X. Scarlet Fever (Febris Rubra) Scarlatina.
Scarlet Fever is chiefly a disease of childhood, especially from the second to the fifth year of life. It is by no means unfrequent in the second year, and even occurs in the first, although infants a few months old seem to enjoy a special exemption. Of the entire mortality from Scarlet Fever, about sixty-eight per cent, is among children under five years of age, and about twenty-four per cent. more among children from five to ten years. After the tenth year the liability to it rapidly diminishes. The common notion that Scarlatina is mild, and Scarlet Fever a severe, form of the disease is incorrect, for the terms have the same meaning.
VARIETIES. I. S. Simplex. A scarlet rash with moderate fever, redness, but no ulceration of the throat. 2. S. Anginosa. Ulceration of the throat, with tendency to the formation of abscess in the neck; the temperature is high, and the circulatory disturbance great. 3. S. Maligna. The rash comes out imperfectly or irregularly, is hardly visible, or appears and disappears alternately, and is dark-red rather than scarlet; the throat is dark, or even sloughy; the tongue is brown; the nose is excoriated; intense fever, extreme debility, great brain disturbance, and low delirium are present. In this variety there is consequently great danger to life.
Scarlatina is more likely to take on a malignant form than any other eruptive fever, and it sometimes prevail as an epidemic in low, ill-drained, and densely-populated districts. It should always be under the care of a homoeopathic physician, as the mildest forms, neglected, have often led to the worst results.
GENERAL SYMPTOMS. After lying hid in the system for about five days, Scarlatina commences with the ordinary symptoms of fever shivering, hot skin, frontal headache, rapid pulse, nausea, sometimes vomiting, thirst, and sore throat. The last-named symptom is generally the first complained of. After a short time the pulse becomes very quick, often 120 to 140 in the minute. In about forty-eight hours after these symptoms, the rash comes out on the breast, neck, face, body, joints, and limbs, till the whole body is covered with it.
The eruption usually fades away in the same order. Its appearance is a bright scarlet, having the colour of a boiled lobster-shell. The colour disappears on pressure, but immediately returns on its removal.
The tongue at first is coated with a creamy fur, the tip and edges are red, the little dots are red and raised, giving it a straw-berry-like appearance. This is always seen in the course of the disorder, and not unfrequently at its commencement. The tongue afterwards becomes clean and raw-looking. From the fifth day to the ninth the rash disappears, leaving the child more or less prostrate. The outer skin now comes off in scurf, or in large pieces from the hands and feet.
In the malignant form the eruption is either entirely wanting, or dark and partial. Sometimes the lining membranes are threatened with mortification, the glands and even the tissues of the neck are very much swollen, and the fever is attended with prostration so extreme that the patient may sink in a few hours.
EPITOME OF TREATMENT.
Scarlatina Simplex. Belladonna Alt. Aconite; Arsenicum (during scaling of the skin); Sulph, (recovery).
S. Anginosa. Apis (much swelling and hoarseness); Mercurius, Cantharis (ulceration of throat); Veratrum-Vir. (severe brain symptoms, vomiting, and fever).
S. Maligna. Ailanth., Baptisia, Arsenicum, Murex-Ac. Carbolic Acid; also spray of Sulphs.-Ac., Hydrastis, or of Condy’s Fluid, diluted; one part of any to about ten of water.
Belladonna. Is specific, and exerts a direct power over Scarlet Fever in its simple form.
Aconitum. Much feverishness, thirst, dryness, and heat of skin.
Gelsemium. Imperfect eruption, nervous restlessness, remittent symptoms.
Veratrum Viride. Severe brain symptoms, vomiting, and very rapid pulse. It may be given turn-about with Belladonna These two are most frequently useful.
Muriatic Acid. Malignant sore throat, with extreme depression, tremors, etc.
Ailanthus Gland. Malignant Scarlatina, with purple or nearly suppressed rash, foetid discharge from the nostrils, cracking at the corners of the mouth, etc. It should be given directly unfavourable symptoms are observed, and frequently repeated until improvement ensues. This is indicated by increase of the eruption, by its taking on a scarlet colour, and by lessened fever.
Arsenicum. Prostration, excessive thirst, cold clammy sweats, frequent weak pulse, diarrhoea, dropsy.
Sulphur. When the disease is on the decline, to prevent secondary complaints.
ADDITIONAL REMEDIES . Coffea, Hyos,(restlessness and sleeplessness); Cuprum-Ac. (sudden going-in of the rash); Ant.- Tart. (in the first stage, if preceded by convulsions, cold sweats, difficult breathing or by vomiting); Kali bichromicum Alt. Nit.-Ac. or Mur.-Ac. (white patches on the tonsils); Kali Hyd. (considerable swelling of the glands); Apis Alt. Digit (little urine, dropsical symptoms); Nit.-Acid, or Hydrastis, as a gargle; ten drops of strong tincture to a gill of water; it should be used once in two hours.
If the patient is too young to gargle, the throat should be mopped out by means of a small piece of sponge secured to the end of a stick, and the gargle afterwards applied by means of a cleaned sponge or a feather.
SECONDARY DISEASES. The following are the chief: 1. Inflammatory swelling of the glands of the neck, Mercurius, Help.-S., Calcarea, Silicea 2. Deafness, Belladonna, Aurum. or Pulsatilla 3. Dropsy the urine being cloudy, scanty, and becoming thick when boiled is the most frequent and dangerous result of Scarlatina. It may appear about twelve days after the fever subsides. Apis., Helleborus, Bryonia, Apocynum, and Digitalis are the chief remedies. Warm baths are also advisable
Complete suppression of urine without dropsy is far from uncommon. It may last for several days, and terminate either in the gradual reaction of the kidneys, or in blood-poisoning, sudden convulsions and death.
ACCESSORIES. The patient should be placed in a separate room, which can be so ventilated as to secure a copious and continual supply of fresh air. The room should be as free from furniture as possible. Curtains, carpets, and unnecessary furniture should be removed from the room. A fire is necessary, unless the weather is too hot; for a fire is a great aid to ventilation. Condy’s fluid or carbolic acid should be freely used. Sponging the body with tepid water, piece-by-piece, moderates the heat and restlessness, quiets delirium, lowers the pulse, and favours sleep. A wet bandage to the throat seldom fails to relieve. It should be fastened both at the back of the neck and top of the head, so as to protect the glands near the corners of the jaws. Inhalation of steam from hot water is useful when the throat is sore.
When recovering, warm clothing, including flannel, is necessary; and afterwards a change of air, if possible to the seaside. The patient must not go out too early, as secondary symptoms are then apt to follow.
DIET. During the fever, milk and soda-water, gruel, dry toast, simple biscuits, yolks of eggs beaten up with cold milk, grapes, oranges, cooked fruit, etc., should be the staple diet. The drink may consist of cold water, gum-water, barley-water, weak lemonade, etc., in small quantities as frequently as desired. As the fever abates, milk-diet may be given, gradually returning to more solid food. Strong drinks are rarely necessary, except in malignant cases, when wine, brandy, Liebig’s extract of beef, beef-tea, etc., may be administered in frequent small doses, under medical care.
PREVENTIVE. During the prevalence of Scarlatina, a dose of Belladonna should be given, morning and night, to children who have not had the disease. The first dilution or strong tincture is best for this purpose. Should the disease occur notwithstanding, its severity will be much mitigated.
XI. Measles (Morbilli).
Measles is a disease of childhood, highly infectious, often epidemic, and frequently fatal. In England and Wales, 16,765 persons dies from this disease in 1887. It generally attacks the same patient only once.
SYMPTOMS. About ten days after infection, the disease comes on with the symptoms of a cold sneezing, running from the nose, red, swollen, and watery eyes, a hoarse harsh cough, languor, and fever, which increase in intensity. About the fourth day the eruption begins, and appears on the face and neck, then on the body, and lastly on the legs. It is in the form of small round spots resembling flea-bites, which multiply and run into blotches, slightly raised above the surrounding skin, so as to be felt particularly on the face, which is often a good deal swollen. It is raspberry-coloured, and turns white for an instant under pressure; a dark purple is a bad sign. It is two or three days in coming out, and remains at least three days. The fever then abates, and a bran-like scurf is thrown off the skin.
As the rash declines, diarrhoea sometimes occurs; which, unless very troublesome, should not be interfered with.
The highest temperature, in ordinary cases, is 103* on the fifth day; if above this, the case is severe; if below, it is mild.
DIAGNOSIS. A most important symptom of Measles in its preliminary stage is, red spots on the soft palate, more especially on the uvula, which appear five or six days before the eruption, even if there is no other symptom of disease perceptible.
It may be distinguished from Scarlet Fever by the eruption being rough and light-red or raspberry-coloured, beginning near the hair; also by sneezing, watering of the eyes, and other symptoms of a cold, and the absence of sore throat.
The presence of sore throat, together with sneezing, and running of the eyes and nose, indicates not Measles but Rubeola. (See p. 44.).
REMEDIES. Aconitum. Feverish symptoms at the outset or during the progress of the disease. A dose every third or fourth hour.
Pulsatilla. Symptoms of cold, stomach derangement, phlegm in the chest, etc. It is most useful after the fever has been modified by Aconite.
Belladonna. Sore throat, dry, barking cough; headache, drowsiness, or restlessness, and tendency to delirium,
Bryonia. Imperfect eruption, stitching pains in the chest, difficult breathing, cough, etc. For a sudden going in of the eruption, this remedy, Aconite, or Gelsemium may be given every half- hour; also a hot bath, or a blanket bath.
Veratrum- Vir. During the fever stage, especially if congestion of the lungs be feared.
Antim tart. Nausea, retching, or vomiting.
Mercurius. Ulcerous, glandular, or dysenteric affections.
Sulphur. When the eruption if going off.
Euphrasia. Profuse flow of tears.
Phosphorus. Dry, hollow cough; pain under breast-bone.
SECONDARY DISEASES. Measles is often followed by diseases of the lungs, eyes, ears, bones, or some affection of the skin. These generally require professional treatment, but may often be prevented by the administration of Sulphur.
REMEDIES FOR DISEASES LEFT BY MEASLES.
Inflammatory Affections of the Eye-lids. Aconite, Belladonna, Mercurius- Corr. Sulph.
Discharge from the Ear, or Deafness. Pulsatilla, Sulphur, Silicea, Mercurius, Hepar-Sulph.
Swelling of the glands. Mercurius, Iodium, Calcarea carb.
Chronic Cough, Hoarseness, etc. Phosphorus, Hepar-Sulph., Spongia, Arsenicum, Kali bichromicum
Eruptions. Sulph., Iodium, Arsenicum
MEASLES AND CONSUMPTION. Disease of the lungs or bowels is by no means an infrequent result in delicate children. Whenever, therefore, a child makes but a slow or imperfect recovery, more particularly if there is tenderness, pain, or enlargement of the abdomen, Diarrhoea or Constipation, and a high temperament, no time should be lost in obtaining professional homoeopathic advice. Domestic treatment may then be dangerous.
ACCESSORIES. An infant at the breast when attacked may refuse to suck, in consequence of the closure of the nasal passages; resort must then be had to artificial feeding with the spoon. The patient should be kept warm in bed, with the room darkened to protect the eyes, and the same general treatment observed as directed under Scarlet Fever.
PREVENTIVES. Pulsatilla every morning, and Aconite every evening, for a week or ten days, during the prevalence of Measles, will prevent or at least modify an attack.
XII. Rubeola Scarlet Rash.
This disease somewhat resembles Scarlet Fever, for which it has been frequently mistaken. But to the sore throat and scarlet rash, which ally it to Scarlatina, there are the catarrhal symptoms commonly met with in Measles; hence it has been regarded by some authorities as a hybrid of the two diseases.
SYMPTOMS. The spots appear irregularly on different parts; they are darker and rougher than those of Scarlatina, and not rendered white by pressure. The child perspires when the rash is out, and in proportion to the fulness of the eruption. One attack does not prevent others. It runs no regular course. The sudden disappearance of the rash may be dangerous.
REMEDIES. Aconitum. Simple scarlet rash. Belladonna. Severe throat symptoms. Pulsatilla. Preponderance of catarrhal symptoms. Bryonia. Sudden disappearance of the eruption.
ACCESSORY MEANS. The same general precautions should be observed as in Scarlet Fever. If the eruption suddenly disappear, a warm bath, 98* Fahr., is advisable.
XIII. Small-pox (Variola)
VARIETIES. This, one of the most malignant, loathsome, and contagious of diseases, is of two varieties: (1) the distinct, when the pustules are separate and well defined; (2) the confident, when they are thick-set. run into each other, and form large suppurating surfaces. In this variety all the symptoms are aggravated, the glands are affected, the limbs swell, the mucous membranes show the eruption, and there is danger of suffocation, putrescence, and delirium. This is therefore very dangerous.
No contagion is so strong, so sure, or operates at so great a distance of time and place. It is probably most infectious when the peculiar odour is perceived, and when the pustules gather. Recurrence of the disease is rare.
SYMPTOMS. Lassitude, chilliness, heat, headache, a thickly- furred white tongue, a deep flush upon the face, a feeling of bruised pain all over, especially in the back and loins; more or less pain or tenderness at the pit of the stomach, and sometimes vomiting indicate a severe attack. About the third day the eruption appears in the form of red spots, feeling like shot in the skin. If first comes out on the forehead and wrists; then on the neck and breast; then over the body.
The eruption being completed, the fever subsides; the pimples fill with fluid matter, first watery and transparent (vesicles), then yellowish (pustules); they become depressed in the centre, and are surrounded by an inflamed ring. The eyelids, face, and hands are swollen, and the features sometimes obliterated. A peculiar, disagreeable smell now rises from the patient. In eight or nine days from the first appearance of the eruption, the pustules discharge; secondary fever sets in; scabs then form, which dry up, and fall off in the course of five days. Purplish spots, which do not fade away before the sixth or eighth week, or indelible depressed scars, which are called pits or pocks, remain.
DANGERS. The more numerous and close the pustules, the greater the danger; the more perfect their maturity on the fourth day, the less the danger. The greatest danger arises from the secondary fever, about the ninth to the twelfth day; for then the fever is likely to return, when the strength is already much exhausted. In a confluent case, fatal chest symptoms, or abscesses in various parts of the body, or ulceration and opacity of the cornea (and loss of sight) may arise. Stoppage of perspiration, scanty or bloody urine, great hoarseness, convulsions, or delirium, increase the danger. Half the deaths occur between the seventh and eleventh days of the eruption.
Infancy is unfavourable. The disease is seldom fatal to children between seven and fourteen years of age. Small, dark, and badly- ventilated dwellings, poor or scanty food, and want of cleanliness constitute unfavourable conditions.
REMEDIES. Aconitum. Fever, headache, rapid pulse, etc. A dose every third hour.
Antimonium Tart. Should be given as soon as Small-pox is suspected. Spasmodic retching, nausea, and hoarse cough may be relieved, convulsions averted, and the disease greatly modified by it. Ant.-T may be given at any stage, alone or in alternation with any other remedy.
Belladonna. Stupor, or delirium, severe headache, dislike of light, Ophthalmia. Belladonna also tends to retain the eruption upon the surface.
Apis. Considerable swelling of the face and eyelids. For swelling with hoarseness, and pain in swallowing, Apis and Belladonna may be alternated.
Mercurius. Ulcerated throat, Salivation, and Diarrhoea, with bloody stools; especially during suppuration.
Coffea. Restlessness and sleeplessness.
Camphor. If the eruption suddenly disappear, or assume a malignant type, with coldness of the skin, difficult breathing, disorder of the brain, etc., one or two drops every ten or fifteen minutes, till the skin becomes warm, and the eruptions reappear. The blanked bath may be had recourse to with much benefit at the same time.
Sulphur. When the pustules are green, purple, or black; during the formation of the pustules; when there is excessive itching, and to prevent the usual after-diseases.
ADDITIONAL REMEDIES. Rhus Tox. Severe pain in the back. Aconite and Bryonia Congestion of the lungs. Phosphorus Pneumonia. Bryonia, Kali bichromicum Bronchitis. Mercurius Glandular swellings. Apis. Belladonna Dropsical swellings, closed eyes, swollen throat. Belladonna Hyoscyamus Delirium. Arsenicum Prostration. Carbo Veg. Gastric disorder or putrescence.
ACCESSORIES. The patient should be placed in a moderately high room, and the general directions under Scarlet Fever observed. The patient’s posture in bed should be frequently changed, so as to avoid bed-sores. As soon as the eruption is well out, the whole surface should be smeared over with olive-oil, cream, cold- cream, or glycerine (1 part) and water (2 parts), twice of thrice daily. As the pimples begin to ripen into pustules, and before they break, the skin may be sponged with glycerine and rose- water, in equal parts, and dusted with a powder of the first trituration of Antim tart. (1 part) and violet powder (8 parts). The glycerine-water causes the powder to adhere, and pitting is effectually prevented. The hands of children should always be muffled to keep them from scratching, which might lead to ulceration and unsightly scars.
Attention is especially necessary to be directed to the urinary organs of children of both sexes, as serious disease sometimes occurs in those parts.
Great watchfulness is necessary to allay excessive irritation. Whenever the skin becomes hot or irritable, much relief will be afforded by sponging it with warm water to which, a few drops of Carbolic Acid have been added, and drying with a soft towel. When the pustules burst, powdered starch or corn-flour should be freely applied to absorb the matter. Cleanliness and frequent washing with tepid water are imperatively necessary, especially during the last stage of the disease. If the eyelids are glued together, they should be sponged frequently with warm water.
DISINFECTION. All infected clothing, and bedding should be burned; or, in default of this, baked or boiled for half an hour at a temperature of 212*. Rooms should be fumigated with burning Sulphur, the walls cleansed and divested of their paper, the floors scrubbed and washed with a solution of chloride of zinc, and walls and ceiling lime-washed; afterwards the doors and windows kept open for several days.
PREVENTIVES DURING AN EPIDEMIC. Vaccination; tincture of Sulphur (once of twice daily); and fresh air. Too much importance cannot be attached to the dilution and dispersion of the Small-pox poison by free ventilation; this operates as a preventive, and improves the condition of patients suffering from the disease. The spread of Small-pox is just in proportion to the overcrowded and insanitary condition of the places in which the disease occurs.
XIV. Vaccination. Cow-pox.
This disease is similar to Small-pox; and when artificially introduced into the human system is as possible protective against Small-pox.
Since its general use, it has probably saved more lives ( to say nothing of disfigurement, loss of sight, etc.) than all other remedies put together. It has fallen into disrepute in some quarters on account of the troublesome affections that have occasionally followed. These, however, bear but a small proportion to the number of cases in which no secondary effects appeared, and are not to be mentioned in comparison with the loathsomeness and fatality of Small-pox.
Vaccination should be performed not later than the third month of infancy, before teething disturbs the system. If a child suffers from any disease which renders vaccination undesirable, a medical certificate is necessary to postpone the operation.
SYMPTOMS. When the operation is successful, a slight rosy elevation may be felt on the second day, and a small red pimple appears on the fourth of fifth day. The next day this becomes a pustule, which increases in size to about a quarter of an inch in diameter.
The lymph in it is at first ( on the eighth day) clear, and of a pearl colour; then milky; next yellow; and finally dries into a reddish brown scab. About the twenty-first day the scab falls off, leaving a permanent scar.
The constitutional disturbance is usually not great. Should there be much local redness and swelling, a few doses of Aconite or Belladonna will relieve the patient. The latter remedy is curative of erysipelatous complications. Care should be taken to protect the arms from friction, that the sores may not be irritated, and the scabs not torn off. Occasionally a poultice is necessary if inflammation or suppuration is excessive; or the application of fine-powdered starch or corn-flour. About the eighth day, a dose of Sulphur, morning and night, for a few days, may prevent affections that sometimes follow Vaccination.
RE-VACCINATION. After a number of years the virtue of Vaccination is weakened, and on arrival at puberty the process should be repeated. By some it is recommended that adults should be re-vaccinated once every ten years; well-recorded statistics show that well-vaccinated persons are almost entirely secure against infection.
This is an eruption almost peculiar to the young, and spreads by contagion.
SYMPTOMS. Slight fever; eruption of pimples on the second day, which becomes vesicles, and sometimes pustules, and dry up in three or four days.
The eruption comes out in successive crops, so that while some vesicles are disappearing others may be forming.
It differs from Small-pox in the slighter fever which attends it; in the earlier appearance of the eruption; in the absence of an inflammatory ring round the spots in the first stage; in the vesicular character of the eruption, etc.
REMEDIES. If the fever be considerable, Aconitum every four or six hours. Generally Rhus Tox. is the best remedy, under the action of which the disease soon disappears Belladonna. For headache and disturbance of the brain. Excessive itching. Mercurius Suppuration. Ant.-T. When the vesicles fill with matter, or convulsions set in.
ACCESSORIES. Milk-diet is best. Exposure to cold should be avoided, especially in cold weather, but the room should be kept well ventilated. The child should be prevented from scratching the skin when the scales are formed.
XVI. Simple Fever (Febricula).
This is a feverish attack, which generally disappears in from twelve to thirty-six hours.
SYMPTOMS. Alternate chills or flushes, followed by heat and dryness of the skin; hard, full, quick pulse; dry, coated tongue; thirst; hurried, anxious breathing; highly-coloured, scanty urine. Also, often, pains in the loins, headache, deranged bowels, and loss of appetite. As these symptoms may be harbingers of serious diseases, they require prompt attention. Constant sighing indicates the approach of some eruption.
CAUSES. Suppressed, perspiration, exposure to damp or cold, sudden changes of temperature, wearing damp clothes; poor or insufficient diet; injuries, internal or external; fatigue, etc.; or it may be modified variety of more serious fever.
REMEDIES. Aconitum is the chief remedy for all simple febrile symptoms. A dose every two or three hours, or, in urgent cases, every half-hour, till perspiration, the sign of its beneficial action, breaks out.
Camphor. Sudden seizure of chilliness; shivering, with lassitude, and general indisposition which has come on rapidly. A dose repeated three times, at intervals of fifteen or twenty minutes, may precede Aconite, or it may be alone sufficient.
Belladonna. Headache, flush, congestion, wakefulness, dread of light and noise.
Bryonia. Cough, oppressed breathing, pains in the limbs, gastric disturbance.
Arsenicum. Prolonged cases; prostration; weak patients.
If the fever does not quickly yield, a homoeopathic practitioner should be called in, as it may be initiatory of a more serious disease.
ACCESSORIES. Quiet, repose in bed. Light bed-coverings. The hot foot-bath or the wet-pack. Water should be the principle beverage in small draughts.
As the fever declined, milk-diet should precede more substantial food.
XVII. Enteric Fever. Typhoid Fever. Infantile Remittent Fever.
In children, Enteric Fever is called Infantile Remittent Fever. Its chief effects are concentrated on the portions of the bowels (entrails ) called the solitary glands and Peyer’s patches, which become inflamed and ulcerated.
CAUSES. Exciting. Impure milk, or drinking-water which contains decomposing organic matters. Impure air containing the gases given off by decomposing organic matters.
Predisposing. Youth. Although Enteric Fever may occur at any period up to about the forty-fifth year, it shows a marked preference for young subjects, especially boys, though it seldom occurs before the fifth year. Children are very liable to it, especially from the fifth to the ninth year of life. The season, The disease is always most widely diffused in the autumn and in the first setting-in of the cold weather. The atmosphere A long continuance of hot, dry, summer weather generally promotes the occurrence of the disease. There is little risk from contagion.
SYMPTOMS. The early symptoms are languor, poor appetite, diarrhoea, pain in the head, sleeplessness, dull wandering mind, especially at night; thirst, and a dry, red, or cracked tongue. The pulse is quick and feeble, the skin hot, and a bright flush appears on the cheek. Enlargement of the abdomen takes place, with tenderness on the right side, below the level of the navel, and a gurgling feeling produced there on pressure. The diarrhoeic discharges are of a light ochre colour, copious and liquid.
The eruption appears about the seventh day, consisting of a few rose-coloured dots, which fade away for a moment on pressure, and appear chiefly on the back and extremities.
The temperature rises gradually in the evening, being about 2* higher than in the morning. A considerable difference between the morning and evening temperature (that in the morning being the lowest) is favourable. A persistent temperature of 104*, or an elevation of the morning over the evening temperature, is unfavourable.
Mild cases are over in twenty-one days, but severe ones may last four or five weeks, or even longer.
DANGERS. The great danger is from perforation, consequent upon ulceration of the bowels, which destroy many patients when recovery seems to be setting in. Haemorrhage, severe diarrhoea, and lung complications are dangerous. The disease often calls into activity the slumbering germs of Consumption.
REMEDIES. Baptisia. This remedy administered early modifies the symptoms, and even cuts short an attack by antidoting the poison. Two or three drops of the I X dilution, every two hours.
Arsenicum. Frequent, copious diarrhoea, which becomes involuntary; excessive prostration; intermittent pulse. When Baptisia has been omitted in the early stages, and the symptoms are severe, Arsenicum and Baptisia may be alternated.