On Mother's Day

Mothers 

hold the hands of their children 

for a while, 

but 

their hearts forever.

       On Mother's Day,  

      

     from their children                       

             with Love

History of vaccinations

Some infectious diseases leave behind a natural immunity. The knowledge of this led to attempts to acquire this protection artificially through a controlled amount of contact with the illness at a favourable time and under favourable conditions.  Such trials have been known over a thousand years in chinese medicine and later also in arabic medicine, the most important historical example being that of developing the vaccination against smallpox. These attempts were associated with risks of actually contracting the disease and dangers of the consequences. 

The enlgish doctor Edward Jenner carried out the first vaccination against smallpox on 14. May 1796, using the crusts of skin lesions from an infected cow. What followed showed the characteristics typical of the development also of other vaccinations later, i.e. an initial partial success,  recognizable adverse effects and the suppression of the disease to smaller outbreaks at a later stage. According to Jenner's judgement, his own son suffered from serious damages from the vaccination. The next milestone was the discovery of microorganisms by Louis Pasteur (1822-1895). The contemporary German doctor and Nobel prize winner Robert Koch (1843-1910) discovered the tubercle bacillus and developed the tuberculin vaccine. A series of vaccinations was developed against the big "killer epidemics": Smallpox (1798), Rabies (1885), Pest (Black Death) (1897), Diphtherie (1925), Tuberculosis (1927), Tetanus (1927). After the second world war, scientific progress enabled the development of more vaccinations also against virus diseases: Polio (dead vaccine 1955, live vaccine 1962), Measles ( 1964), Mumps (1967), German Measles (1970) and Hepatitis B (1981).

A critical review of history shows that well earned progresses often go hand in hand with set backs and sacrifices, which is also characteristic of the advances of humanity. On 8th April 1874, the German government declared vaccination against smallpox to be legally compulsory. At the same time, vaccinated citizens suffering from adverse effects were eligible for compensation. It has been documented, that under the WHO vaccination programme with the oral Polio vaccine and the simultaneous injection of DPT (Diptherie-Whooping cough-Tetanus)- vaccine the cases of Polio in India around 1980 actually increased rather than decreased. The problems associated with the wild polio virus under tropical conditions were not yet recognized. Now and again, vaccines had to be withdrawn from application due to unforeseen problems. The previous whooping cough vaccine was discontinued from 1974 to 1991 in Germany because of causing brain damage and fatal cases. It was only in 1997 when the neurological adverse effects of vaccines containing mercury (Thiomersal) especially affecting infants were officially acknowledged. Thereafter, all such vaccines concerned were removed from the market in Germany. Instead of Thiomersal, the conservation material used nowadays is mostly Phenoxyethanol.

Such collective experiences in the past justify an initially reserved attitude towads a newly introduced vaccine, e.g. the HPV.vaccine for teeange girls.

The interested reader is referred to the numerous publications on this issue. Among these, the book by the German paediatrician Dr. Martin Hirte "Impfen, Pro & Contra" is probably the most well known. In the current up-dated edition of March 2015 are many quotations from recent studies and documentations.   

Vaccinations - general comments

In Germany, there has been a very active, sometimes heated, debate about the necessity and complications of vaccinations for a long time. The official vaccination scheme is laid down by the "STIKO" (Continuous Commission on Immunization), a commission of 16 experts within the Robert Koch Institute in Berlin. It is known that individual members of the commission work closely with industrial firms producing vaccinations, and that doctors get paid for each vaccination they carry out. The list of the recommended vaccinations has become longer and longer over the past years. At present, the official vaccination scheme for children up to 17 years, starting at the age of 9 weeks, covers 14 diseases (13 for boys). By the time a child is 15 months old, he would have received 27 individual vaccinations (several of these are combined in a single injection). What a heavy demand on the response from the immune system of a young and tender body!

I appeal to parents and readers not to be polarized into the two camps of "fans for" or "opponents against" vaccinations. It is not a simple question of "Vaccination - yes or no?", rather it should be a neutral and factual discussion on "Vaccinations - why for and why against which vaccination?"

Legally speaking, each vaccination involving an injection is a physical assault and could only be carried out with the consent of the client, in the case of a child, his parents. Many parents take the responsibility to give this consent very seriously, making the decision carefully after a lot of considerations which vaccination the child should have and when. The doctor has the duty to explain to the parents about the vaccination, the disease it is supposed to prevent and the possible side effects and complications of the vaccination, so that the parents are able to make an independent decision (according to the "special instructions for carrying out vaccinations" by the STIKO Commission).

Parents who are reluctant to have their children immunized according to the scheme are often charged for being irresponsible. Criticism against them is mostly based on the following arguments. Well meaning relatives such as grandparents who have lived through times when infectious diseases were often life threatening tend to think that all vaccinations would keep the child away from illness and could only be good for them. Another argument maintains that only if each and every child is vaccinated without any exception could a disease such as measles or hepatitis B be completely exterminated, which is the aim of a vaccination campaign. These arguments are not equally valid for all the 14 different diseases concerned. The tremendous improvement in hygiene and living conditions have contributed as significantly as the availability of vaccinations to the decrease of dangerous infectious diseases. The possible side effects and complications of the vaccinations have to be weighed against the reduced risk of contracting the diseases.

As a paediatrician working with Homoeopathy I am often asked whether there is any "homoeopathic vaccination". The answer is No. If there was any assertion that the application of a homoeopathic remedy has the effect of preventing certain diseases, this has not been proven to my knowledge. Homoeopathy is a treatment method for an existing illness and the observed symptoms are necessary for the prescription of a remedy. Thus it is not a preventive measure in the strictest sense. In the debate concerning vaccinations we should leave out Homoeopathy.

I have written these comments following the last essay on Goethe's ballad "The Erl-King" about a dying child and my thoughts on children's mortality rates in the times of Franz Schubert. Perhaps the child in the poem who was having hallucinations before his death was suffering from measles encephalitis? Those were the times when vaccinations would have been most needed. Times when a seriously ill child had to be taken to the doctor on horseback in the cold night. A colleague from the USA once told me about his memories of childhood in Upstate New York, how during an illness he was taken to the doctor on a sledge in the midst of winter. No mother in Europe nowadays would dare to do that. The paediatrician would be asked to do a house call. In 2001 I was doing voluntary work in the Philippines as a member of the "German Doctors for the Third World". There, where infectious diseases were frequent and life threatening, we were vaccinating children conscientiously. There, small children were also dying from severe diarrhea. Unfortunately, no vaccination was available for that. Quite to the contrary I do not think that the vaccination against Rotavirus (causing diarrhea) now in Europe is at all necessary.

We shall go into the discussions about individual diseases and vaccinations in the next articles.

Goethe's ballad “The Erl-king” from a paediatrician's point of view

“Der Erlkönig” is a well known classical song which depicts the death of a child assailed by a supernatural being, the Erl-King or “Erlkönig”, a ballad written by Goethe in 1782 and set to music by Franz Schubert in 1815. Goethe was supposedly inspired to write the poem by the news of a farmer from a nearby village riding desperately with his ill child in the night to look for the doctor.

Who rides there so late through the night dark and drear?

The father it is, with his infant so dear;

He holdeth the boy tightly clasp'd in his arm,

He holdeth him safely, he keepeth him warm.

…...

“Father, do you not see the Erl-king?
The Erl-king with crown and cape?"

“My father, my father, and dost thou not hear

The words that the Erl-King now breathes in mine ear?”

“My father, my father, he seizes me fast,

For surely the Erl-King has hurt me at last.”
........

The father now gallops, with terror half wild,

He grasps in his arms the poor shuddering child;

he reaches his courtyard with toil and with dread,

The child in his arms finds he motionless, dead.

I never liked the song as I find it oppressive with fear and sadness, in spite of the beautiful music. There are many unanswered questions about the poem itself and different interpretations in the literature. I developed my thoughts about it from a paediatrician's point of view last November when I listened to the song in Schubert's birth house in Vienna, having just read his biography. Schubert was one of the only four surviving children out of fourteen (!) births of his mother. What a tremendously high mortality rate for children at that time! (Schubert himself only lived to his beginning 30's.) Being there in this house where the Schubert family had lived and worked (his father ran a school in the same house) and listening to this ballad about the fears of a sick child before his tragic death suddenly brought home to me how precarious the life of a child was 200 years ago.

Not long thereafter I had a family of three generations in my consultation room. The grandfather accompanied his daughter bringing the ill child to the practice. Before they left, the discussion about immunizations somehow became lively. The grandfather was full of anxieties from his times when serious illness was often life threatening for children. Vaccinations were to him undoubtedly a great savior of modern medicine. To the daughter, in this day and age when children's mortality is fortunately not any more imminent except in hospitals whereas side effects from chemical drugs a real concern, the necessity of vaccinations has become questionable.

I tried to explain to both father and daughter that they have different points of view because the issues and concerns about children's health of their generation are so very different.

Next time, we shall discuss on this hot topic, the vaccinations.

Greetings of spring with cough and snuffles

                                                                                                                       4. April 2017

Last Friday, Mrs. K. registered her two sons for an acute appointment because of their cough, snuffles and fever. Simon (13) and Elias (14) first came to the practice a few years ago with complaints of stomach pains and bowel problems. Mother is also a patient in our family practice. She suffers from hay fever and food allergies, the greatest problems being with cow's milk and gluten.

The children's symptoms were not quite so acute. They have been there for a few weeks since the beginning of March, sometimes better and sometimes worse. Because Simon's fever went up again and Mrs. K. was still anxious from the experience with Elias' pneumonia some time before, she brought the children for treatment before the weekend.

Simon has had a “barking” cough since quite a while. I asked him to please cough a couple of times. Indeed the cough sounded neither dry nor “wet” with phlegm, but rather hoarse coming from the larynx (at the level of the vocal cords) as though the airways there were narrowed. Some mothers would describe such a cough as “like a little dog barking”. This is the typical description of the cough of “croup”, a frightening attack which could happen to small children in the night with wheezing on inspiration (stridor) and shortness of breath. Parents often seek help in the emergency department of hospitals because of the fear that the child might suffocate. The episode is less dramatic with older children. Many of these children have a tendency to have repeated croup attacks or to have a croupy (barking) cough when they catch a cold, especially in early spring and autumn.

From my experience, a barking cough is not just a simple virus infection of the vocal cord area. Especially if it tends to be repetitive, it speaks for an over reactive basic state of the airways, which is what “allergy” means. There are often other expressions of this allergic basis such as hay fever or asthma like symptoms in the family. I always ask about the child's previous history, the association with the seasons and the family history.

The mother thought for a long time and could not quite answer the question, whether Simon was also coughing a lot during the same season last year. Simon, however, could remember it well, “yes, I coughed a lot on my birthday and before too.” His birthday is on the first of April. So, during the same spring season, when mother has hay fever symptoms, Simon is also susceptible to coughing. The homeopathic remedy for a barking cough would be Spongia, D30, 3 times daily 5 pieces.

Simon also had a blocked snuffle. The allergic reaction and the infection caused swelling of the nasal mucosa. The nose is almost completely blocked, left and right side alternating, and mucous secretions could not flow down. This could lead to the danger of Sinusitis. His fever was a warning signal. Nose drops to decrease the mucosal swelling and medicines to dispel the phlegm (“expectorants”) would be necessary to avoid further infection and inflammation of the sinuses.

The elder brother Elias had a really dry cough. This irritant cough sounded rough, was short and frequent, “staccato” without long stops. The homeopathic remedy for it would be Sticta pulmonalia, D30, 3 times daily 5 pieces. While listening to the chest I noticed reduced breath sounds on expiration. The child could breathe out better if he pressed his tummy with his hand. There is obstacle to breathing out caused by narrowing of the small airways. This is the point on which the diagnosis “asthma” or “obstructive bronchitis” is based. I prescribed regular inhalation with physiological salt solution first. If the difficulty with breathing got worse, it would be necessary to use “bronchodilators” (medicines which act to widen and relax the narrowed small airways again).

From a holistic point of view, the two children and their mother show different symptoms of the same allergic basis. The bowels, the middle of the human organism, is the important centre of most of the immunological events in the body. All three patients have problems with the digestive system. The mother admitted, that since she has stayed away from cow's milk products and cereals containing gluten, after blood tests confirmed the intolerance of these, and went through treatment of the intestinal flora, her hay fever this year has been significantly better. Logically, I recommended that the children follow the same measures and treatment.

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