Possible Treatment Approaches to Problems of Perinatal Origin
By: Georg Soldner, Hermann M. Stellmann
(Original title: Therapiemoeglichkeiten nach gestoertem Geburtsverlauf. Der Merkurstab 1998 51:159 - 64. English by A. R. Meuss, FIL, MTA)
-- In this pre-publication presentation of the chapter on perinatal problems which is part of a book on pediatrics, the authors offer some suggestions for the treatment of some major pediatric syndromes. The material is presented in a form that does not require detailed knowledge of anthroposophical medicine. Readers’ suggestions and comments concerning content and presentation will be most welcome.
Initial care of the newbom is generally in the following order 1) Warmth 3) Circulation 2) Respiration 4) Feeding, substitution The sequence is based on clinical experience, but it can also help us to gain deeper understanding of the relationship between the essential aspects of the human being in infancy.
The most important (and demanding) requirement of the human organism is to maintain a stable body temperature. A healthy neonate increases its specific heat generation by almost a factor of 2 on the day of birth.(1) Evolutionally, homoiothermia (warm-bloodedness) came to realization very much later than pulmonary respiration and the blood circulation. Man is superior to all other life forms in the function and regulation of the warmth organization.(2,3) All respiratory and vital processes are essentially governed by the warmth organization, serving it and depending on an intact homoiothermia for their function. The hierarchy of physiological functions clearly shows that generating and regulating body temperatures is the most important function of the human organism.
The tremendous increase in this output at birth and also every time we wake up and with febrile diseases and physiological activities relates directly to the individual's incarnation in a body and his will activity in coming to terms with the outside world (only possible in this way because of homoiothermia). The human I is active in and organizes within the living human body by generating and organizing warmth.
With our approach to treatment, it is therefore most important to take careful note of the child's body temperature conditions, providing treatment to support them if necessary. This applies not only in neonatology.
Protective warmth is maintained if we are calm and gentle in our approach to the infant, limiting diagnostic procedures to essentials and not applying them on a routine basis. The child is given the enveloping warmth it needs by having its mother close and being wrapped in warmed blankets, and woolen(!) baby clothes, including head-covering (20% of body surface area).
If the child's warmth organization nevertheless shows weakness and instability - both peripheral and core temperatures must be noted for this), treatment will be indicated, especially with premature infants and those with defects or deficiencies. Antibiotics, for instance, will frequently upset the warmth organization (measurably so).
A highly effective way of maintaining warmth are whole-body oil rubs (trunk and limbs) given once or twice daily on a regular basis and using Malva comp. Oleum (Wala), for example. This composition contains among other things elder, lime and blackthorn flower extracts as well as St. John's wort oil.
The warming effect is above all evident in the limbs growing warm and staying warm. The well-known British homeopath J. Compton Bumett noted and reported the beneficial and prophylactic effect of whole-body oil rubs around the turn of the century.(4) The children would thrive better, with infectious diseases less frequent and severe, which was particularly evident in comparisons made between twins.
Asphyxia, cardiorespiratory control problems and SIDS
Primary care with peri- and postnatal asphyxia is now the responsibility of neonatal intensive care medicine. Apart from full use of intensive care facilities, one does also see again and again that potentized medicines have a definite place in this field.
Tartarus stibiatus 6x (- 30c) trit. Weleda or pilules from various manufacturers has proved a specific, e.g. 2 pilules or a small pinch sublingually every 5 minutes initially, and every 30-60 minutes when it is taking effect; maintenance with a dose of the 3x-5x once a day.
A fellow pediatrician was able to observe the effect of Tartarus stibiatus in the helicopter emergency service. He was called to see an infant born very prematurely with tracheomalacia following long-term artificial respiration. Intubation carried major risks in this case, even in hospital. My colleague therefore did not intubate but gave the cyanotic and hypercapneic child Tartarus stibiatus, using the above scheme. On arrival, blood gas values had practically returned to normal and intubation was no longer necessary.
Tartarus stibiatus or Antimonium tartaricum (tartar emetic) is a compound of antimony trioxide and the potassium salt of tartaric acid.(5) The salt becomes soluble in form of the antimony compound and is also highly toxic. The main action seen with potencies of it is relief of stenoses and severe mucous congestion in the lower respiratory tract, with respiratory function generally stimulated and stabilized. Indications for Tartarus stibiatus in neonates and infants are all conditions of threatening asphyxia, obstruction of respiratory pathways with mucous rales and circulatory failure, livid skin color and incipient weakness of respiratory regulation (e.g. also pneumonia, bronchiolitis, pertussis, severe vaccination reaction). Tartarus stibiatus is one of the most important medicines in pediatrics and should always be to hand.
If the respiratory center is immature (mainly in premature infants), with more frequent phases of periodic breathing, and a greater number of extended apneic episodes, Tartarus stibiatus 3x-5x once a day is indicated for an extended period. The effect may be enhanced by also giving Carbo Betulae 8x-12x (various manufacturers), 2 or 3 pilules b.i.d.
Carbo Betulae, birch charcoal, is produced by heating wood with the air largely excluded. Generation of heat with oxygen supply and carbon dioxide release largely suppressed gives us the "physiology” of a charcoal burner's clamp. Potentized Carbo Betulae intensifies respiratory activity in the organism and above all expiration, which also relieves the circulation (stasis of micro-circulation and venous congestion). Central respiratory paralysis is counteracted, and the function of the respiratory center is stimulated, so that (ex)halatory activity is adapted to heat generation (and release of carbon dioxide) in the organism.
The question arises as to whether Tartarus stibiatus and Carbo Betulae might be given to prevent potential SIDS. In the first place, peripartum asphyxia is a major risk factor.(6) The behavioral features noted prior to SIDS (reported by parents) "showed that there are two types: a quiet, pasty, hypotonic infant who moves little, and the timid infant who cries shrilly and is hyperactive".(6) This shows remarkable correspondence with the polar opposite types of potential shock sequels (see guiding symptoms of Aconite and Opium below). The last set of symptoms also shows connections with those often seen with cervical spine lesions. In this respect, every therapeutic approach mentioned in this chapter may be useful for SIDS at risk infants. However, the combination of obstructive respiratory tract disorders (inspiration movement of thorax frustrated) and central regulatory disorders at brain stem level in the SIDS pathogenesis means that Tartarus stibiatus 6x and Carbo Betulae (8x-) 12x is indicated whenever a SIDS risk is suspected. In infants with manifest respiratory regulation disorder one often sees initiation of treatment followed by a marked reduction in the number and duration of apneic episodes and in phases of periodic breathing on the monitor.
Breathing relates directly to soul experience in the body (e.g. pleasure and pain). There is hardly any powerful analgesic, for instance, that does not depress respiration.(7) Stabilizing respiratory function thus means to make soul activity possible in the living body.
Every state of shock puts the connection between body and soul, the incarnation of the soul, at risk and causes it to be unstable. At the level of the psyche, shock causes above all fear and restlessness, but it may also have long-term consequences such as sleeplessness.
At the somatic level, severe shock endangers vital functions, especially those connected with circulatory and renal/adrenal functions. Treatment for shock may be important with all the disorders considered in this chapter and later in life also whenever the history suggests shock as a triggering factor (see case report below).
The most important potentized medicine for the sequels of shock is Aconitum 10x-30x pilules (Wala (The potentized plant-based medicines produced by Wala are made from fermented basic substances rhythmically exposed to light and heat conditions and not from alcoholic mother tinctures or triturated plant material.) or other manufacturers), in acute situations after birth 1 (30x)-3 (lOx) times 2 pilules.
Aconitum napelhis, monkshood, produces aconitine, "probably the most poisonous of all alkaloids; 3 mg are sufficient to kill a horse".(8) The sturdy alpine plant, growing at altitudes of up to 3,000 meters, likes a soil rich in nitrogen from animal manures. The flower shows bilateral symmetry (like the human face), is dark blue and turned away from the sky (unlike a daisy family flower with radial symmetry such as Arnica or Calendula, which never produce powerful poisons).
Aconite poisoning is of sudden onset, with deadly fear, circulatory failure (cardiotoxic) and acute anuria. Both the toxicology and the homeopathic drug provings show a wide range of other Aconite actions.
Aconite is indicated for shock if an external force has come suddenly upon the child, primarily causing tension and fear. Delayed or absent micturition may be a sign (conversely, this also serves to indicate the positive effect of potentized Aconite). A single initial dose of Aconite improves the response to Tartarus stibiatus in acute asphyxia if this has been triggered by shock-type external circumstances during birth. It is also effective in treating peripartum shock events that lie a long way back.
A boy aged 5 presented with severe asthma that had not responded a great deal to treatment for years. Taking a thorough history once more, we heard of postpartum asphyxia, when for a short time the mother, a medical receptionist, thought her child was about to die. She herself also suffered from asthmatic symptoms from that time, something she had not reported before. As the condition had persisted for a long time and related to an event that happened quite some time ago. Aconite was given to both mother and child in relatively high potency - first the 30x and then the 200x. The symptoms disappeared almost completely after this. The child's asthma, only controlled with steroid inhalations before, showed marked improvement. The steroids could be completely discontinued (follow-up observation 3 years). Early treatment with Aconite, ideally immediately after the birth, would no doubt have been even more effective, though in that case the effect would probably not have been so evident.
The state of shock in which Aconite is indicated primarily results in excessive inspiration, with the breath held fast (anxiously) in the process (see connection with asthma in above case record). The opposite effect may occur with full anesthesia, for instance, when the soul element is separated (too much) from the living body and then cannot find its way back to its normal activity in that body. The child is not in spasm, but primarily atonic, his breathing stertorous (marked tendency to apnea), the fades flaccid and free from pain. Inactivity of the intestinal musculature and even paralytic ileus are a major indication.
This state of shock, often partly triggered by opiate-related anesthetics, responds to potentized Opium 30x pilules (various manufacturers), with 2 pilules given three times at 6-12 h intervals.
Opium should be considered above all after a caesarean under full anesthesia or the exhibition of opiates during parturition. It may also produce dramatic effects in other, comparable situations.
A girl aged 2 had an operation to reposition and reimplant the right ureter in the bladder. Postoperative complications made two emergency operations necessary within 5 days. The child then developed paralytic ileus, and all measures to achieve defecation failed. The child's general condition was poor; she was apathetic and indifferent, only wanting to be left alone. Opium 30c in the above dosage scheme was prescribed by telephone. Six hours after the first dose she passed stools; she started to take some nourishment again and recovered within a few days.
Aconite and Opium relate to two polar opposite states of shock. In the one, psychic activity in the body and hence respiration, fear and pain are increased, in the other one has partial excarnation of the soul and spiritual individuality, leaving the vital organization to itself (reversion to a plant-like state). All the listed symptoms can only be an aid to our perception of these fundamental shifts in the child's configuration of soul and body.
Aconite (poisonous tuber) fear, tension, neuralgiform pain soporific, acute anuria, too wide awake, too powerful inspiration
Opium (dried latex from capsule) atonic, painless, paralytic ileus, atonic constipation, sleepy, breathing stertorous
Oxalis ointment 10% (Weleda) may be used for external application to treat the sequels of shock, massaging a pea-size amount into the skin between sternum and navel twice a day, going clockwise.
The tender, thin leaves of wood sorrel (Oxalis acetosella) "manage with only l/70th of full daylight but perish on full exposure to the sun, when their chlorophyll is destroyed.” (9) The leaves are highly sensitive (e.g. to touch) and mobile (opening out and folding up like an umbrella within just a few minutes), characteristics normally seen only in flowers. Even the roots of the plant are contractile, which prevents the woodland soil from covering the plant over.
The corresponding feature in human pathology is autonomic hypersensitivity. On the one hand organic functions in the metabolic sphere are excessively influenced by psychic affects (e.g. intestinal colic, meteorism, irregular stools), and on the other the child is too conscious of its own vital processes in this sphere. We might speak of a hypersensitive sense of life,(10) a common sequel of shock which characteristically also develops at a particular age, in about the 3rd to 5th years of life, in form of infant colics. Applications of Oxalis balance out this inner hypersensitivity by means of a corresponding process on the skin surface.
Potentized silver has a broad-spectrum balancing effect in the treatment of shock. It may be used to continue the shock treatment initiated with potencies of highly toxic medicinal plants, complementing and consolidating their actions. The silver action - relating to organs - addresses above all the neurosensory system. The properties of the metal show an essential relationship to all organs that are ectodermal in origin. It is the most conductive of metals, like the nerve fibers that develop maximum conductivity by the 7th year of life. Nerve fibers are argyrophilic, i.e. can be selectively stained with silver (Golgi stain). Silver also produces a perfect mirror, another basic function the neurosensory system has in the organism.
In the creation of the child's vital organization, the emphasis is on the development of the neurosensory system perinatally; this priority is a basic characteristic of human growth. The composition of the mother's milk, markedly differing from that of animal milk, with high lactose levels, a specific combination of fats and relatively little protein and mineral salts, also serves primarily to nourish the neurosensory system (the mammary gland is also ectodermal in origin). It is therefore easy to see why an insult to the vital organization due to shock will cause changes in sensory perceptions and their processing, especially in infants.
For man, silver is the metal most helpful to life and least toxic. Microorganisms are killed by traces of silver in very fine distribution (oligodynamic effect), but water sterilized with silver is harmless to humans. Silver wires and plates are common surgical appliances and easily tolerated by the human organism.
Potentized silver fundamentally supports the child's life organization. Used medicinally to treat shock sequels, it will help to reduce hypersensitivity of the senses (and hence nervousness and anxiety). Rhythmic alternation of sleeping and waking, when the emphasis is on alternation between anabolic processes in the growing body and processes of conscious awareness in the soul (always going hand in hand with catabolic processes in the body) is promoted and harmonized. Potentized silver is therefore particularly important in the treatment of premature infants and those with defects or deficiencies (v.i.).
A range of silver preparations are used in anthroposophical medicine:
Argentum met. prep. 6x trit. Weleda, (The raw material is silver that has been evaporated and precipitated to produce a mirror surface (= prep.). It is then triturated to potentize it. The aim is to vitalize the above mentioned morphogenetic quality of the generative powers inherent in silver. a good pinch at night or t.d.s.
Argentum/Cane sugar pilules Wala, 3 pilules at night (neonates). Seven pilules (young children) daily. Argentum 6x and cane sugar lOx are potentized together, using a method specifically designed for the treatment of shock by Dr H. H. Vogel(11)
Bryophyllum Argento cultum Rh 3x Weleda (Weleda Rh preparations are based on a fermentation process in specific rhythms. They do not contain alcohol. , 3 drops t.i.d.; young children 5-7 drops t.i.d.
The raw material for this is the plant Bryophyllum grown in soil fertilized with silver. The unusual metabolism of this succulent is active during the night, enabling it to maintain the necessary turgor and high-level reproductive activity even under difficult conditions. The pharmaceutical method used puts emphasis on the relationship silver has to the vital organization, to anabolism and growth. Indications are sleep disorders due to shock, failure to thrive, and also hysteriform states of excitement.
If the original shock was connected with exposure to toxic substances (anesthesia, antibiotics, etc.), the silver sulfide preparation may be used Argentite 6x trit. Weleda (dosage as for Argentum met. prep. 6x).
Birth trauma The type of birth trauma that has the most consequences is the one affecting the circulation, with hypoxemia and ischemia; intracranial hemorrhages are not always easy to diagnose, however. In spite of the great advances made with ultrasound, it still is vitally important to take careful note of any deviation or unusual occurrence during parturition. If there is the least suspicion of hypoxic, ischemic or hemorrhagic brain damage (e.g. after extended labor that finally had to be terminated with a caesarean), potentized medicines may be used to try and prevent or reduce long-term consequences.
Again it is a potentized metal that shows broad-spectrum action in restoring the balance - copper in form of Cuprum met. 30x pilules (various manufacturers), 1 or 2 pilules given 1-3 times over 24 hours. This is the most important potentized medicine for treating vasospasm; other indications are hypoxemia (cyanosis), poor peripheral circulation (delayed filling reaction, cool extremities), epileptic seizures with cerebral circulation disorders or following asphyctic brain damage, mental stupor and a tendency to develop muscular spasms (both smooth and striated muscle).
The background to these symptoms is that the soul organization - or astral body, to use the anthroposophical term - has difficulty penetrating the body and "gets stuck half way". This shows itself above all in low oxygen partial pressure on the one hand, and the tendency to go into spasm on the other. The soul principle is struggling to incarnate but it is not possible to create the necessary conditions for this. It is especially in the sphere of respiration, of partial pressures, that conditions partly persist that were physiological in utero but are now quite inadequate for independent individual respiration and heat generation.
The heart of the matter is that separation from the mother does not succeed. The physiological phenomenon relating to this is a 2 or 3 fold increase in maternal serum copper levels, whilst the child shows maximum corpuscular iron concentrations at birth; thus the child's Hb and the maternal Hb are between 3:2 and 2:1. The child needs iron to break through the maternal protection and be able to incarnate, whilst the mother uses the quality of the copper substance, among other things, to envelop, hold and nourish the unborn child (her own Hb decreasing physiologically).
Copper in high potencies is of general clinical significance in pediatrics to treat a tendency to go into spasm (respiratory tract, vessels, musculature) and if bonding with the mother is too close (ambivalent).
To sum up, potentized copper primarily effects spasmolysis in the vascular system, respiration and musculature. It may be used to prevent or reduce cerebral ischemia with its serious consequences. In my own practical experience, stressed neonates recover much more quickly if given Cuprum 30x.
The positive effects of Arnica montana in treating blunt trauma, hematoma and hemorrhagic insults are well known. If there is the least suspicion of intracranial bleeding. Arnica e pi. tota 30x pilules Wala (With hemorrhages. Arnica preparations made from the whole fresh plant (as recommended by Hahnemann) are preferable to the usual preparations made from the root. They are manufactured in pilule form by Wala and as dilutions by Weleda.may be given immediately; 1 to 3 times 1 pilule over 24 hours, together with Cuprum 30x These hemorrhages almost always result from hypoxemia and fluctuations in perfusion.
Manifest brain hemorrhages (ultrasound ICH II - IV) call for Arnica in rising potencies: Arnica e pi. tola 6x pilules Wala, 1 pilule 3-5 times daily for 1 week, then the 12x, 1 pilule b.i.d. for 1 week, and finally the 30x, 1 pilule daily for 3 days.
For cephalhematoma give Arnica e pi. tota 4x pilules Wala, 1 pilule 3-5 times daily, and apply Arnica 10% ointment Weleda twice daily.
Quite generally, it is advisable to give Arnica and Cuprum 30x together, 3 times in 24 hours, in any suspected case of perinatal brain damage, also treating for shock and asphyxia as required.
More extensive intracranial hemorrhages may also lead to obstruction of CSF fluid movement (hydrocephalus). A shunt procedure will not always be required. In my own practice it was repeatedly found that exhibition of Stannum met. prep. 20x-30x trit. Weleda, a good pinch once or twice daily, can reduce the degree of hydrocephalus and reduce the pressure.
A premature infant born in the 30th week of pregnancy had a grade III intracranial hemorrhage with progressive ventricular enlargement. A shunt procedure seemed inevitable. At the mother's request, treatment with Arnica e pi. tota 6x and Stannum met. prep. 20x was initiated c. 7 days post partum, using the above dosage. The hydrocephalus did not progress; instead the condition improved slowly but steadily. Five years later, neurologic development is normal, with internal spaces only moderately enlarged.
The initial treatment with Stannum and Arnica should continue for 3-9 months with Hypophysis/Stannum pilules Wala, 2-5 pilules once of twice daily.
Hypoxic and ischemic encephalopathy following asphyxia is a severe neonatal condition requiring intensive care. Cerebral tissue destruction (leucomalacia) results above all in premature neonates. Circulatory and renal functions are unstable or seriously impaired; CNS damage may lead to seizure disorders. The individual soul and spirit's incarnation is seriously affected, and the body threatens to fall into a vegetative state. The children often appear stuporous and hypotonic. If they are not intubated, one sometimes \hears shrill crying or whimpering, with little modulation. Helleborus niger 12x (various manufacturers) may be given in addition to other treatment, 1 or 2 pilules 2 or 3 times daily.
It is equally important not to neglect external applications when treating seriously ill neonates in hospital. In this situation, involving the shock of being separated from their mothers and inevitably painful invasive treatment procedures, and also considering the significance of the skin as a sense organ (especially with neurological disorders), loving care and attention given by means of skin contact have significance and justification even in modern neonate intensive care. We would above all suggest applying oil to the back in the craniocaudal direction, for instance rose oil alternating with blackthorn flower oil (see also the section on protective warmth).
If there are signs suggesting perinatal lesion of the cervical spine/cranio- cervical transition, an experienced osteopath should be asked to examine the child and if indicated apply the necessary manipulation. This can avoid many problems later on. Medical treatment if the condition is diagnosed may consist in Hypericum 12x pilules (various manufacturers), 3 pilules once a day, e.g. at midday, and Disci comp. c. Stanno pilules Wala, 2 pilules b.i.d., e.g. morning and night.
For paralysis due to birth trauma, e.g. Erb's palsy or facial nerve paresis, the healing process is facilitated by giving Hypericum 6x pilules (various manufacturers), together with Arnica 6x pilules (various manufacturers),**** 2 pilules, t.i.d.
In treatment-resistant cases, homologous organ preparations may be used in addition, e.g. Nervus facialis GL 5x-30x potency series ampoules Wala to treat facial nerve paresis, (The potencies are given in rising sequence, starting with the 5x. The contents of one ampoule, kept in a syringe, provide three daily doses for the above dosage scheme. giving 0.3 ml per os once a day (or every 2nd day).
These preparations have proved effective (among other things) when there was need to stimulate vital regenerative processes in a specific organ region.
Hermann M. Stellmann, MD
Hasslach D-83043Bad Aibling
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