

Kali iodatum
Far too hot--the hottest remedy

Calcarea
Calcarea will act in a limited way and might fortify the child, but it will not cure the child and the problem will still be present. We have the starting of the problem with the sting and the reactivity to the remedies given. You will have the cases where you give the wonderful big polycrests and the child is better on certain levels, but the underlying problem and susceptibility are still there. The desire for cold is strongly against Calcarea The intensity of the body energy is strongly contraindicated for Calcarea.

Potency Selection
He is a sensitive boy
Give 30C or 200C
The referring homeopath decides to give Ledum 200C

Follow-up one year later.
The report from the mother:

We have had the most wonderful year—it has been wonderful. I have got just a couple of things written down. It has been exactly a year. When Jonathan received his remedy it was noon and he had already given up taking naps but he said, “Mom I really need a nap.”  He slept for five hours and woke up flushed. Before that he had been in a wheelchair and the pain was very severe. He woke up and wanted to run and play. The pain was gone in 24 hours. About one month later the skin eruption came back and it was very light and it was resolved in one week, never to return.

He has been very accident prone. One week later he ran into a shopping cart and he hit himself in the eye and it swelled and got black. The hardest thing for me was not give him the Arnica—yet the bruise was gone extremely quickly. At the pediatrician’s office they wanted to put him up on a scale and he ran right into a chair.

The mother felt he was having a problem seeing things correctly. She took him to an eye doctor and the testing showed that he had no peripheral vision and he appeared to be going blind. Several weeks ago he had a follow-up exam and his vision had returned to normal.

At the end of last summer the family contracted the flu. He got the flu, which was unusual for him, and he didn’t pull out of it like everyone else did. After 24 hours he had no symptoms but he was lethargic. He had stopped eating again. The previous year (before the remedy) he had gained no weight and this year he gained 15 pounds.

The mother waited and eventually he did pull out of it—although it was hard. His previous tendency to nosebleeds then returned. When he bleeds it comes out only from one side—the left side. They last five minutes but it is profuse. It is not spurting, it is a gentle flow but a lot of it. He had two per week until October. They were severe enough that he was becoming anemic. At the end of October (25th) he was given a repeat of the remedy. Then he came down with a cold with no fever, just a runny nose for two days. He had nose bleeds until the end of November, now they have stopped. He has joined a soccer team and has never complained of pain in the hip.

They had another appointment with an orthopedic surgeon who diagnosed the Perthe’s disease based on x-ray and MRI findings of the hip joint. The first MRI showed that the top of the hip bone was flattened and the cushioning was completely eaten away. The recommendation was to put him on steroid medications which the mother refused. The doctor said they would re-test later. In September Jonathan went in for a second MRI. The mother was told that there was bone degeneration and that bone does not grow back. Early last year the doctor reported to her that the plan was to wait until he was full grown and then replace both hips.

After examining the newest MRI, the doctor eyed them with suspicion and treated them in a very cold manner. The film showed that there were several milimeters of “good” growth. He told them that the original tests must have been wrong.

Jonathan reports that he enjoys playing soccer. He has a couple of friends and he would rather play in a small group. He still does not like being alone. Jonathan reports that he absolutely loves sweets. He does not like black eyed peas. Henny senses that the boy has some fear as he cannot be alone. He says that he is afraid of animals that bite, like alligators and big dogs.

After Jonathan and his mother leave, the class has a lengthy discussion about the result. Many syphilitic symptoms, such as the temporary loss of peripheral vision and the nose bleeds, still occur but they are less severe and destructive. Henny suggests that, in the future, the child might another remedy, perhaps Lycopodium, a remedy that is social, a bit fearful and desires sweets.

Long Term Follow-up

At first glance this seems like an easily cured case.  The colleagues in Florida have followed this case for eight years, watching as this boy has developed into a teenager.  As might be expected with a case of this depth, over time an additional remedy was required.  In January of 2002 Jonathan began having severe nosebleeds.  He was given Nitric acid 200C at that time.  The nosebleeds receded and the skin and hip joint have been stable to this date.

I cannot adequately underscore the value of a master homeopath who is willing to travel great distances over many years to generously share a lifetime of clinical experience.  Calm logic infuses the analysis of every case.  Henny has the ability to remain deeply compassionate while deftly dissecting and teasing out the influences that result in disease: physical, mental, emotional and societal.
 
The teaching of Henny Heudens-Mast brings a living vitality to the concept of the miasms.  No longer an archaic or confusing theory, practical knowledge of the miasms becomes the essential infrastructure for recognizing etiology, focusing the case, and informing the delicate process of long term case management.  Once grasped, miasmatic expression becomes the language of the vital force, illuminating the path to cure.

Karen Cohen DC, CCH.

Karen is a homeopath and Chiropractor, practicing in Santa Cruz, California.  She has been in practice over 15 years.  She originally trained with Ananda Zaren and has taught homeopathy at the Pacific Academy of Homeopathy, San Francisco and at conferences throughout the country.  She has been studying with Henny Heudens-Mast for the past 6 years.