Dr Aishwarya Balkal
ABSTRACT
This was published as a pamphlet in 1801.It gives brief information regarding the treatment and prevention of scarlet fever with the application of law of similars. He gives information regarding symptoms, course, and complications. He divides disease into 2 states. Ipecacuanha and opium for 2 different states. He also mentions administration, doses, and preparation. Belladonna was used as a preventive medicine. He also gives importance to moral and environmental assistance. Instructions for treating after effects with belladonna or chamomile, based on the type of presenting symptoms.
PREFACE PART-
Chief Aim: “To excite a great interest in a subject of so much importance to humanity as this is, to ascertain the truth by bringing their observations of many to bear upon it”
Quotes Callimachus, “A great book is a great evil and is soon laid aside”. His aim would not have been achieved if he had released a large book. So, he released this work as a Pamphlet at Gotha (1801). Had announced a prophylactic remedy for one of the most destructive children’s diseases. He asked the physicians to try his new method of prevention for Scarlet Fever. Arranged to send the medicines to them and test them themselves on the patients
IT IS NOT THE FAILURE OF MEDICINE BUT THE FAILURE OF THE PHYSICIAN
Why did Prophylactic fail in the Epidemic?
Extract of Belladonna lost its powers because of, the great distances it was sent, long periods it was kept, fell into the hands of those who had no expertise/goodwill in administering the medicine, precautions and dangers couldn’t be enumerated on a small piece of paper, the law of minimum dose was not followed, hurry and inaccuracy of young doctors, cold weather – < disease – dosage turned useless.
Why was Belladonna the best preventive?
According to Samuel Hahnemann. Cow-pox infection gave immunity to Smallpox. Both had similar symptoms – pain and swelling of axillary glands, pain in the back & loins, fever, pustules, and erythematous inflammation. Relates this to the new maxim – Law of Similars. Symptoms of Belladonna too matched to that of Scarlet fever
HISTORY OF THE SCARLET FEVER EPIDEMIC
1799 — Small pox entered Konigslutter from Helmstadt. Previously Scarlet fever also was present along with Smallpox. It got mixed up and appeared in Konigslutter. Spread slowly but was very deadly. Small eruptions — warty looking, serious symptoms of atonic kind — seizures. Middle of 1799 — Smallpox ceased almost entirely.Now, Scarlet fever appeared alone and spread faster than Smallpox
SCARLATINA (OR) SCARLET-FEVER
Most spreading and contagious of all diseases in children. If 1 child was affected, the whole family was sure to be infected. Children < 15y — most susceptible, children 15y – 20y — moderately susceptible, 21 – 30y — scarcely susceptible, 30 plus— hardly affected forms of Scarlet Fever.T two forms
- Mild Form
If it occurred in mild form, it remained mild in the whole family
First day
Slight weariness, faint-heartedness, difficulty in swallowing, mild fever, red face and hot hands, spots of various shapes, pale & red – NECK, CHEST & ARMS
THIRD OR FOURTH DAY
Most symptoms disappear, slight constipation, appetite – slightly diminished, sleep – not affected
- Bad Form
Symptoms break out suddenly on the 7th day of infection, no previous signs of illness
Previous night – horrible dreams – PRELUDE, unusual fearfulness
First day
Rigour with chilliness, violent pressive headache (frontal), pain in the abdomen (Hypochondria), violent attacks of vomiting (every 12 – 24 hours), followed by increased anxiety, weakness and trembling, swelling of parotid & sub-maxillary glands – hard & painful, swallowing extremely painful – shooting pains. The body becomes very hot, itching, burning – FACE, NECK, HANDS & FEET are swollen. Swollen parts – SHINY APPEARANCE (lasts till the end of disease). Now the person starts sweating profusely all over the body except the HEAD, HANDS & FEET – Paroxysms
Second day to third day
Cinnabar-coloured spots – on the swollen parts (shiny) – PIT OF THROAT, ARMS & LEGS. Scarcely raised above the level of skin, smarting, itching, burning. Spreads out – as the disease advances. Fever persists even after an outbreak of eruptions. Sore throat. Painful swallowing. Inflammation of interior of mouth & palate – painful, raw as if ulcerated. Worst cases – Jaw closes due to swollen cervical glands. Excessive salivation – dribbles from mouth as tongue – painful. Worst cases – lining membrane of the nose – ulcerated. Voice becomes weak, suppressed (unintelligible). Respiration is difficult, taste – putrid, stools – rarely passed, involuntary (Asafoetida-like odour), urine – light coloured. A drawing pain in the back and cutting belly ache occurs in the evening after sunset
Worst cases: Alternate paroxysms of agonising pain in stomach, groaning, grinding of teeth, comatose stupefaction or sopor (drowsiness), half shut eyes, now he is extremely exhausted – sinks to the bottom of the bed. Anxiety <, A/F: the sight of the smallest quantity of food
Fourth to seventh day
Death (or) advances further, eruptions become bigger – small pointed miliary vesicles (goose skin), extremely red and empty (no fluid),fever persists, uncommon emaciation, stiffness of joints, blood red spots — sclera of the eyes, the cornea of both eyes is completely obscured, skin starts peeling off in places of redness, large pieces peeled – hands and feet (like torn gloves), smaller scales on the rest of the body, nails of fingers and toes fall off
After-sufferings
Hair fall (after a week or a month), continued debility, weakness of the back (narcosis), pressive headache, painful constriction in the abdomen <bending backwards, abscess inside of the ear, ulcerated angles of the mouth, lining membrane of the nose, face, great hurriedness in speaking and acting, extreme drowsiness, the puffiness and earthy colour of the face, swelling of feet, hands, loins etc.
TREATMENT OF SCARLET FEVER
States of body during infection had to combat 2 different states of the body during infection, these states rapidly alternate with each other, each state has its own set of symptoms
First state
Burning heat, drowsy stupefaction, agonising pain in the abdomen, vomiting & Diarrhoea, convulsions, second state, increase of fever towards evening, sleeplessness, total loss of appetite, nausea, intolerable lachrymose peevishness (weeping and complaining), groaning with pain
Treatment of First state
MEDICINE: OPIUM (externally or internally)
In case of vomiting, a piece of paper must be moistened with a strong tincture of opium, should be laid upon the pit of the stomach until it dries, if case of no vomiting, a small quantity of solution opium is given internally.
METHOD OF PREPARATION
OPIUM TINCTURE (FOR EXTERNAL USE)
1 part of finely pulverised crude opium and add 20 parts of weak alcohol (diluted); (Let it stand for 1 week) + (occasional shaking to promote solution). This becomes OPIUM MOTHER TINCTURE (FOR EXTERNAL USE).
OPIUM DILUTION (FOR INTERNAL USE)
1 drop of Opium mother tincture add 500 drops of dilute alcohol (Shaken well to promote the solution) opium dilution (taken internally).1 drop of dilution in 10 tsp of water for children up to 4 years, 2 drops of dilution in 10+ tsp of water for children up to 10+ years
REPETITION OF DOSE: Every 4 to 8 hours (or), every 24 hours, (DEPENDING UPON THE SEVERITY OF SYMPTOMS)
Treatment of the Second state
MEDICINE: IPECACUANHA
METHOD OF PREPARATION OF TINCTURE
1 part of fine powder of Ipecacuanha and add 20 parts of alcohol this gives Ipecacuanha mother tincture
IPECACUANHA DILUTION (FOR INTERNAL USE)
1 drop of Ipecacuanha mother tincture and add 100 drops of diluted alcohol this becomes Ipecacuanha dilution. Youngest children 1 drop, older children 10 drops
Moral Remedy & Diet
Physicians should try to dispel all fear. Kind & cheerful words — ignite hope, nice little presents, allowed free choice of all kinds of drinks but in moderation, avoid solid nutriment.
PROTECTION AGAINST SCARLET FEVER
Hahnemann’s Discovery of prophylaxis
Samuel Hahnemann discovered a new prophylactic against Scarlet Fever. Specific remedy specific to the disease. Belladonna was chosen by the Law of Similia. Covered all the symptoms of Scarlatina.
The primary action of Belladonna: Lack of determination or courage, dull staring, inordinately open eyelids, obscured vision, coldness and paleness of the face, thirstiness, rapid pulse but very feeble, paralytic immobility of the limbs. Painful swallowing with shooting pains in parotid glands. Pressive headache, constrictive pain in the abdomen aggravation on bending backwards. Rigours, synochus (continuous fever), erysipelatous spots, sopor (drowsiness), hot face, etc peculiar symptoms.
Steps of Preparation of Belladonna Prophylactic
Take a handful of fresh leaves of a wild variety of Atropa Belladonna when the flowers are not yet blown. Crush them in mortar to form a pap (semi-liquid). Press the juice through a linen. Spread this juice on a flat porcelain plate. Expose it to drought or dry air. After it becomes a bit dry, stir it in the mortar and spread again. Follow this process until it completely dries up to form a fine powder. Store it in a well-stopped bottle.
Preparation of Belladonna mother tincture
Mix 1 grain of Belladonna powder and add 100 drops of distilled water (Stir this solution in a mortar with a pestle). Pour the thick solution into 1-ounce bottle. Rinse the mortar and pestle with 300 drops of dilute alcohol (5:1). Add this to the solution and shake well. Label this bottle as the strong solution of Belladonna (mother tincture).
Preparation of Belladonna Prophylactic
1 drop of strong sol of Belladonna and add 300 drops of diluted alcohol (Shake well to promote the solution). Label this as the medium solution of Belladonna.
1 drop of medium solution of Belladonna add 200 drops of dilute alcohol (Shake well to promote the solution). Label this as a weak solution of Belladonna (Prophylactic). Dosage of Prophylactic medicine for children below 1 year — 1 drop, 1 year — 2 drops, 2 years — 3 drops, 3 years — 4 drops,4 years — 5 to 6 drops (according to the strength of his constitution). And so on……. Each successive year increases by 2 drops. 20 to 40 years — not more than 40 drops. Every 72 hours until the epidemic lasts and 4 to 5 weeks thereafter.
Diet & Lifestyle
The usual mode of lifestyle. A usual diet can be followed but with moderation, light exercise in the open air, avoid sour fruits, and vinegar as they increase the action of Belladonna. In case there is violent injurious action of Belladonna. Opium it is an antidote for Belladonna. Use externally or internally as indicated for treatment of Scarlatina. In cases of mental or physical stress, if there are any scarlatina symptoms seen then 2 drops of weak solution of Belladonna given immediately. Results in the removal of symptoms. They can be taken in usual repetitions every 72 hours until the end of the epidemic. In children of naturally fearful, dull dispositions. The usual dosage won’t be sufficient, the physician should add a few more drops and stir for longer than 1 minute.
SUPPRESSION OF SCARLET FEVER IN ITS FIRST GERMS
Initial symptoms (Partially developed)- uneasy dreams, paralytic stiffness of limbs, pressive headache, approaching fever.2
DOSAGE: 1/2 of the dose as it was advised as a preventive every 3 hours until symptoms disappear. Then continue giving the full dose every 72 hours until the end of the epidemic.
Symptomatic stage (almost developed)- shooting pain, swelling of cervical glands, high-grade fever (without redness)
DOSAGE: Similar to the previous dosage
Advanced stage (Fully developed)- Not advisable to give Belladonna. Due to the presence of high-grade fever, it may complicate the disease
Belladonna in After-sufferings- Belladonna is valuable in removing the after-sufferings of Scarlet-fever
DOSAGE: Same as prophylactic.
If the original disease was extremely violent, unhealthy skin, tendency of every part to ulcerate, suffocating cough. Belladonna will be useless in such cases. Best remedy is Chamomilla
Preparation of Chamomilla Dilution
1 grain of Chamomilla and add 500 drops of water and 500 drops of alcohol (Shaken well to promote the solution) — FIRST DILUTION
1 drop of first dilution add 800 drops of dilute alcohol (Shaken well to promote) -MEDICINE
Dosage of Chamomilla: below 10 years 1 drop, 10 years or more 2 drops (Consumed after it is mixed and stirred well in any kind of drink)
REPETITION: Every 24 hours
CONCLUSION
Dr Samuel Hahnemann approach shows the significant importance of patient-centered care, public health, epidemic management. His strategy for treating scarlet fever is an early, methodical attempt at symptom targeted treatment based on law of similars and preventive medicine. the efficacy of these treatment, the work is nevertheless a noteworthy illustration of early 19th century medical innovation. In the end, the booklet functions as a call to cooperatively and ethically observe, test, and improve medical practice in addition to being a treatment guide.
Dr Aishwarya Balkal
PG Scholar Department of organon of medicine and homoeopathic philosophy
UGO of Dr Sebastian P. A. Asst. Professor
Father muller homoeopathic medical College and hospital, Deralakatte, Mangaluru
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