CHILDRENS TYPES

BY DR. D.M. BORLAND.

NO.1.

LAST week you asked me if I would give you a lead as to how one tackles the average case of a child. Well, if you are considering prescribing for a child I think you have got to take it very much as one does in ordinary everyday homoeopathic prescribing; that is to say you begin to group your homoeopathic patients under headings, you get one of the commonly indicated drugs and you take that as your type of a group. Suppose you are dealing with children, far and away the commonest type of child is the CALCAREA child. Well, in practice what you do is, you are tackling a child, your first thought is, is that a Calcarea child?

That is far and away the commonest type in young children. And if you see a child and it is of a Calcarea type but you are not quite satisfied it is a Calc. silicate? Then immediately you begin to think of a Calc. phos. you wonder if the Calc. element is very marked after all, cant it possibly be a Phosphorus? You see you grade them down, starting from your Calc. carb. type. And so in practice one gets into the habit of having various outstanding types of that kind, and various other drugs that follow on.

Well, I think as far as kids are concerned, I got into the habit of grouping them roughly into about five different headings, and the way I used to group them was something like this. There were the Calcarea children first of all. Then what I would label the Baryta carb. type of child. Then the Graphites type of child. Then the Pulsatilla type. And, lastly, the Arsenic type.

Well, under the first lot, as I say, I would follow on with the Calcium salts, Calc. phos., Calc. silicate – these are the three commonest. Then there is the possibility of Phosphorus. Then under the same heading I always consider the Silica types, and, with the Silicas, Sanicula and AEthusa. Then, a little further away from the strict Calcarea, the possibility of Lycopodium. And, following on Lycopodium, the possibility of Causticum. and then in every case of any child I always consider the possibility of a dose of T.B. Well, that pretty well covers the first group.

In the second group-that is to say, under the Baryta carb. heading-the next drug that one always thinks of is Borax; it is the same kind of type of child, the same sort of indications. And then you have immediately got into the Sodium group-is it Natrum mur.? And never do you think of Natrum mur. without the possibility of Sepia. And immediately you are dealing with depressed drugs at all, you always consider the possibility of one of the Gold salts, either straight metallic Gold or the Chloride of Gold. And where you are dealing with a sluggish mentality or sluggish physical make-up you always consider the possibility of Carbo. veg. And that is the way that group runs.

Then, under the Graphites heading, one always begins to consider the possibility of Capsicum. And immediately you are dealing with any skin condition you always have to consider will a dose of Psorinum help them? And then, in connection with children, again where you have got definite skin indications, you always consider the possibility of Antimonium crud. Then, again under the skin indications, although it isnt really like Graphites, you always have at the back of your mind, is Petroleum a possibility?.

Then in the next group, what I myself call the Pulsatilla group, you have got again a definite crowd of drugs which are possible. First of all there is the Pulsatilla type. And following on Pulsatilla you always think of the possibility of Kali sulph. And immediately you get any drug with a Sulphur compound you consider, is it a straight Sulphur? Then, very much the same sort of mentality as Pulsatilla, you have got to consider the possibility of Thuja.

And immediately you get on to the Pulsatilla-Thuja group, you think of the possibility of Silica. And Silica always suggests the possibility of Fluoric acid. Then you are dealing with hot-blooded patients, and think of Bromine and Iodine. Immediately you get Iodine with its emaciation and hunger, you wonder is it Abrotanum?.

Then your last group of all. Here you have got your nervy drugs, Arsenic at the head of it with all its terrors. Immediately you get terrors you begin to think of Stramonium. And then you get your hyper-sensitive nervous system, and wonder if it is a Chamomilla.

Immediately you get Chamomilla you wonder if it is Cina-a little more violent. Then, with the strange digestive disturbances of Cina, you wonder if you are running to a Mag. carb. Then, getting back again to your strictly nervy type, is it possibly Ignatia? And wherever you get the Ignatia nervous type, restless, fidgety, you wonder, can it possibly be Zinc?.

Well, you see, if you have a grip of that list you will carry on in Out-Patients for a couple of years and practically cover 99 per cent. of your cases. But you see the principle on which one works; you get a drug, get to know it well, get to know all its symptoms, and then various things crop up in that drug which suggest some other possibilities, and you begin to tack one or two other drugs on to the first one; but it is always in definite groups that you work. That gives an outline of how one does it. then to take the groups in a little more detail.

If you take the CALC. CARB. type; at least in this country, the majority of young children are Calc. carb. children, and what one means by them is the typical soft, over fat, fair, chilly, lethargic children. Very often they look surprisingly fit, and yet they havent much energy either mental or physical. In early life they very often are over-weight, they look surprisingly healthy but when you begin to handle them you find it is soft fat rather than muscle. They have a tendency to quite frank rickets, with the enlarged epiphyses, bit head, slow closure of the fontanelles, and tendency to sweat. The children themselves are chilly, and yet they get very hot on the slightest exertion.

They sweat at night, and very often you get Calc. carb. children who stick their feet out of bed-dont think all the kids who shove their feet out of bed are Sulphur, they are not. Then a little later in life you find these kids again very much of the same type. They look fairly healthy, they look well nourished, and yet they are sluggish, mentally and physically. They are slow at school, they are slow at games, they are liable to sprain their ankles, they have got weak muscles, they sweat on exertion, and are liable to catch colds.

You find them with enlarged tonsils, enlarged cervical glands, rather big bellies, and they lack stamina; they are scared; they lack initiative. They are perfectly content to sit about and do little or nothing, and very often you find them peculiarly sensitive, they dont like to be scoffed at; they are clumsy in their movements, bad at games, and it tends to push them back into themselves; instead of sticking at it and becoming efficient they chuck their hands in and give up the game altogether; they hate being scoffed at or laughed at.

You find exactly the same thin in work; these kids very often have a difficulty with one or other thing at school, and the subject they have difficulty in they simple dont strive over, they chuck their hands in again, and if they are not sure of themselves nothing will induce them ever to answer questions in class in case they are wrong-in case they are laughed at.

Then, in early childhood, practically all these Calc. carb. children tend to have a relative constipation, though if chilled they tend to get attacks of diarrhoea, and as a rule the Calc. carb. children tend to have a relative constipation, though if chilled they tend to get attacks of diarrhoea, and as a rule the Calc. carb. small child has a pale stool which appears to be lacking in bile pigment. Then there are one or two odd outstanding Calc. carb. characteristics, which, when you get them, simply clinch the Calc. carb. diagnosis.

The one that is easiest to tack on to their sluggish mentality and sluggish physical make-up is that they are constipated and are much more comfortable when their bowels are inert. If you give an aperient it will upset them; if they have an attack of diarrhoea they are ill; if their bowels are relatively sluggish they are comfortable. The next thing you can tack on to their sluggish make-up is that they are aggravated by any physical exertion, or mental exertion, or by any rapid motion; they get car-sick and train-sick. Another thing about them which you tack on to their general sluggishness-at least I do-is that they have a very definite dislike of too hot food.

They are quite found of ice- cream; they have an aversion to meat, and occasionally you get one with a very definite egg craving, a craving for eggs in any form; if you get it, it is helpful, but you met many Calc. carb. children who have not got the carving for eggs.

Then there is other Calc. carb. indication, and that is that when they are seedy they become nervous; scared; you find a child who is perfectly happy so long as there is somebody about, they sit peacefully and play, and when it gets dark they are scared of going to bed in the dark, very liable to develop acute nightmare, wake up in the night screaming, and the kind of nightmare they get is that they get is that see horrible faces in the dark – that is very common Calc. carb. childs nightmare.

Well, that is your main starting point.

Suppose, instead of getting that typical picture, you get the same type of child who is beginning to lose his fat a bit, is getting a bit thinner, doesnt tend to flush up quite so easily, instead of the hypertrophy of the tonsils and enlarged cervical glands he is tending to get more hypertrophy of adenoid tissue, developing a more adenoid expression, becoming a little more reserved, a little brighter at school, but very liable to get headaches if he overworks, rather dislikes being interfered with, still with the main Calcarea characteristics-the probability is that the child has gone on from Calc. carb. to CALC. PHOS. And if, in addition to that general appearance, the child is tending to become rather spotty there is more probability still that it has gone to Calc. phos.

Then, another of the strong indications for the Calc. phos. in preference to Calc. carb. is that most of these Calc. phos. children, if they get thinner and begin to grow a bit begin to suffer from definite growing pains. There is one point that I always tend to consider in connection with their growing pains.

In the Calc. phos. child I think their growing pains are definitely muscular; you will get a very similar type of child with growing pains, not quite so much touchiness as the Calc. phos. child, and with pains in bones – shin bones particularly – and they respond to Manganese better than to Calc. phos. You see even as I am talking other things come to my mind. Well, that is the Calc. phos. child.

Suppose the child has gone on thinning down and is tending to become definitely slight, possibly a little delicate, definitely brighter mentally, more nervy, more excitable; in addition to being afraid of the dark becomes sensitive to atmospheric disturbances, afraid of thunder, rather anxious, rather more sensitive, developing a definite dislike of being alone, not quite so shy, more capable of expressing himself, still chilly, liable to flush up on excitement, liable to get very flushed after taking any hot food, losing his desire for eggs, increasing his desire for meat, wanting things with a bit of taste, preferable if it has a salty taste, still liable to night terrors – and there you have got your PHOSPHORUS case coming along.

He will still get colds, but he does not run to the same colds in the throat, they have gone further down and he is much more liable to get a bronchitis nowadays, he is very sensitive to sudden changes of temperature – and you see the way they grade into one another.

Then you get the other kid, who again has fined down a bit, he is still chilly, very much thinner, has not grown nearly so much as the Phosphorus child, very much paler, has a fine skin, and his not the worse curly hair you associate with the Calcarea but rather finer hair without the reddish glint you get in the Phosphorus, becoming rather sandy.

He is becoming more touchy, more difficult, rather resenting interference, more inclined to retire into his shell, fairly bright mentally, very easily tired out physically, liable to sweat but particularly about the extremities or about the head and neck. Very often you get a history that they have developed a dislike of milk, or an intolerance of milk, possible with some enlarged cervical glands, and there you have got your SILICA child.

Then, as I said, you never think of Silica without the possibility of SANICULA. In Silica and Sanicula the indications are practically identical. I think the Sanicula is more irritable than the Silica, but it is definitely more unstable mentally, you get attacks of laughter and crying following one another very much more easily in the Sanicula child than you do in the Silica, and the Silica child has got rather more sticking power than the Sanicula child, the Sanicula child never sticks long at anything, they take up a thing for a moment or two and chuck it away again.

And the Sanicula child is definitely more obstinate and more difficult to control, and there is liable to be a row if you interfere with the typical Sanicula child. But it is very difficult to distinguish between the Silica child and the Sanicula child, the physical symptoms are almost identical and in most instances where I have had a child like that to treat I have given Silica in the first instance, and only on failing to get all the response I wanted have I gone on to Sanicula.

Then the reason why one considers AETHUSA there is because of the notorious susceptibility to milk of AEthusa, and wherever you get an acute milk aggravation, in the acute attack you always tend to consider the possibility of Aethusa controlling the acute attack- it is the drug that jumps to your mind. Then again, with that you consider the possibility of one of the milk preparations themselves – Lac. def. and Lac. caninum – coming in, in an acute condition.

Then if you go back to the Phosphorus type of child for a moment-that is to say, the Calcarea that has thinned out and become Phosphorus. There is another type that comes in there. You have got the child who has grown a bit, lost weight, become thin, but instead of having the fine skin, the unstable circulation of the Phosphorus child, the child has become rather sallow. It is beginning to lose its tendency to sweat very easily, the skin appears to be getting a little thicker.

The child appears to be very diffident, although it isnt quite the shyness of the Silica child; they seem to lack assurance and yet you get the impression that underneath they have got a fairly good opinion of themselves. You find that they are liable to digestive upsets, very often they have quite good appetites, eat well, and in fact very often eat more than the average child, and yet they are not putting on weight. They may have a somewhat enlarged abdomen, but you dont get the typical enlarged palpable mesenteric glands.

Instead of the Phosphorus desire for meaty things and tasty things, these children are definitely developing a desire for sweet things. Instead of the Calcarea desire for ice-cream, they prefer their food hot. Very much like the Calc. phos. child they do get headaches from over-work at school; it is just a dull sort of headache. They are still chilly, but they are much more sensitive to stuffiness than any of the other drugs we have looked at. And you are beginning to come on to the LYCOPODIUM type.

Then there is another drug which is not nearly sufficiently used in kids, which comes in as a sort of counterpart of the Lycopodium, and that is CAUSTICUM. I think the typical Causticum child is not unlike the Lycopodium, only it is a little more sallow. The Causticum children are definitely more sensitive than the Lycopodium children. They are sensitive to pain, but they are particularly sensitive to any emotional disturbance. You will see these children very often crying because they think that you are hurting some other child.

It is much more the idea of pain that upsets them than actual pain to themselves, they very often stand things quite well, but they cannot bear to see another kid crying. Then another thing about the Causticum children is that they have very much the same sort of clumsiness as you get in the Calcarea children; they are rather unhandy, and they are very liable to, not sprain their ankles as the Calcarea children, do, but definitely strain muscles.

They are mostly rheumatic children, and they are very liable to get acute muscular rheumatism, particularly from exposure; you get the Causticum children coming in with acute torticollis from having been caught in an icy wind, or an acute facial palsy. And associated with that tendency to acute torticollis or palsy, they do get very definite growing pains, which are usually accompanied by stiffness in or about their joints – it feels as if their joints were tight.

Then, linking up with that rheumatic condition, the Causticum child overworked or nervously distressed is very liable to develop chorea symptoms, and the outstanding point about the Causticum chorea is that the jerking persists during sleep. And the thing that always distinguishes them from the Lycopodium children is that the Causticum child has a definite aversion to sweets, whereas the Lycopodium child likes them.

Then there are two other points which, if you get them, clinch the Causticum diagnosis; one is that the Causticum child in its rheumatic conditions is very much better in damp weather; the other point is that where you have a Causticum child with any digestive upset they tend to develop acute thirst after meals. Then there are two other points which are sometimes useful. One is that the Causticum children very commonly tend to develop endless warts; and the other is that they have a very marked tendency to have a nocturnal enuresis.

Then as regards T.B. in these children. Wherever you have a definite history of family T.B. I think you will find that sooner or later in the treatment of any child, no matter what drug is indicated, they will helped by giving them a dose of T.B. In the Out-Patients here, I used, in a case which had a definite T.B. family history, to make a point of giving them a dose of T.B. about once in twelve months.

Then I came across an American article in which they recommended the giving of two doses of each potency of T.B. from the 1m to the cm – two of 1m, two of 10m, two of 50m, two of cm-and they gave these on successive days, two 1m one day, two 10m the next day, and so on. And they maintained that they got very much better results. I thin it is true. I tried it out in quite a number of cases, but I gave up the childrens Out-Patients before I had time to convince myself that it was better than the method I had carried out before. But the Americans claim that by that administration you can produce a practical immunity to T.B. in a child of T.B. parents.

Then there is one other point in which the treatment of children appears to differ from ordinary practice, and that applies particularly to the Calc. carb. child. If you get young children under two years of age, with definite Calc. carb. indications, I think that one tends to lose time by following the rule that we all observe in other cases of never repeating so long as the child is improving.

I know when I first started doing childrens Out-Patients a child would come with a definite Calc. carb. indications, and I would give a 0m of Calc. carb. and i couldnt find any reason for repeating under six months or so-the child was going straight ahead, slowly but steadily, there was no let- up in its improvements, and I simply went on giving Placebo. Then one day one of my friends came down to see the Out-Patient department, and watched the work that was being done. A child came along who had had nothing for three months, had had a 10m and then Placebo.

I said “it is still improving, what are we to do?” He said, “Yes, it is improving, but is it improving any more than any other child would at a post-natal clinic? You have dieted it; you have instructed the mother; is your Calcarea child doing better than any other well-fed child?” So, having done a good deal of child welfare work, I couldnt honestly say that the child was doing better than many children that I could duplicate the welfare centre who were having no Calcarea at all. It had jumped ahead the first month after its Calcarea, but after that went on much as other children in a welfare clinic.

So after that, in young children, I started giving Calc. carb. at much more frequent intervals; wherever I got a child who wasnt jumping ahead still, I repeated my Calcarea, and I think the point is this that the average young growing child, free from acute illness, will tend to improve, supposing you are doing nothing at all, and what your drug ought to be doing is increasing that improvement; so I think in many of these cases you hurry up your work, in dealing certainly with Calcarea children, if you are not satisfied to wait indefinitely before you repeat.

You see what I mean-it is different from where you have got an adult who is stationary; here you have got a growing, developing child who is going to improve apart from acute illness, and in a case of that sort you can repeat much more frequently than you would in the ordinary static adult case.

No.2.

YOU remember last week I more or less completed the first group of the drugs which one commonly finds indicated in children, and you said that you would like the others done in much the same way.

Well, if you glance at the list of drugs I gave you as forming the second group you will notice that they are all very much the same type of child, and they all apply more or less to the backward kind of kid, either purely delayed development, or the definitely mental defective. These are what I am trying to cover in this second group of drugs; and, of course, the outstanding drug in that group is BARYTA CARB. which has got more of the backward child than any other drug in our Materia Medica.

The characteristics of the Baryta carb. child are very definite I think the easiest way to get hold of it is to have a clear idea in your minds that here you have got a dwarfish child, dwarfish mentally and dwarfish physically. I have never seen a Baryta carb. child who was up to standard height. I have seen them up to standard weight. And the next glaring characteristic when you see them is that you always in the Baryta carb. child have got an excessively shy child; and that shy characteristic covers quite a lot of the Baryta carb. child.

It is nervous of strangers; it is scared of being left alone; very often it is terrified of going out of doors; a town bred child going to the country is terrified in the open fields. They often get night terrors, without any clear idea of what the terror is. And they always have a fear of people. There is another characteristic you can link on to that fear of people, and that is the Baryta carb. kids are always touchy; they dont like being interfered with; they are very easily irritated. Then the next thing that you will always get in them is that throughout their lives they have been late in everything-late in speaking, late in walking, late in dentition, slow in gaining weight.

Then, the next marked feature of them is their exaggeration of the normal childs forgetfulness. Every child is forgetful, every child is inattentive, but the Baryta carb. child has that very much exaggerated. If they are playing they never stick to it for any length of time, they pick up a toy, play with it, and drop it; you may get their attention for a minute or two, then they turn round and look at the nurse or mother or whoever happens to be there.

They pick up a thing from your desk and fumble with it for a minute or two, and the next moment they are playing with the handle of a drawer. It is that lack of concentration that is the outstanding characteristic. As they get older you get the same report from the school-the child is inattentive, never concentrates on a lesson, appears to learn to-day and has completely forgotten it to-morrow. The mother would teach the child its alphabet a dozen times over, and apparently ten minutes afterwards it knew it, it would be allowed to go out and play and half an hour later it had all gone.

The next thing about them-and it is one of the things you would expect with that type of child-is that they are very easily tired out; any attempt at systematic effort exhausts them. When they are young they become cross and irritable, as they get older any systematic effort and they get very troublesome headaches- usually a frontal headache with a feeling as if their forehead was bulgy and sitting right down over their eyes, and it is an awful labour for them to keep their eyes open.

Then the next point about them-and it is pretty constant to all the Baryta carb. kids-is that they are very liable to get colds. Their colds are fairly characteristic; they always start as a sore throat,and I do not think I have ever seen a Baryta carb. child that hadnt hypertrophied tonsils.

Then, with the hypertrophy of their tonsils you can link on the other glandular tissues; the Baryta carb. child very probably has enlarged cervical glands, possibly enlarged abdominal glands. With the enlarged abdominal glands you link up that the kid stands badly, there is often marked lordosis and a very prominent abdomen. Then again, with the abdominal condition you link up the symptom that the Baryta carb. kid is usually worse after eating-more inattentive, more irritable, more touchy, and very often more tired after eating.

The next thing about them is-you link this on to the tonsillar hypertrophy-if they do get enlarged tonsils and do get cold they are very liable to run to a quinsy. And there is another tip there that is worth remembering; if you get a typical Baryta carb. kid who has got an acute tonsillitis you are wiser to give a dose of Baryta mur., rather than Baryta carb., during the acute phase; and very often you will want an intercurrent dose of Psorinum after your Baryta mur. before you go back to your Baryta carb.

And it is quite easy to tack on the Psorinum to the Baryta carb. because many of these Baryta carb. kids tend to get a crusty skin eruption on the head, they very often have crusty margins to the eyelids, they may have a definite blepharitis, and most of the Baryta carb. kids are worse from washing-all definite Psorinum symptoms also.

Another point about them-and you tack that on to their skins-is they are very liable to get intensely irritable skin eruptions, very often without very much eruption but with intense irritation, and that again is liable to be worse after they have been bathed.

As you would expect with that type of child with low physique, they are chilly, and if they are exposed to cold they are liable to get their tonsils affected.

Well, that is the keynote to the mentally defective group of drugs, and, as I say, that is by far the commonest. By following on that you get the other drugs that I mentioned, starting off with Borax.

Well, in BORAX I think that the thing that begins to make you query whether a child is a Baryta carb. or a Borax child is the manner in which the Borax child is frightened. They are both scared children; them are very often quite similar to look at; but you will find that, whereas in the Baryta carb. child it is anything strange in its surroundings which terrifies it, in the Borax child it is any sudden noise in its vicinity. Any sudden noise in the vicinity of a Borax child simply terrifies it.

Oh, there is one other point I should have mentioned about the Baryta carb. kid, and that is they have a marked tendency to salivation. If you have seen many of these mentally defective kids you know it is quite a common characteristic of the mentally defective children; you see them dribbling. And it is equally marked in Borax, but in the majority of Borax children you are getting a definite stomatitis, and associated with the salivation you get white spots on the tongue, pearly spots round the margins of the tongue, spots on the lips and on the inside of the cheeks.

Then the next thing is that you do get a very similar history in regard to night terrors under the Borax child, but you can practically always get an exciting cause in the case in the case of the Borax child; the child has been doing too much during the day, or the child has been over excited in the evening, and then they are almost sure to have a marked night terror.

Then the next thing about the Borax child is that there isnt the same degree of inability to learn. But you will very often get the statement from the school, or from the parents, that the child is simply purely idle; if they would give their hearts to it they could learn, but they are just idle. They never settle to anything, and even at play they wont stick at anything they get bored and change from one thing to another.

And the next thing that rather distinguishes them from the Baryta carb. is that they are much more irritable, and their irritability does not end up in weeping as it very often does in the Baryta carb. but it ends up in a violent passion-the child very often kicks and screams.

The next thing about the Borax child which distinguishes it from the Baryta carb. child is that where the Baryta carb. child tends to get a generalized skin eruption, or a very definite crusty eruption on the scalp, you are much more likely to get herpetic eruptions in the Borax child-very often herpetic spots about the lips, or a generalized rash of small herpetic spots on the body.

Then again you are more liable to get acute digestive upsets than in Baryta carb. Baryta carb. is the typical chronic constipation, the hard stool; Borax is very liable to get sudden attacks of diarrhoea and vomiting. There is another characteristic of Borax which is peculiar to it as distinguishing it from Baryta carb., and that is that Borax has a peculiar sensitiveness to fruit and is liable to develop violent colic after fruit- colic followed by diarrhoea.

Then, associated with the tendency to inflammation of the mucous membranes, acute stomatitis and that sort of thing, it is a very common history in the Borax kids to find either enuresis or pain on micturition; I think pain on micturition is much more common, and very often it is without any definite urinary infection.

The other thing that distinguishes the Borax child from the Baryta carb,. when it is a little older is that the Baryta carb. child gets depressing frontal headache from over study; the Borax kid tends to become sick, it tends to get definite nausea from intense concentration.

Then, there is the final clinching point in connection with the Borax child, and that is the notorious Borax aggravation from downward motion. Baryta carb. kids often get train sick or car sick; Borax kids will get train sick and car sick too, but Borax children have a peculiar terror of downward motion, and it is that terror much more than the actual feeling of discomfort which is the characteristic thing of the Borax children.

You get it occurring in all sorts of circumstances; the typical thing is the child who yells every time it is laid down in bed provided the nurse does not lower it very gently; but you get it equally marked in older children who simply scream on going down in a lift in a shop. But it is the peculiar terror, rather than the physical discomfort, which distinguishes Borax from any other drug we have got.

Then the other thing is, it like Baryta carb. in being sensitive to cold, but it has much more sensitiveness to damp than Baryta carb.

By the way, there is one useful practical tip that comes in in connection with Borax, and that is in connection with air sickness. You know we have various drugs for train sickness and sea sickness and that sort of thing; Borax acts in the majority of cases of air sickness, because it is the sudden dip which upsets most people, and particularly their terror of falling, and I have had a number of cases in which I have completely stooped air sickness by three or four doses of Borax before they started flying. It is quite a useful tip sometimes.

Then, of course, Borax is one of the Sodium salts, and immediately you strike any of the Sodium salts you begin to think of the possibility of the others, and, of course, much the most commonly indicated of the Sodium salts is NATRUM MUR. So one always considers the possibility of a childs being Natrum mur. Well, in children, in the majority of cases.

Natrum mur. again is a rather undersized, underweight child. You very often find them coming in and at first sight they are a little difficult to distinguish from the Baryta carb. kid with its shyness, because the Natrum mur. child, until you get to know it, has a very definite dislike of being handled; it has a very definite dislike of being interfered with and it is very liable to burst into tears, which is not unlike the shy terrified reaction you get from a Baryta carb. kid. But if you begin to pursue the matter a bit further, you find the reaction is quite different, it isnt shyness in the Natrum mur., it is much more a resentment at being interfered with.

You find the Natrum mur. child cries, but cries much more from rage than from terror. You can very often stop the Natrum mur. childs crying if you are sufficiently firm; try and soothe it down and it gets worse. i have seen a mother try and soothe a Natrum mur. child till it was nearly in convulsions with screaming, whereas as soon as you leave it alone it will settle down and sit in a corner and watch you. The Baryta carb. will sit in a corner and play with anything within reach-you have got an entirely different mentality.

Another thing that you meet, distinguishing the Natrum mur. from the Baryta carb. is that they both tend to be awkward in their movements. The Baryta carb. child is awkward because of incoordination, it is clumsy. The Natrum mur. child knocks things over because it is in too big a hurry.

Then you will get a history of delayed development in the Natrum mur. child, particularly that the Natrum mur. child was slow of learning to speak; it may have been slow of starting to walk, though that is not nearly so constant. You very often find that the Natrum mur. childs speech is faulty, but it is much more a difficulty in articulation in the Natrum mur. child than a lack of mentality as it is in the Baryta carb. child.

Then the next characteristic about the Natrum mur. child is that it is probably small, underweight, but in opposition to the Baryta carb. where you get a lot of enlarged cervical glands, the typical Natrum mur. child may have very small shotty enlarged cervical glands in a thin neck. The Baryta carb. have a chain of quite large glands running down both sides of the anterior borders of the sterno mastoid; the Natrum mur. children have small shotty glands at the back of the neck, and the neck itself is rather skinny.

The next thing is that the Natrum mur. kid does not tend to run to the same degree of crusty skin eruptions as the Baryta carb. kid. In the Natrum mur. you are much more likely to get an eruption restricted to the margin of the hair, rather than spreading over the whole scalp.

Then the next thing about them is that there isnt the same tendency to salivation in the Natrum mur. child, and, instead of the small patches that you get in a Borax mouth, in Natrum mur. you are much more likely to get a sensitive tongue which is red in places and white in places, but not with the little white vesicles which you get in Borax but much more the irregular mapping which you associate with Nat. mur. either in children or in adults.

Then as the Natrum mur. kids get older, they are very liable to develop school headaches-that is to say, under pressure, working too hard, attempting to concentrate too much, they get headaches. The headaches are almost identical with the Baryta carb. headaches; they are frontal headaches, with exactly the same feeling or pressure down over the eyes, and they are brought on by intense effort-mental effort particularly.

Then the temperature reactions in Natrum mur. are definitely different from the temperature reactions in Baryta carb. In Natrum mur. you very often have a chilly child, sensitive to draughts, who will shiver from a change of temperature, and very often start sneezing from a change of temperature; but they are very sensitive to heat-stuffiness particularly-and they are sensitive to exposure to the sun and are very liable to develop a sun headache.

And, of course, when you get it, and you very often do,you find that the majority of these Natrum mur. children have a definite salt craving. When I first started Homoeopathy I didnt believe that one would ever come across the excessive desire for salt that is recorded in the Materia Medica, in children. But you will find in a very short time that you meet case after case in which there is a very definite salt craving in these kids-they will steal salt as other children would steal sugar.

Then there is one other thing that I got into the habit of looking for in children when I was thinking of giving them Natrum mur., and that was that they have a very marked tendency to develop hang-nails, splits up the side of the nails which were horribly sensitive, very painful, and very difficult to heal. It is a little point, but it is quite useful sometimes in practice.

By the way, there is another distinguishing point which is sometimes helpful in trying to pick out these children, and that is the appearance of the skin. In the Baryta carb.-typical Baryta carb. children-they have usually got very little colour, they are sallow, rather earthy looking. In the Borax kids there is very often considerably more colour in the cheeks, the skin in a little more yellow, not quite so earthy looking and a shade more inelastic, thick and greasy.

In the Natrum mur. kids the probability is that they are a little darker still, they flush a little more easily, they perspire a little more easily, and again you have got a slight exaggeration of the greasy appearance.

Well. whenever you begin to think of skins the next thing you run on to as possibility is SEPIA, which has the same kind of sallow greasy skin, and Sepia is a drug which is far too much neglected in the treatment of kids. I was looking after kids for four of five years before it dawned on me that many of the kids who ought to have had Sepia werent getting it.

I think the thing that is outstanding in the Sepia children is their negative attitude to everything. The kids tend to be depressed, moody, indolent, disinclined for work, not even interested in their play. If you attempt to push them they are liable to sulk or weep. They are usually nervy kids, scared of being alone, very often afraid of the dark; and yet they dislike being handled.

They very often have a definite dislike of going to parties, and they give you a thing which you sometimes confuse with Baryta carb., and that is a dislike of playing with other children. It is the sort of thing that later develops into the typical Sepia dislike of meeting its friends, and you often confuse it with the Baryta carb. dislike of people altogether, but mostly it is pure indolence in the Sepia kid, and once they get to a party they are perfectly happy.

Then the next thing about them is that practically all these Sepia children, though so lazy and indolent, are definitely greedy, and if I get a definitely greedy child nowadays I always consider the possibility of Sepia. Then another thing that you will commonly be told by the parents is that these Sepia children, although they loathe to go to a party, when they do get there if they start dancing they wake up at once and are as happy as sand boys; it is astonishing the effect of dancing on these Sepia kids.

I remember one, the heaviest dullest child I had seen for a long time, and I saw it at a party dancing and she was an entirely different being, she had suddenly come alive. It is quite a useful tip if you get it from the parents.

Then there is another odd symptom that one comes across every now and then in children which is a definite Sepia lead, and that is that these slow developing Sepia kids very often develop the habit of head-nodding; I cant explain why; but whenever you get a head-nodding child think of the possibility of Sepia for it, dont dash off to one of the typical chorea drugs at once.

Then various other points which are pretty common in the Sepia children are that you practically always get constipation, and associated with the constipation you practically always get a tendency to enuresis. And there you have one thing which is very constant in children, and that is that the enuresis takes place early in the night; as a rule if these Sepia children are lifted about 10 p.m. they remain dry the rest of the night; it is in their first sleep that they lose control.

Then, as the kids get older, in that sort of sallow, dull, greedy, locked-up child, you are very liable to get a history that they are developing fainting attacks,and these fainting attacks are induced by standing, or really taking up any fixed position in a close atmosphere-standing in school, standing in church, kneeling in church-the Sepia child is very often liable to faint.

Then, all these Sepia kids, of course-like very Sepia patient- are sensitive to cold; and in children they are particularly sensitive to weather changes, and the typical Sepia child will develop a cold from change in the weather apparently without any contact with infection.

Then there is another thing that is a useful lead towards Sepia in children, and that is that they are upset by milk very often; they get a digestive upset and you put them on milk diet and the Sepia child will be certain to be constipated.

The, associated with their s allow, greasy skin Sepia children usually tend to sweat pretty profusely, and they are very liable to develop very itchy skins without much sign of an eruption, and without much comfort from scratching.

There is one other drug I want to tack on there before we finish, because it comes in after Sepia better than anywhere else that I know, and that is where you meet with this sallow, dispirited, sluggish type of child-where you meet with that depressed, negative attitude you have always got to consider the possibility of Gold or one of the Gold salts. The typical Gold child is always an undeveloped child.

It isnt so much a question of undersize and underweight as it simply doesnt grow up. The typical Gold child of 5 years of age is probably about the level of 3. The majority of cases in which I have seen Gold indicated have been in boys, and in the majority of these cases there has been some failure of development- an undescended testicle, a very poorly developed-an undescended testicle, a very poorly developed scrotum-something which made you feel that child was slow in developing of developing satisfactorily; again the sort of thing one thinks of Baryta carb. for.

Next thing, the Gold child always gives the impression of being lifeless. They are always low spirited, rather miserable, lifeless, and for a boy they are absolutely lacking in to; they have no initiative at all, and they give you the impression of finding everything a frightful effort. Then you always get the report from school that they are backward, and that they have very, very poor memories. One of the odd things about them is that, in spite of this dull, depressed, miserable, lifeless sort of creature the thing that they do respond to is contradiction; you think he is a kid with no go in him, and he makes some statement and is contradicted and he flies into an absolute rage; it is the thing that does stir them up.

Then, another thing that is constant, and is rather surprising in the type of child as they give the impression of being sluggish, is that they have a weird hyperaesthesia to pain; they are terrified of it and horribly sensitive to it. And, in spite of their sluggishness, they are very sensitive to noise and they have a very acute sense of taste and smell.

They are very liable to get very persistent, very troublesome catarrh; they have very definitely infected hypertrophied tonsils, and always practically with a lot of offensive secretion struck in the tonsillar crypts. They get hypertrophied adenoids, again with a very offensive nasal discharge. And with the tonsils and adenoids they are very liable to get attacks of acute otitis with perforation of the drum, and very often a stinking, purulent ear discharge.

Another thing about them is that if they are forced to exert themselves they very easily get out of breath, and they may get suffocative attacks where they have acute difficulty in breathing, without any obvious physical cause.

Another odd characteristic of the Gold child is that they are frightfully sensitive to any disappointment; they will grieve over it for days, quite out of all proportion to the normal childs reaction. And associated with that you can always tack on the other typical Gold symptom, which is that the parents will often tell you that the child sobs in his sleep, without waking up and apparently without having been distressed the night before.

NO.3.

I THINK last week when we finished up we had just run through Aurum met. with its usual depressed outlook, and there is another drug which has got a very definitely sluggish condition which is sometimes a little like Aurum and that is CARBO VEG., although you have got an entirely different cause for it. In Carbo veg. kids the thing that strikes you about them is that they are definitely sluggish, but it is more a physical sluggishness than a mental and results from physical stagnation not from any lack of brain capacity.

They are slow in thinking; they are dull mentally; they have a slow reaction time; and they are lacking in go of any kind. They are very easily discouraged, rather dispirited and miserable sort of kids, and if they are pushed they become peevish, but it is a futile sort of peevishness without much bite about it. Then, associated with that general mental sluggishness, there is always sluggishness of circulation. They are very often heavy, sallow complexioned children, and they always tend to have bluish extremities, bluish fingers, bluish toes, and the extremities are always cold.

Then the next thing about them is that if they are pressed at all at school, made to work, they are almost certain to develop a dull, occipital headache. And they are very liable to get the same kind of headache they get a complete inability to work, to concentrate, almost to think. And very often you get a history that the child has been pushed at school, is developing headaches like that, seems dead tired in the evening, and yet it gets the most violent nightmares, so much so that the kid is almost terrified to go to bed, particularly to go into the dark.

The kind of nightmare they get is they see ghosts, they see faces, all sorts of terrifying spectres. Associated with that you can link up the other thing that these cold sluggish kids are very liable to get very hot and sweaty at night, particularly the extremities, but it is pretty general, and the Carbo. veg. kids are awfully liable to have a sour smelling sweat.

Then another thing that you can always link up with the Carbo. veg. sluggishness of circulation is that they tend very easily to get a pretty persistent epistaxis; you very often get a history of these kids having a severe epistaxis in the night.

Then another thing associated with their general sluggishness is that they are mostly constipated. They mostly have digestive difficulties and tend to have big bellies; they get a lot of flatulence. They very easily, in spite of their constipation, get attacks of diarrhoea – a very offensive, watery, diarrhoea – and then they return to their constipated state again.

And with their digestive difficulties they very often have pretty marked likes and dislikes in the say of food. They like sweet things – which very often upsets them – they like to have their appetite tickled with something with a bit of taste so they like salt stuff. With their general sluggish digestion they are upset by fat things, rich food of any kind, very often they develop a definite aversion to fats, and very often they have a marked aversion to milk.

Then the other thing that is pretty constant about all these Carbo. veg. kids is that they are not primarily Carbo veg. children, that this condition has developed as the result of some preceding illness, sometimes it is a case of measles, sometimes an illness like bronchitis or pneumonia very often influenzal in origin, and it very often dates from an attack of whooping cough.

Well, I think that pretty well finishes the group of sluggish drugs. That is how I always classify them in my own mind.

The next group that I wanted to take up is the group that is headed by GRAPHITES. This third group I think I tend to associate with definite skin eruption kids. You may require practically any of the other drugs we have mentioned for skin eruptions, for instance Carbo veg. kids have a very obstinate eczema of the scalp, Calcarea kids have eczema of them scalp, Causticum kids have a lot of skin eruptions.

You may get a very obstinate eczema of the scalp with Sepia indications. But this Graphites group is the group that I tend to think of when a child comes up with a definite skin history. I think there is a tendency with children wherever you get an irritant skin to push in a dose of Sulphur, and I have seen so many cases where that dose of Sulphur has done hard that now I am chary of starting with Sulphur in these skins with children.

The typical Graphites child is a fat, heavy child. It is usually pale, very little colour, it is always chilly, and it is practically always constipated. Well, in the majority of instances where you have got that obstinate constipation in the small child you get the enlarge abdomen, but that is so constant that one does not stress it.

The next thing about the Graphites kids is that they are always timid. They are rather miserable, and they have a complete lack of assurance. You find in the slightly older kids that they hesitate over what they are going to reply to any questions you give them; you get the report from the school that they are indefinite, there is the same hesitation there; and most of these Graphites children are lazy, they have an aversion to work.

And then you get a queer contradiction in the Graphites children. With that uncertainty and hesitation. laziness, general physical sluggishness, you always get an element of anxiety in the Graphites kids. They always tend to look on the hopeless side of things; if they are going to a new school, say, they dread it. They are always looking for trouble.

Then the next thing that you notice under the Graphites kids is that, associated with their pallor, under any stress at all they flush up-they have got a definitely unstable circulation. And under stress, when they are excited, with this flushing you very often get a history of not awfully profuse but troublesome epistaxis; but it comes on under excitement- that is the diagnostic point.

Then the next thing that is pretty constant about the Graphites kids, and at once distinguishes them from the Calcarea children who look not unlike them, is that, instead of the soft sweaty Calcarea skin, in Graphites you have a harsh dry skin which tends to crack, particularly on exposure to cold, and you find if these Graphites kids have been playing in water in cold weather they come in with their hands absolutely chapped and bleeding. Then, associated with that dry harsh skin, you get the Graphites skin eruptions, and the type of skin eruption is pretty constant no matter where it is.

You get, as I say, cracked fingers which tend to bleed, but they also ooze a sticky thick yellow serous discharge. You get exactly the same kind of condition in any of the folds in Graphites, the back of the ear, canthus of the eye, angles of the mouth, in the groins, bends of the elbows, round the wrists, and particularly about the anus and there you get deep painful fissures oozing a thin, sticky yellowish discharge. Then the next thing about them is that as the discharge dries it forms thick crusts which simply pile up and they go on secreting stuff underneath them; the crusts come off and you get the same kind of gluey yellowish discharge, very often streaked with blood.

Then you can link that on to one or two other typical Graphites symptoms in children. They are very liable to get a very persistent purulent nasal discharge. You are very liable to meet them with a chronic otitis, maybe with a perforation of the drum, and again the same kind of yellowish excoriating discharge, with an irritating eczema of the external ear wherever the discharge runs over.

And, associated with the purulent nasal discharge, many of these Graphites kids have got marked hypertrophy of the tonsils, with a lot of offensive secretion locked up in them, and they often complain of difficulty in swallowing in consequence.

Then, you very commonly see these kids with a chronic blepharitis and the history you get is that the childs eyes are completely stuck in the morning with the same sort of gluey discharge. And when you see them you find that discharge dried across the edges of the lids.

Then another thing about them is that, in spite of their apparent fatness, they are flabby, and there is a general muscular weakness. They are very easily tired out. They are sensitive to motion of any kind; they stand travelling very badly. And you are very liable to get a history of rheumatic pains, particularly, in kids, affecting the neck and the lower extremities.

Then there is another Graphites symptom which is sometimes useful in that sort of flabby kid – they are very liable to get attacks of abdominal cramp; and if you consider their constipated state you are not surprised. The thing about the abdominal cramp is that in Graphites the mother will often tell you that they can relieve the abdominal pains by giving the child some hot milk to drink.

Then, as regards the constipation in the Graphites child. In the majority of cases, with the constipated stool they pass a quantity of mucus-stringy, adherent mucus. It links up quite well with the type of discharge you get from the skin surfaces, though it isnt commonly yellow.

Then the other thing that is useful when you get it, and again it is pretty common, is that these Graphites kids have big appetites; they are hungry children; they are upset if they go long without food; they are better for eating. And yet, in spite of their appearance of fatness and flabbiness, there is often a very marked aversion to sweets, it is surprising when you look at them.

And where you are dealing with an adolescent Graphites it is still more surprising because there you have the same sort of flabby, fat, soft adolescent with, instead of the ordinary cracks behind the ear or cracks at the corners of the mouth or blepharitis, you get an acute acne, and one of the question you always asks is “do you eat many sweets”? and if it is a Graphites you are told, “no, I cant stand them at all” which is sometimes a very useful tip.

Then another point about their appetite which you can very often get in the young children is that they have a definite dislike of fish. You know it is part of the normal constituent of a young childs diet, so you can very often find it if there is anything of the kind; and most of these Graphites kids have a very definite dislike of fish.

Then, where you are considering these children with chronic ears, chronic discharge from an old perforation, possibly with an eczema of the external ear, there is another drug which always has to be considered, and that is CAPSICUM.

Well, the typical Capsicum child to my mind is again a fat, rather lazy, somewhat obstinate child who is very definitely clumsy in his movements – I have never yet seen a neat Capsicum child. The next thing about them is that mostly they have got an appearance of rather reddish cheeks, but that is by no means constant, they may be pale and flush up much like the Graphites child.

The next thing about them is that they tend to be very forgetful. They will be sent on an errand and will come back without what they have been sent for. It is partly lack of attention. And the next thing is that they are always touchy, easily offended easily irritated. And then a thing comes in which always strikes me as odd in the Capsicum children, and that is that they have a strange dislike of being away from home. I think it is partly their feeling that they are not appreciated, partly their touchiness, and partly laziness-they have to make an effort if they are away from home, they have to be more or less agreeable and at home they are very often quite unpleasant.

Then always the Capsicum children are rather dull; they are slow at learning in school, and their memories are poor.

Then next thing about them is that they tend to have local hyperaemias. If you get a typical Capsicum child with a mild earache you find the whole external ear a bright crimson. You get a Capsicum child with a rheumatism, it is usually one or other joint that is affected, and you get a localized blush over the affected area.

If you get a Capsicum child with a cold they get very much enlarged tonsils and they are very hyperaemic-bright crimson – and associated with that the child complains of a burning heat in the mouth with pretty intense thirst. There is one odd symptom in Capsicum which you sometimes meet with in these kids with sore throats running usually a pretty high temperature, the child very flushed, cross, sleepless and thirsty; they want cold drinks, and yet you find them shivering after they have taken something cold to drink.

I have seen that repeatedly in a child with a sore throat who is gong on to a definite mastoid symptoms. And where you get a mastoid in Capsicum – and it is probably the most commonly indicated drug for mastoid – you always get marked tenderness over the mastoid, and you get a blush on the skin surface long before you have got a definite mastoid involved.

One of the nuisance of these mastoids in Capsicum kids is that they usually blow up at night; the child becomes extremely irritable, sleepless, worried, the mother can do little or nothing wit it, it is as obstinate as a mule, and they send for you and you have to look at it in artificial light and you cant see the blush. Time and again I have seen these Capsicum kids and couldnt make out the blush at all, but when I saw them next morning in day-light there it was perfectly obvious.

Then, associated with the tenderness over the mastoid, I usually link up the general hyperaesthesia you find in Capsicum; they are sensitive to noise, sensitive to touch, and they have a hyperesthesia to taste.

Then in the majority of Capsicum kids in their acute illnesses you will get some degree of urinary irritation. You may get an a cute cystitis with an acute burning pain, intense irritable pain on passing urine, and it is always of the same burning character; but even without the acute cystitis in the majority of their acute illness they get some urinary irritation, and it is always of a smarting nature.

Then where you meet with a child of that type, clumsy, rather red cheeked, rather sluggish, backward, with a chronic hoarseness and a history of having had acute sore throats-not quinsies, just acutely inflamed throats – very often with transitory attacks of earache, not going on to a mastoid, but with chronic hoarseness, in the majority of cases you find that is a Capsicum child.

Well, that comes in there because of its association with the ear condition, but the next of the skin drugs in the children is PSORINUM.

The Psorinum children are pretty common. I think the majority of Psorinum children tend to be thin rather than fat. They are always sickly children; they have got very little stamina; they are easily exhausted by any effort physical or mental; they are very liable to become mentally confused under stress; they are rather dispirited, hopeless youngsters, and like all kids when they are out of sorts they become peevish and irritable.

Then I think the next thing that strikes you about them is that they are unhealthy looking. They look dirty and unwashed. You will practically never see a Psorinum child who hasnt got a pustule of some sort somewhere about the body. The skin condition – I think more commonly in the children – is a very rough, dry skin. In the adolescent Psorinum I think it is much more commonly greasy. But whether in the child or the adolescent on exertion the Psorinum kids tend to sweat, and they are always unhealthy, smelly.

Then you get a skin condition under Psorinum which is not unlike the Graphites skin, that is to say, there is a tendency for fissures to develop about the hands and in the folds, but you do not get the honey like discharge of Graphites, you get a watery discharge or you get a purulent discharge, and it is always offensive; and in all the Psorinum skin conditions you get intense irritation.

Many of these Psorinum kids suffer perfect torture because they are intensely chilly, feel the cold very badly – they are upset by it, and yet they have this horribly itchy skin and they are driven nearly dotty by being put into woollen clothes.

Then the next thing about them is that with this dirty looking gray, rough skin the Psorinum kids are very generally upset by washing, and the irritation of their skin is vastly increased by washing.

The next thing about them is that practically all the Psorinum kids, in spite of their thinness, have got abnormal appetites, and one of the constants of Psorinum kids is that any lack of food brings on a violent headache, very often a definite sick headache.

Then, if you see a typical Psorinum skin child you very often have it coming in practically bleeding, the skin irritation is intense, you find the kid scratching its face until it runs blood, in between the scratches there is a filthy pustular eruption, very often associated with a generalized blepharitis. In the acute condition you might think it a Graphites, but it is much more acute, often with the eyelids a bit everted looking almost like raw beef. You get the kid stripped and you find the same scratches all over the body, and again the same purulent condition.

You get exactly the same kind of eruption on the scalp; you find the Psorinum kids never at peace, nearly driven distracted, rubbing their heads against the pillow, and with that you get a yellow, purulent nasal discharge, excoriating the upper lip, and very often you will get a purulent otorrhoea which simply stinks.

Well, that is the kind of intensely irritant skin condition which you will only cover with Psorinum, and for which you are tempted to give all sorts of other things.

“Do you always give Graphites to cases where asthma has developed after eczema has been cured?”.

I have never yet seen an asthma child with a skin history who responded to Graphites. I have tried it but without result. These suppressed skins with asthma developing afterwards are frightfully difficult. My experience is that Graphites fails altogether. It is in Kent I know. But it has not worked in my hands. All sorts of other things have been successful, such as Psorinum, Antimonium crud., Natrum mur., Sulphur. Thuja has quite frequently, and I think if I had no other lead I should probably start on Thuja.

Incidentally, associated with the Psorinum nasal discharge, Psorinum is much the most commonly curative drug, in the interval, for hay fever cases. There you have got a very similar hyperaesthesia in the mucous membrane as you have on the surface in Psorinum kids, and a dose in the spring I have seen repeatedly wipe out hay fevers of long standing. I have never seen it help in the acute condition, but given in the spring – Psorinum gets a spring aggravation – I have seen it stop hay fever altogether.

I think we finished up Psorinum last day. Well, there are two more of these common skin eruption drugs which we have got to consider, and it doesnt matter which order we take them in. I think possibly the best is to take Antimonium crud. first and then Petroleum: and the reason is that the Antimony crud. children with skin eruptions have got just as marked aggravation from washing as the Psorinum cases.

The Antimony crud. kids are very interesting. They are always fat, rather over-weight, usually pale, and they have a very marked tendency to get a redness round about the eyes, very often moist eruptions behind the ears, and mentally they are interesting because they are such an apparent contradiction. They are irritable children, peevish, and they get more and more peevish the more attention they get – the kind of kid that will cry if anyone looks at it and the more you attempt to soothe it the worse it gets.

You very often get a history of the Antimony crud. kid having night terrors, cross and irritable, and the more the mother attempts to nurse it the worse it becomes, walking it up and down like a Chamomilla kid drives it nearly distracted.

Then, as a contrast to that, there is the other side of the kid. They are very impressionable children, sensitive, they are easily upset emotionally, very liable to burst into tears from any emotional stress if their feelings are touched at all, and under stress they become pale and very liable to faint.

Then the next thing is that with these Antimony crud. kids in their skin eruptions they tend to get very large, crusty, smelly eruptions – the typical crusty impetigo that you see on a childs face. I think I have seen more cases of impetigo in children clear on Antimony crud. Than on any other drug in the Materia Medica. And in adults I should think nine out of ten cases of acute impetigo do clear on Antimony crud.

There is another point about them, and that is that all their skin eruptions, no matter what they are, are made very much worse from water, application of water in any form, and they become very inflamed and painful from exposure to radiant heat, sitting in front of a fire will simply blow them up.

Then the next thing in the Antimony crud. kids is that they are very clumsy, and they get very jerky in their movements and you may get an actual chorea.

Practically all these children suffer from warts on their fingers, you may get one or two small ones, or you may get masses of warts; they are usually flat; they are not usually very painful. Associated with their watery condition, most of these Antimony crud. children tend to have rather deformed nails – thickened and unhealthy looking.

Then there are two other points about the Antimony crud. kids which you always get, and one of them is that you are very liable to get digestive upsets from any acids, sour fruits, sour drinks. And the other point about them is that you always in the Antimony crud. children get a soft, flabby, coated tongue – it is a white coating as a rule. It is much like a Mercury tongue with a white coating.

I think that pretty well covers the outstanding points of the Antimonium crud. and you will see it is not unlike the Petroleum, at least as far as the skin conditions are concerned.

But in the majority of cases where you have got indications for Petroleum you will get a thin child rather than a fat one. And associated with this loss of weight in the typical Petroleum case you have got a good appetite, very often a plus appetite, and very often there is a history of the childs being hungry between meals.

Then the next thing about the Petroleum children is that they are just about as irritable as the Antimony crud. kids, but it is from a quite a different cause; they are much more quarrelsome, and they easily take offence. You will very often get a history from the parents that the child is quite bright mentally, and yet is lazy at school, it doesnt want to work, and is inattentive and forgetful.

They are practically always sensitive to noise and quite scared from any sudden noise, loud noise, which they dont understand. They are very liable to be nervous of crowds – crowds of people. Then they are just as sensitive to cold as the Antimony crud. kids or the Psorinum kids.

Then, in appearance you practically always find some signs of skin eruption in the Petroleum children, and much the commonest is an eruption at the back of the ears, deep cracks which are oozing a yellowish, watery fluid. And very often these cracks tend to split and bleed.

But you will get the same sort of cracks any place in the Petroleum child, particularly in any fold, you get similar cracks at the corners of the mouth, you get cracks at the angle of the nose, and very commonly you get similar cracks round about the anus, in the groins, or in the axillae; and the fluid that oozes out of them tends to crust up and they get thick crusts which are always very sensitive.

Then practically all the skin eruptions in Petroleum itch. They are very liable to be more irritable, I think, during the day than the night, which is sometimes a help because it is occasionally a little difficult to distinguish them from Sulphur.

Then the next thing about the Petroleum children is that they are very liable to catch cold, and with their colds they get an acute nasal obstruction, with an excoriating discharge, tendency for the nose to get crusty, sensitive, bleeding, and very often crusts on the upper lip and round about the sides of the nose.

And with these nasal discharges you almost always get some deafness, very often with acute pain in ear, and a sensation as if the eustachian tube was blocked up. They do quite frequently have an otitis, with the same kind of watery, yellow discharge, and very marked redness of the external ear, an acute eczematous condition, again with the irritation and the tendency to bleed.

Then another thing that you can link up with their itching is that they get very definitely itchy eyes, and very often you get a blepharitis, reddened margins, but they particularly tend to get cracks at the inner canthus, and they are quite liable to get an infection spreading down the lachrymal duct – you may even get an abscess in the lachrymal sac. You can very often squeeze pus out of the lachrymal duct and you get excoriation running down the side of the nose, raw and bleeding. With that, of course, you may get an acute conjunctivitis.

Then, with the amount of infective processes you have got going on in the throat and nose it is very common in these Petroleum children to get an enlargement of the submaxillary glands.

Then another thing that you very commonly get in the Petroleum children is a history of some bladder irritation; it is very often an enuresis, but it is much more commonly an acute irritation, it may be an acute cystitis, and again you get the same description of the sensation of rawness and smarting.

Another very common feature in the Petroleum kids is that after any exposure to cold they are liable to develop acute abdominal colic and diarrhoea. And with their diarrhoea they always get a degree of inflammation about the anus and perineum, with again he burning, red, raw eruption.

Then, another point about the Petroleum kids is, that in cold weather the skin of their hands tends to crack, particularly on the finger tips, and these cracks are very sensitive, very painful to touch, and they get quite deep fissures, which again split open and bleed easily.

Then, of course, all these Petroleum kids have the typical Petroleum aggravation from motion, that is to say, they get train-sick and sea-sick; and there is one other point which is sometimes very helpful and that is that you quite frequently get a history from the parents or the school that with that rather poor mentality if the child is pressed it is very liable to develop a severe occipital headache. That occipital headache is rather rare from mental effort, and it is a little difficult to cover, and Petroleum sometimes helps you out.

By the way, incidentally if you ever get a case of sea-sickness and you are in doubt between Petroleum and Tabacum, which is the other common drug for sea-sickness, you almost always get that occipital headache as well as the sea-sickness in Petroleum and the Tabacum people have not got it at all. So if you get sea- sickness with occipital headache give Petroleum every time. You quite frequently get patients coming in for prophylactic treatment against sea-sickness and it is very difficult to spot if they are going to be Tabacum or Petroleum, and if you remember the occipital headaches of Petroleum kids it puts you on to the Petroleum sea-sickness at once.

Well, of course, there are various other drugs which come in the skins in children but I think these are much the commonest. Of course you immediately think of the possibility of Sulphur because Sulphur is almost automatic in skins, but I think it is better to take the question up with Sulphur in general under the next group.

CHILDRENS TYPES.

NO.4.

THE way I usually group the next crowd are the warm-blooded drugs, that is to say, starting off with Pulsatilla which is the most commonly indicated warm blood drug in children, and following on from that.

Well, it really seems like a waste of effort to attempt to describe a Pulsatilla child to you because you all know them as well as I do. They are very typical. I think they run into two types, you either get the very small, fine Pulsatilla type, with a fine skin, fine hair, an unstable circulation, liable to flush up from any emotion, very often going pale after it, definitely shy, sensitive, always affectionate, very easy to handle, and always definitely responsive.

Or you get the other Pulsatilla type, which is much fatter, with definitely more colour, usually rather darker hair, a little more sluggish in reaction, a little more tendency to weep rather than to bright and gay as the smaller fine Pulsatilla is, rather craving for attention without so much response to it, always asking for a little more. And if you get one picture clear you are apt to forget the other one.

The thing that is common to both of them is their temperature reaction, all the Pulsatilla children are sensitive to heat, they flag in hot weather, they lose their life, they lose their sparkle, their energy, they hang about, they either get tearful or irritable, and they are very liable to get digestive upsets. But they are much more liable to get digestive upsets.

But they are much more liable to be upset by a to get an attack of acute sickness from being chilled in hot weather, they are liable to get an attack of diarrhoea from being chilled in hot weather, they are liable to get cystitis, they are liable to et earache; but it is the sudden chilling during the heat; they are flagging in the hot weather, no energy, no life, but their acute conditions are much more liable to be brought on by chilling. In exactly the way they are liable to be upset by taking ice cream in hot weather; it is quite as common as the ordinary Pulsatilla aggravation from too rich food.

Then I think sometimes one misses a Pulsatilla case because of their odd reactions when they have got a feverish attack. These Pulsatilla kids very often get acute colds in their head acute coryza, and very often with their acute colds in the head these Pulsatilla kids get shivery, they feel very chilly, they very often, with their coryza, get a certain amount of gastric catarrh too, a feeling of nausea, and they may actually vomit; and yet, in spite of their chilliness, their sense of blockage in the head is better in the open air, it is worse in a stuffy room, and you will never get a Pulsatilla cold that hasnt got a bland discharge.

Then again, with these colds you sometimes get an apparent contradiction too, because with their colds they are very apt to get a conjunctivitis, and it is pretty marked in Pulsatilla, and in the Pulsatilla conjunctivitis the eyes are very sensitive to any cold draught, they simply stream water in the open air. There is usually pretty definitely photophobia in Pulsatilla and a good deal of itching of the eyelids, and of course the Pulsatilla kids are always apt to get styes, particularly affecting the lower lid-the lower lid rather than the upper.

Then there is one point that is sometimes a help in the Pulsatilla earaches which are very intense, and, as I say, are usually brought on from exposure to cold; they get very violent pain, which seems to spread all over the side of the face, as well as into the throat, and if the condition has gone a little farther you often get the Pulsatilla patient describing the condition as a feeling of absolutely bursting out of the ear. The other thing that helps you, of course, is again the amelioration from cold-their earaches are better from cold applications.

Then there is one other thing about the Pulsatilla kids and that is that you very often find them tired and edgy and sleepy during the day, and yet they seem to become more lively as the day goes on, they are liable to get the Pulsatilla nervousness just about sunset, the ordinary sunset aggravation of Pulsatilla, and then become very lively towards bedtime, slow of going to sleep, and once they have they tend to get nightmares, night terrors, usually some kind of strife drams, it may not be particularly being chases by the black dog of Pulsatilla, but is is always something worrying, terrifying. And, of course, most of these Pulsatilla kids are afraid of the dark, afraid of being left alone, just the sort of thing you would expect in that shy, nervous type of child.

There one thing that will produce a night terror in the Pulsatilla child, and that is telling them ghost stories in the dark before they go to bed; you can practically bank on that Pulsatilla child having a nightmare that night.

Then there is one other tip which is sometimes useful in spotting the Pulsatilla children, and that is they are awfully liable to become giddy from looking up at anything high. The only other drug that I know that has it so marked is Argentum not., it has an aggravation from looking down, but it has also an aggravation from looking up, but I think Pulsatilla has it very much more marked than Argentum nit.

Then the other thing that is sometimes a help, although it is by no means constant, is the position that the Pulsatilla child takes up in sleep, that is to say, lying with the hands up above the head.

I think that gives you a fairish sketch of the type of child you are dealing with.

And on to the Pulsatilla kid, the hot-blooded child of that type, the next thing you always consider is the possibility of whether it is Pulsatilla or Kali sulph. Well, Kent says that Kali sulph. is merely an intensified Pulsatilla. Personally I dont think it is. The Kali sulph. temperature reactions are identical with the Pulsatilla ones, that is to say, the child is sensitive to heat and it flags in the hot weather, cant stand stuffy atmospheres, is better in the open air, tends to stagnate if keeping still, and is better moving about.

It has got an aggravation from rich food. It is liable to be upset by sudden changes of weather. But I think there is a definite difference, I think the Kali sulph. child is much more flabby than the Pulsatilla child, it certainly does not approach the thin fine type of Pulsatilla it approaches more to the sluggish heavier type of Pulsatilla. Its muscles are flabby, it is easily exhausted by muscular effort.

It is more liable to sit about, and it has got a much more sluggish reaction generally. And there is much more obstinacy in the Kali sulph. than in the typical Pulsatilla. Pulsatilla may be irritable, it may flare up in a temper but it is over; Kali sulph. is much more liable to be obstinate.

Then then Pulsatilla kids are shy, but the the Kali sulph. children tend much more to have a lack of confidence in themselves-it isnt shyness. And they are lazy, they dislike work and you dont get the keenness and interest that you get in the Pulsatilla children. And the Kali sulph. kids are not bright, they get tired out by mental exertion, whereas the Pulsatilla kids are very often bright and sharp and do quite well at school.

Then there is a certain amount of similarity again, they are both nervous, they are both afraid of the dark, they are very easily frightened, easily startled at strange noises, strange surroundings.

Then, I think the typical Kali sulph. child tends to be more sickly than the typical Pulsatilla child; the Pulsatilla kid may not be strong, but the Kali sulph. kid tends to have less colour and if they are flushed it is much more a circumscribed flush on the cheeks rather than the variable circulation of the Pulsatilla.

Then another thing that very often helps you to spot a Kali sulph. rather than a Pulsatilla is that in practically all the Kali sulph. children you get a yellow coated tongue, particularly the root of the tongue, although the coating may spread right over.

Then another point that is sometimes a help is that there is a slight difference in the type of discharges you get in Kali sulph. and Pulsatilla. The typical Pulsatilla discharge is a thick, creamy, non-irritating discharge; the typical discharge in Kali sulph. is a much more watery, more stringy, yellowish discharge.

The, as far as their liability to actual acute illness, I think you are much more likely to want Pulsatilla for the acute gastric catarrh, the acute gastritis, the acute colic and diarrhoea; but if you have a gastritis that has gone on to a jaundice in a Pulsatilla type of child you are much ore liable to get indications for Kali sulph. rather than Pulsatilla.

And again, if you have got a Pulsatilla type of child who has caught cold, who has developed a bronchitis and the bronchitis has gone on to a broncho-pneumonia with the ordinary Pulsatilla indications, that is to say aggravated from stuffy room, relief from air, sense of suffocation, possibly a loss of voice, very dry mouth without much thirst, and where you have got a yellowish, watery sputum, probably patches of consolidation at the left base-left base more commonly-you get better response from Kali sulph. than you will from Pulsatilla.

And again, if you have got a whooping cough in Pulsatilla child, with a lot of rattling in the chest, of the ordinary Pulsatilla modalities, Kali sulph. does you much more good than Pulsatilla.

You see, that, I think, is what Kent means by saying Kali sulph. is Pulsatilla intensifies-in these acute conditions their symptoms are very similar and yet the more severe the condition the more definitely you get indications for Kali sulph. But where you are prescribing on the type of child I think there are very definite difference between the two.

“What potency of Pulsatilla would you use usually?”.

Usually low in chronic case; they are usually sensitive kids, and where you are dealing with the sensitive type you dont want high potency. Where you are dealing with bovine types I go high. But where it is sensitive type like Pulsatilla they simply blossom on a 30. Phosphorus is exactly the same thing, Phosphorus children respond beautifully to lower potencies.

“What potency do you give for impetigo?”.

I have found very good results from Antimony curd. 12, repeated three times a day for two days, or something of that sort.

“What about Calc. carb. or Graphites?”.

Calc. carb. or Graphites I would give high every time-a 200, or higher.

WELL, for my sins, you asked me to talk about Sulphur to-day, and it is a little difficult to know where to begin and how to tackle it. But you have got to remember that here we are talking about the drugs that apply to children much more than the general picture of the drug, which does make it much more simple.

From the point of view of children, I think there are two definite Sulphur types that you can recognize. I think much the commonest Sulphur child that you see at least that we see here is a fairly well-nourished, well-grown child, always with a definitely big head. They are usually fairly heavy in build and rather awkward and clumsy in their movements. They are apt to have a very coarse, strong hair, and they always have a fairly high colour. Their skin tends to be roughish, it will roughen in a cold wind, and they tend to have rather red extremities, red hands and very often red feet.

Then the next thing about them is that they always have very red lips, very often red ears, and they easily run to redness of the margins of the lids. That is one of the places that you do get the exception to your coarse hair, because that type of Sulphur child very often has poorly developed eyelashes; they have had repeated attacks of blepharitis, they have crusty eruptions about the eyelids which they have picked and scratched, and consequently the eyelashes tend to be undeveloped or poor.

Well, that is much the commonest type in appearance. I will go into a little more detail in a moment, but that is the commonest type we see here.

There is another Sulphur type, which is thin usually, with a fairly big head but rather spindley legs, very often with a biggish abdomen, rather a poorly developed chest, very often not so much colour, tending to be paler, with a definitely rougher skin the other type of Sulphur tends to sweat pretty easily, this is a dryer skin, coarser skin, a very marked tendency for the skin to split, to crack, on exposure, and the child is rather more miserable generally. The child looks more seedy, it has got less vitality, it is more easily tired, and it always stands badly.

Then the next thing that is pretty definite about the Sulphur kids again I think they differ in type, where you are dealing with the heavier Sulphur type I think you get much more bite about them, they tend to be quarrelsome, impatient, rather critical, fault-finding, discontented, very often generally dissatisfied, they are apt to feel they are not getting a fair deal, very often feel they are being underestimated, and they are lazy.

But it is very difficult often to say whether it is real laziness or lack of stamina, because they do get tired out on exertion. Another thing that you will commonly come across in that type of child is they have a great dislike of interference, they think they know how to do a thing, they know what they want to do, and they very definitely resent their parents butting in, they would make a better show of it if they were left alone they think.

Then the thin Sulphur type, I think, are much more inclined to be miserable, low spirited, much less vitality, much less bite about them; but there is the same sort of resentment of outside interference; it shows itself differently, these thin Sulphur kids are liable to weep, and any attempt to comfort them is apt to annoy them, then they will spit I dont mean literally, but figuratively! and these thin Sulphur kids have got even less stamina than the fat ones, they are more easily exhausted and, like all the Sulphur patients, it is exaggerated in that type of child that they cannot stand for any length of time; they stand badly in the ordinary instance, and if they are kept standing they simply go to bits. .

Then there is one outstanding characteristic of all Sulphur patients, whether children or adults, and that is that they have got a pretty hefty appetite it doesnt matter whether they are fat or thin and their appetite is pretty definite in its likes and dislikes. You will find all Sulphur patients with a desire for something with a taste; they like highly seasoned, spiced foods. And the other thing that you will get in all Sulphur patients is they have got a very marked desire for sweets.

You occasionally get a Sulphur patient craving for salt, but it isnt really salt they are craving for, it is much more something with a taste. And another point which I think you will always find in the Sulphur children is that they have an almost perverted desire for out-of-the-ordinary food, the unusual dish that the average child jibs from the Sulphur child mops up with avidity. That is one constant feature.

Another constant feature that you meet in children and adults is that they are always very sluggish after meals, they get heavy and sleepy, they want to lie about, and they are irritable if they are disturbed.

And, in connection with their food, there is one very useful point in children Sulphur children and that is that they are very liable to get digestive upsets from milk. The small Sulphur baby very often gets sickness, it may get diarrhoea and vomiting, from milk, and it is one of the drugs that one tends to forget as having the marked milk aggravation.

Then the next thing that is constant to all Sulphur patients is their skin irritation. You practically never come across a Sulphur patient who has not got irritation of the skin somewhere, and there are one or two characteristics features of the Sulphur skin at least of the Sulphur irritation. The first thing is that it is very much worse in warmth of any kind, warm room, warm bed, warm sun, warm clothing, all set up the Sulphur irritation.

The next thing is that when the irritation is present they do get definite comfort, and they sometimes get a peculiar sensation of pleasure, from scratching, and occasionally the scratching does relieve the irritation. Then the next thing about it is that it always tends to be much more troublesome at night, and that is apart from being hot; very often when they are about, active and occupied, during the day the irritation does not worry them much but when they are at rest in the evening or at night the irritation tends to become much worse, and much more worrying. Then, of course, you link on to the irritation all the Sulphur skin conditions.

Well, Sulphur has every skin eruption that is known to the dermatologist. And the only point that does distinguish it as a Sulphur eruption is its reactions to temperature, and the fact that it always irritates. It is an intense irritation that they cant leave alone; they describe it in all sorts of ways itching, feeling of animals crawling over the skin, sensation of stinging of nettles, any description that describes an intense irritation of the skin.

Another point that you tack on to the general surface irritability is that in Sulphur kids you tend to get very marked irritation of all the orifices, nose, ears, mouth, urethra, anus, any orifice tends to be congested, red, hot and itchy.

Then there is another point which is sometimes helpful in the Sulphur children. You know, of course, that the Sulphur patients are aggravated by heat, but one of the things one is apt to forget is that the Sulphur patients have an unstable heat mechanism; they are very liable certainly in feverish conditions to get waves of heat and waves of chilliness.

You very often get them becoming horribly hot, breaking out into a sweat and getting shivery very much the sort of condition that you associate with Mercury. You cover them up and they get hot and beastly uncomfortable; you uncover them and they get a draught on the surface and they are immediately chilly. So dont always be put off from Sulphur by the fact that the kid does not necessarily want to be uncovered all the time.

Then the next thing about the Sulphur patients which is constant no matter what their condition, whether it is a skin eruption, or a child with rheumatism, the child with a tummy upset, no matter what it is, it is aggravated by bathing. And, as you know, practically all these Sulphur kids look dirty.

Associated with that, there were several kids that we used to see in out-patients who at first sight were not unlike Calcarea kids, that is to say, they were heavy, had big heads, were rather pale with a tendency to flush, rather big bellies, clumsy; and yet they hadnt the Calcarea chilliness, they were hot-blooded, and they had a very marked tendency to the development of blackheads all across the forehead. These kids were practically all Sulphurs. They had rather paler lips than the average Sulphur children, and at first sight one wouldnt have spotted them, but, with these blackheads scattered about over the forehead particularly, always look out for the possibility of the child being a Sulphur child.

Then there is another contradiction that one sometimes meets with in the Sulphur kids. You except them to be horribly hot, but you will meet Sulphur children who have disturbed areas of heat; they have hot heads and cold hands, or they have hot hands and cold feet, or they have hot feet and cold heads very often cold, damp heads so that you get local disturbances of heat and cold just as you get the general disturbances of heat and cold. So that again if you get a child with cold feet dont automatically rule out Sulphur because it does not put its feet out of bed.

Then there is another typical Sulphur characteristic, and that is that they are sluggish. They are better for exertion, they are better when they are stimulated, and they are better when they are moving about. I know quite a number of Sulphur patients who can be the most lethargic, dull, uninteresting people and yet if they are stimulated in the proper kind of society they wake up; they are clever; and you wouldnt recognize them as the same beings. You get exactly the same with Sulphur children; badly handled they are dull, heavy, cross, irritable; and properly handled they can be bright, interesting, quite friendly, and very often clever. I have seen some of these Sulphur children with the most astonishing command of language not necessarily unprintable!.

You see how you just tack all the things on together.

Then there is another pretty constant characteristic of all the Sulphur children, and that is constipation; the majority of these Sulphur kids suffer from more or less constipation, very often it is quite extreme. And associated with that constipation, you tack on the enlarged abdomen, very often big liver, the abnormal appetite, the sleepiness after meals, and the very definite tendency to get attacks of colic. I think all the above applies more to the heavier type of Sulphur; I think the thinner type of Sulphur are more liable to get attacks of diarrhoea; they very often suffer from a chronic diarrhoea with the ordinary Sulphur modalities, that is to say, a diarrhoea tending to come on early in the morning, any time after four oclock, with any kind of stool provided it is offensive.

And when you are there you tack on the other constant Sulphur characteristic which is that they all smell; their discharges smell, any eruption smells, their perspiration smells, and the Sulphur child is very difficult to get clean and wholesome.

Then there is another feature that one often meets with in these Sulphur children, and that is that they are often heavy and lethargic and sleepy during the day, and very sleepless at night, and they are liable to get most terrifying nightmares. It is always a terrifying nightmare of some kind, but it isnt constant in its character, but the kid is always being frightened, very commonly being terrified of fire or something of that sort.

Then there is one other point which one occasionally comes across in a Sulphur child. It is pretty lively in the evening, slow of going off to sleep, gets off to sleep, gets off to sleep, and wakes up in fits of laughter; it is an odd symptom, and I have come across it several times, and always it has been in Sulphur children.

Well, in a general way I think that is about as much as I can give you, with possibly the exception that they do get a hungry period about eleven oclock in the morning, and that all the Sulphur children are liable to be seedy, headachy, irritable, tired-out, if they have to wait for their meals.

“Are there any special acute conditions in Sulphur children?”.

There are all sorts of acute conditions from which the Sulphur children may suffer. Oh, there is one other condition which might be worth mentioning, and I think you can tack it on to the redness of lips and orifices, and that is that in acute or chronic conditions they tend to have a red coated tongue, with a very red tip, and very often a red margin running along their sides. It isnt unlike a Rhus tongue. And most of these Sulphur patients have a dry mouth, a hot mouth, and are thirsty. Of course you meet that more in the acute conditions than in the chronics.

As regards the actual things from which they suffer acute diseases practically all of them are associated with, as I say, some skin irritation. You will very commonly get Sulphur indicated in acute styes with intense irritation of the lid margins, the lids very hot and burning, aggravated by heat, and particularly aggravated by bathing they smart and sting if you give them an eye bath.

You very commonly get indications for Sulphur in chronic nasal discharges; and in Sulphur children with a nasal discharge you will always get the same old Sulphur offensiveness. The discharge is always excoriating, there is a redness about the nose, again with intense irritation, the kids tending to pick at it until it is raw and bleeding.

You will very often get Sulphur children with a chronic tonsillitis, a deeply injected throat, very much swollen, feeling very hot, with a very offensive breath. And practically all these Sulphur kids with their tonsillitis tend to get masses of glands in their neck far more than the ordinary tonsillar gland enlargement, it tends to spread right along and particularly involves the submaxillary glands. And with their tonsillitis, of course, you will get the irregular heat and cold, shivering attacks, sweaty attacks, and the thirst for cold water.

You very often get indications for Sulphur in chronic conditions, chronic ear discharge. And again you get the Sulphur characteristics, the excoriating, offensive discharge, the redness about the external ear, the intense irritation, the aggravation of any pain from hot applications, particularly hot fomentations.

Then you get all sorts of Sulphur chest conditions in Sulphur kids, anything from a mild bronchitis up to an acute pneumonia; and there again you get certain Sulphur constant features, you get a tendency to waves of heat and sweat, very often occasional shivers, very often with burning extremities, and a very definite heavy smell about the child.

Then there is one constant feature that runs through all the Sulphur chest conditions, and that is a very definite sensitiveness, extreme sensitiveness, to lack of oxygen they cant stand a stuffy atmosphere, they want plenty of air, and yet they are chilly in draughts. I think, on the whole, in chest conditions you more commonly get indications of some disturbance on the left side of the chest rather than the right, but it is so slightly more common on the left than the right that I dont think it matters very much.

Then, of course, Sulphur is one of your most commonly indicated drugs in jaundice of children acute catarrhal jaundice particularly with the marked intolerance that Sulphur has got to milk in its acute conditions, intense skin irritation, feeling of burning heat on the surface, very often with attacks of colic, frequently with attacks of diarrhoea.

And where you have got a Sulphur diarrhoea again you have got an excoriating discharge, you are likely to get redness and rawness all about the buttocks, intense irritation, scratching. You see you have constant characteristics all throughout the Sulphur conditions no matter what they are.

Then you very often get the thin type of Sulphur patients running to acute rheumatic conditions. And again you get the Sulphur characteristics, that is to say you get the irregular sweats, feeling of heat, thirst, red tip to the tongue. The actual painful condition is worse from heat, it is rather more comfortable from cold, it is very much better from movement, although it is painful when they start to move; and you are very liable to get a red blush of the affected joint; and you are very liable to get a history of the attack having been precipitated by bathing, either seabathing or swimming.

And so on you go; you can go right through the whole dictionary of medicine and you can find Sulphur in all of them, but the Sulphur characteristics have got to be there otherwise it does not fit. .

“What about the desire for fat?”.

That is very variable in children. It is very common in adults; you find practically all adult Sulphurs want fat with hot roast beef for instance, but it is by no means as constant in kids. I have seen a lot who do not like fat; if you get it it is a help, but it is by no means constant so I dont stress it nowadays. A fair number of adults also dont want it.

“What about butter?”.

I dont think butter comes into the fat craving at all, because you get the majority of your Pulsatilla patients with a definite aversion to fat and they like butter and they like cream; the thing that they dislike is meat fat, and particularly hot fat. Quite a number of Pulsatilla patients will eat cold fat, but they will jib from hot fat. But most Pulsatilla patients will take butter, and very often they take it in large quantities.

“Is the tendency to sweating constant in Sulphur?”.

Particularly the fatter type of Sulphur; the thinner ones usually have a dry harsh skin and dont tend to perspire in the same way.

One other things sometimes is a help about Sulphur kids, and that is that they are frightfully pleased with their possessions; the Sulphur childs toys are the best that could be, and the Sulphur childs family is the best there ever was, and the Sulphur childs motor car is the last word in motors which is sometimes quite a useful tip.

There is another tip about the Sulphur kids which I have sometimes found useful, and that is that they have an astonishing money sense; quite a small child has a very definite sense of values. .

“For severe aggravation of Sulphur is there any one drug to antidote it?”.

I think the most common antidote drug for Sulphur is Belladonna, but it depends entirely what the condition is.

“Is Sulphur often indicated for urticaria in children?”.

Not nearly so often indicated as it is used. But it is very commonly indicated in urticaria in children, particularly if associated with digestive upset.

“What is the best potency for children?”.

Children respond awfully well to any potency, and most Sulphur children respond perfectly well to a 30 or 2000.

“Is Pulsatilla lethargic?”.

Yes, the heavy Pulsatilla is. The heavy Pulsatilla child is the child who is liable to go on to Sulphur. The finer Pulsatilla child is much more liable to become chilly and go on to Silica or Phosphorus.

“Can you mask symptoms with a homoeopathic drug?”.

Yes, you can. For example, where you have got a case that has been exposed to cold and comes down with pretty indefinite symptoms, you dont know what is developing, you can quieten it down with Aconite but they dont clear, and you know you have only modified it and you wonder what is going to happen in the next twenty-four hours. If you push in a dose of Sulphur the child is well next day.

Often you are liable to get mild bronchitis developing, and it is jolly difficult to prescribe for if you have modified it with your Aconite and left it there, and you have got very little indication for anything else.

NO. 5.

WELL, I think we cleared Sulphur out of the way last week, and we get back to our Pulsatilla type of drugs. And, although the majority of these that I am looking at are hot-blooded drugs, there is one other that you have got always to associate with Pulsatilla, and that is THUJA, although it is chilly in its reactions.

I think it is a little difficult to give you a mental picture of the typical Thuja child, although I can remember lots of them coming up to out-patients, and I think the real reason why it is so difficult to get a picture of them is that in the majority of outstanding Thuja cases there has bene an element of mental deficiency.

I have seen quite a lot of Thuja patients, Thuja children, where there has been mental deficiency, some merely backward, some actually deficient; I have seen quite lot in whom there is an obvious pituitary disfunction, and I think that tends to colour ones idea of Thuja. But you will get Thuja children who are not mentally defective, and who have not got a pituitary disfunction, and that type of child is very like a Pulsatilla child in reaction.

I think the outstanding characteristic of the Thuja child is the fact that it is sensitive, sensitive to people, it is responsive to any kindness, it is conscientious in what it does, and it is easily upset emotionally. And there your first strong indication Thuja indication comes in: the Thuja children have a peculiar sensitiveness to music.

It is one of the things that one commonly associates with the mentally defective child, I think; certainly 80 per cent. of the mentally defective children that I have had to do with have been abnormally sensitive to music; I mean much more sensitive than the average child and even in the normal child with Thuja indications you will get this emotional sensitiveness to music. They are affected by it; they may even weep from it.

Then, associated with that emotional disturbance, you do meet Thuja kids who have a sadness, a depression, which is very like a Pulsatilla depression, that is to say they are sad, they are easily upset, and if upset they weep very much as a Pulsatilla child does.

Then there is another symptom which always makes me think of the Thuja child, and that is a strange contradiction that you often come across with a perfectly lively, active child, apparently keenly interested, and yet they have a strange hesitation in speaking, very often a difficulty in finding the words they want, or a difficulty in saying them.

And very often that difficult in speaking gives you the impression that the child is slow mentally, when it isnt really slow, it is really hunting for words. And you may get that going on a little farther and you get some of these Thuja children who have a definite disinclination to talk, they are rather silent, and they appear to be rather heavy.

Then, as far as appearance goes, I think the majority of the Thuja children are rather under than above the average height, many of them are definitely small and rather finely built. I think I have seen as many fair-haired as dark-haired Thuja children, and it seems to apply equally well to either type.

There is one thing that is pretty definite about them, and that is that they appear to get wakened up, alive, the more active they are. If they are made to sit about they get dull, heavy, apt to get depressed, but any activity seems to brighten them up mentally.

Then, another common feature that you meet with in many of these Thuja children is a very faulty development of the teeth. You get rather irregular dentition, and you get very early decay. The enamel of the teeth is definitely faulty in places.

Then, all these Thuja children are sensitive to cold, and yet they are mostly better in the open air. They are very sensitive to damp, and they are liable to be much worse in the mornings. Then I have never seen a Thuja child that didnt perspire on exertion, and even when they are not exerting themselves they mostly have a rather greasy skin. I think probably the greasy skin of the

Thuja child is more commonly noticed, at least I have noticed it more commonly, in the dark-haired type than in the fair; I have seen quite a lot of fair-haired Thuja children who had a rather fine skin, and very often a downy growth on the skin, particularly on the back.

Then the next thing is that these Thuja children dont stand up to mental stress well. They are very liable to get a typical acute neuralgic headache under stress, from getting over-tired or over-excited, and the point about the neuralgic headache in the Thuja child is that it very often picks out definite areas which are extremely painful and very often extremely sensitive.

And with that you can always tack on the other symptom, which is that the Thuja kids are very liable to get chronic catarrhs; they get a thick, purulent, yellowish-green nasal discharge; they are liable to get crusts in the nose; they may get bleeding. They are liable to get a chronic otitis media, and with their otitis media they are very liable to run to a mastoid, again with the very severe and localized pain, and tenderness over the mastoid; if they are old enough they will tell you it feels as if something were being bored into the mastoid region.

Then another common feature in these Thuja children is that they have a poor digestion. You know the typical picture of the pituitary child with the almost pendulous abdomen well, that is the extreme case, but you get all degrees up to that, and these Thuja kids are very, very liable to run a chronically irritated caecum, you very often find a full, boggy caecum in the right iliac fossa, and with that you usually get a history or recurring attacks of diarrhoea, and the Thuja diarrhoea is fairly characteristic . It consists of pale, greasy, almost fatty stools, and they are always passed with a good deal of flatus. And the diarrhoea attacks are accompanied by a lot of gurgling in the abdomen.

Then, of course, as you would expect, these Thuja kids in a great many instances will give you a history of having had crops of warts, or they may actually have them when you see them. The point about the Thuja warts is that they are soft, and they bleed very easily on handling; if they are knocked they are liable to have their surface broken and bleed.

Then you remember the point that is always made in the Materia Medica about the Thuja patient sweating on the uncovered parts. Well, that is perfectly true. I remember seeing a girl of round about twelve years of age, and she was stripped to be overhauled, and the sweat simply poured off her when her clothes were taken off; and she wasnt sweating at all when covered up: so you do occasionally come across that odd symptom of sweating when uncovering, although mostly the Thuja children are chilly and are shivery when they are uncovered.

As a matter of fact that particular case was rather interesting because she was one of these rare bony deposits in the muscles in quite a young child, and she did very well on Thuja. We had her in here for some time just before the war, and the first thing that put us on to the possibility of Thuja was that odd sweating when uncovered.

And then the other thing you get pretty constantly with Thuja children is their strange susceptibility to onions. They are very liable to get a gastric upset, an attack of diarrhoea, from onions, cooked or in any form you like. And there is one other common Thuja symptom, although you dont meet it in the young children you meet it in the adolescent, and that is they are liable to get acute digestive upsets from tea.

Then, of course, if you get a vaccination history it is a great help to you.

I think that more or less covers the general outline of Thuja. It is a little difficult to disentangle the acutely pathological patient from just the average Thuja in individual.

Well, the next drug that comes into that crowd is Silica, of course, but we have dealt with it already. It is again chilly, of course.

Well, to get back to the warm-blooded drugs, I think the next common one is BROMINE.

I think Bromine is one of the drugs which is very frequently missed. I know I missed it for years after I started practising Homoeopathy and was astonished when I did discover it to realize how many patients I should have given Bromine to and hadnt done it. I think the common Bromine type of patient is usually over- fat. The majority of the cases I have seen have been in fair- skinned, fair-haired people, and the majority of them have been friendly, cheerful, fairly happy types.

And then you begin to get your contradictions. You have got your fairly cheerful, happy, friendly type, and yet they are very easily put out, and if they are upset they very commonly flush up, and if you get them to explain what happens they say they get a feeling of heat and tension in their heads.

Then the next thing about them is that they are very liable to become nervous, anxious, very often frightened, in the evening very much about the Pulsatilla time. They dont like to walk home in the dark, they are very liable to have the impression that somebody is following them and they get scared very much like the symptom that Pulsatilla gives you they look not unlike Pulsatilla, and you will occasionally get patches of depression in the Bromine patient which again are not unlike the Pulsatilla. But I think in Bromine you are much more likely to come across more placid depression, much more a melancholy outlook than the acute tearfulness of the Pulsatilla.

Then the next thing that I have come to associate with the Bromine patient is in that rather fat, fair type they tend to run to crops of boils, either acne about the face or over the shoulders, in fact I dont think I have ever prescribed Bromine for an adolescent who hadnt some acne spots about.

Then you get more of the symptoms which again are very like pulsatilla. They are very sensitive to heat, they are uncomfortable in the sun, they are definitely uncomfortable in a hot room. They are definitely better for motion, and they are better for exercise. They are better in the open air. And then you get your first contradiction; the typical Bromine patient is very much better after food, whereas the typical Pulsatilla patient is heavy after a meal. Then you get another contradiction; in spit of the fact that they are better in the open air, they are sensitive to draughts.

Then I think the majority of the Bromine cases I have seen have been of two types, either the chronic catarrh of the upper passages, or the typical acute hay fevers.

And if you take the catarrhal type first you will get either the child with the chronic hypertrophy of the tonsils, and they are not the types who run to recurring quinsies, it is the enlarged fibrotic tonsil, very often with pretty general enlargement of the submaxillary glands, which again tend to be hard, they dont tend to break down. And with the chronic tonsils they are very liable to get acute attacks of catarrhal extension to any of the sinuses, and I think in Bromine more commonly you get the frontal sinuses involved, rather than the antrums, and with the involvement of the frontal sinuses you get the patients complaining of intense pain, fullness, feeling of swelling at the root, of the nose.

The nose feels choked up, and what discharge there is is a thick, yellow, purulent discharge, and if they make violent efforts to clear the nose it is liable to be bloodstained. Then there is another point about that type of case, which is that you are very apt to get what they used to describe to us as a strumous upper lip, in other words a thickened, rather inflamed, reddened upper lip. Well, that is I think the commonest type of case that you will come across requiring Bromine.

You will occasionally get one of these tonsil children getting attacks of very intense croup. And the feeling, the sensation, they get is a sensation of tickling in the larynx; they have a very violent croupy cough, which goes on almost to suffocation, and which is relieved by cold drinks. And they very often complain of a feeling of pressure, or constriction, of the throat, and the larynx in these Bromine cases is usually very sensitive to touch. And associated with that, you very often get in fact you get it independently of their croupy attacks, you get it in children with hypertrophied tonsils quite apart from laryngeal infection you get the typical Bromine hoarse voice.

Then the other thing that you quite frequently require Bromine for is the typical hay fever in this type of child. You have got the fact, warm-blooded child, with rather hypertrophied tonsils, who gets an attack of hay fever coming on some time usually about June, it is usually rather later in the Bromine child than it is in many of the others. You get many of them starting in the middle of May; Bromine does not usually start till June. And there is one outstanding characteristic of the Bromine hay fever, and that is that they have got such an extreme hyperaesthesia of their mucous membranes that any dust, no matter what it is, will set up an acute attack during the irritant period.

I remember one small boy who had a typical Bromine hay fever, and if he went into the room in which they were dusting during the day it would set up a violent attack right away, quite apart from any exposure to irritant out of doors; and incidentally a few doses of Bromine hay fevers is that you are liable to get asthmatic attacks with it. And the asthmatic attacks that they get are fairly typical. They are liable to get very sudden spasmodic attacks with a sensation of extreme constriction of the chest, and in the attacks there is liable to be extreme difficulty in swallowing. And the other point about them is that even though their apparent hay fever doesnt entirely subside at the sea their asthma entirely goes.

Well, I think that is the commonest type of Bromine child, and, as I say, it is one that I used to miss a lot.

There is another in which I found Bromine very useful, and that is the same type of child, the fat, tonsillar child, again sensitive to heat, with a definitely sluggish tendency; but, in addition, they tend to get generalized rheumatic pains, sort of muscular rheumatism. And with that they are very liable to get cardiac affections.

It is much more likely to be a poorly acting cardiac muscle then a definite valvular lesion in Bromine, but I have seen several cases now in which there was definite cardiac hypertrophy in that type of child who have improved very much indeed on Bromine, and the constant in all these cases has again been that feeling of constriction in the chest, feeling of tightness or constriction over the heart. And the other constant has been that that feeling of constriction has been very liable to develop when they have been facing any wind at all; you can tack that on to the sensitiveness to draughts; but it has been particularly noticeable in these Bromine hearts.

“In the mentally deficient type of Thuja child have you found the type of delusions that you get in adults.

Not as a rule; I have merely noticed the music sensitiveness as the marked characteristic. There is one thing about the Thuja kids, even the mentally defectives, they are astonishingly conscientious. There is one other Thuja symptom I have often come across that I didnt mention; they are very often sensitive to motion, they are car-sick, very often. I remember one little boy who was certainly backward, and he used to come up to see me from the country, and always was sick on the way up until he got his Thuja.

I want to try to finish these hot-blooded drugs to-day, and you reminded me that I had not taken up Fluoric acid, but I think I will go on with Iodine first because it is such a useful contrast to Bromine and has so many of the same reactions, and I think Fluoric acid follows Iodine better than coming immediately after Bromine.

The majority of the IODINE children I have seen have been dark haired and rather dark skinned children, and the first thing that always strikes me about them is their intense restlessness. You get a dark haired, very thin child brought in to see you and you will find he is never still at all, moving about the room, wandering about, fidgeting, restless; it is one of the first things you notice.

Then I think the next thing about them is the thing that comes out on your questioning; you will be told that mostly these children are definitely irritable, and their irritability is pretty characteristic; they will go along perfectly happily, playing with others kids and they will suddenly, apparently for no reason, break out into violence; very often they are playing perfectly happily with a brother or sister and they suddenly pick up something and smite them. It is that sudden, impulsive irritability that is the typical Iodine mental characteristic. Then you very often find that after an attack of irritability like that the kid is horribly depressed, not weepy but just silent, depressed, rather losing interest in things.

Then the next thing that you will get from the parents mostly is that these kids almost always have inordinate appetites; they are hungry for their meals, and they are hungry between meals. They get absolutely exhausted if they go too long without a meal, and are very liable to get hungry headaches.

Then all these Iodine children are very sensitive to heat, and it is heat of any kind, hot rooms, hot sun, hot fire, hot baths, heat in any form aggravates the typical Iodine child.

Then you practically always get a history that these children are eating well and yet they cant ever be fattened, they remain thin, they may actually be losing weight.

And very often you will get in these Iodine children a rather inactive skin. They are very liable to get attacks of acute infection of their nose, with a tendency to spread into the frontal sinuses, and if they get such an attack they will get an irritant, watery discharge, a feeling of obstruction at the root of the nose; very often there is actual swelling at the root of the nose, and it is tender on pressure.

And very often with that coryza you will get a very hot discharge, a tendency to sneeze, and with the discharge you always get very watery eyes. You very commonly get a history of repeated attacks of that sort, and then following one of these attacks a development of typical asthmatic breathing; and if you get one of these thin children with a good appetite, with that sort of history, and the asthma is definitely better in the open air, you can very often clear it off with Iodine.

Then, as you would expect, with that kind of extending catarrhal infection, you very often get these Iodine children with a degree of deafness, and it is usually associated with a chronic eustachian catarrh.

Then another thing that you often come across in these Iodine kids that type, where they are getting catarrhal infections, is an involvement of their larynx, they are very often hoarse, and they have a painful larynx, which is painful on pressure. And with their laryngitis they are very apt to get acute croupy attacks which are extremely painful. And one of the distinguishing points about their croupy attacks is that they get very hot, and they have an intensely hot, dry skin.

And very often in these croupy attacks the kid is terrified. You are rather liable to mistake them for an Arsenical croup; there is the same feeling of heat, burning in the larynx, thee is the same kind of choking feeling. But your Arsenic kid is chilly; the Iodine kid is hot and wants air. The Arsenic will perspire a bit; the Iodine kid will be dry and hot.

Then another common disturbance in these Iodine kids is a digestive disturbance. They have got abnormal appetites, they are very liable to get all sorts of abdominal disturbances, and most of these abdominal disturbances are associated with very typical diarrhoeic attacks, with very frothy, fatty, whitish stools. You may get that associated with an abdominal Tabes, enlarged mesenteric glands; I have seen it associated with pretty general enlargement of the liver and spleen without any very definite blood change. You may get it associated with definite pancreatic dysfunction, with the typical pancreatic fatty stool, and you may get definite glycosuria.

Well, that is the one common disturbances that you meet with. There is another that you quite commonly meet with in the Iodine child, particularly the Iodine children with a fair amount of colour, they sometimes have quite bright red cheeks, and in these highly coloured Iodine kids you are very liable to get rheumatic symptoms. It is usually pretty acute rheumatism, pretty violent pains which are more comfortable for moving, and are very much worse from heat. The pains are usually very definite sharp, stabbing pains in character, and I have seen two Iodine rheumatisms who got a definite dry pericarditis with very acute sharp pericardial pain.

There is one thing about the pericardial cases which is apparently a contradiction to the ordinary Iodine restlessness and relief from motion in their chest pains they have an aggravation from moving, the pains are brought on, they are made more acute, by movement. And if you thing of the rather dark skinned, flushed type of patient, rather depressed, with sharp, stabbing pains which are worse from motion, you are awfully apt to confuse it with a Bryonia case.

They are both worse for heat, but you dont get the typical Bryonia tongue in the Iodine patient, and you dont get the intense thirst as a rule. And most of the Bryonia cases are rather more dull, heavy, and the Iodine patients are apt to be more mentally alert. You will practically always have a complete aversion to food in the Bryonia ones, and you very often have a surprising amount of hunger even in the acute Iodine conditions.

I think that pretty well covers the typical Iodine child, sand you see it has a certain amount of similarity to the Bromine child but you are dealing with an entirely different type of child, and yet if you just contrast the various symptoms they are very much alike, but once you spot the child the type of child you cant ever confuse them. You can very easily confuse it with Sulphur, but you dont usually get the intense irritability of skin, the intense itching, that you almost always get in a similar type of Sulphur.

There is one other thing that I have seen crop up in Iodine in these rheumatic cases, and that is that you quite frequently get a history of an acute diarrhoeic attack immediately preceding the rheumatic attack.

Then, the next drug I want to touch on is ABROTANUM, and I only want to touch on it. I think the reason why I only want to touch on it is that I dont know an awful lot about it, but there are one or two conditions in which I have found it immensely useful. I think the clinical picture that always stands out in my mind as characteristic of the Abrotanum small baby is quite characteristic. It is the picture you get with a congenital pyloric stenosis. In other words, you have got the child who is emaciated, with a deadly hydrated skin wrinkled, you can pinch it up and it does not return to its normal state.

It has an inordinate appetite, because it is vomiting all its food. It is hungry all the time: probably has a comparatively big abdomen and spindly legs, it is always cross and peevish because the poor little devil is being starved. It is usually chilly, and it is very often sensitive when handled, it is tender to touch. I think that is the typical small Abrotanum baby, and in these you not infrequently find a delay in the healing of the umbilicus after the cord has dropped off again lack of vitality, lack of nourishment probably. I have seen three of these now, who either had a pyloric stenosis or spasm, who got perfectly well on Abrotanum.

And I know another who had pyloric stenosis who lost all his symptoms for a period of our weeks after Abrotanum, then relapsed and was operated on and had a typical pyloric stenosis and completely recovered. So whether the others were really a spasm, not true stenosis, I cannot tell you, but I have seen three in whom I had given a diagnosis of pyloric stenosis and they did recover, and that is the type of small baby that I look on as typical Abrotanum.

There is another older type of Abrotanum child that I do recognize, and that again is a hungry child, a child with an inordinate appetite, and again it is a thin child, but it is always a child who has tendency to recurring attacks of diarrhoea, usually attacks of diarrhoea alternating with rheumatic pains, and always with a certain amount of numbness in the hands or feet or legs; you very often get the statement from the parents that they cant trust the child with any valuable china or it will knock it over or drop it in other words, it is verging on a chorea.

They are usually rather peevish, bad tempered kids, and you very often get a history that they have got a strangely cruel streak in their make up. Then these kids are definitely chilly; they are not like the other drugs I have mentioned, they are aggravated by cold, and they are aggravated by damp, and their rheumatic pains are liable to be very much worse at night than during the day.

Well, as I say, I do not know very much about the drug but these are two sides of it which I have seen and which are very useful. I cannot tell you any more about it but it is one of the drugs that is very difficult to spot, and it is difficult to remember, and yet it has a very definite clinical picture if you get it.

“Do you use it for T.B. glands of abdomen .?”.

I have never seen it. Iodine does, but Baryta carb. is the commonest for the cold ones; the hot blooded ones are usually Iodine. Abrotanum is recommended for hydrocele in small children, but I must say I have tried it without any success. I merely give you the things I know; you can dig the rest of the things out of the text-books for yourselves.

No. 5 .

The, the last of the hot-blooded drugs I was to take up was FLUORIC ACID. I think the majority of the Fluoric acid people, both children and adults, that I have seen have been fair haired and fair skinned. And at first sight they are not unlike the Silica children to look at. They are rather thin, under-weight, usually fairly fine, boned, fine skeleton. And they have not unlike the Silica yielding disposition.

But they have none of the Silica irritability, they are very often astonishingly patient, and unlike most of the drugs in the Materia Medica they very often have a strange enjoyment of life, they find, it very pleasant indeed, and quite simple things seem to give them an excessive amount of pleasure. That is their normal peaceful state.

Mentally they are not unlike the Silica kids in that they are very easily tired with mental concentration, they are liable to get headaches of brain fag at school, they are not exceptionally bright as far book work is concerned.

Then the other thing that crops up, and which is very surprising very often in the type of child, and that is that they are liable to get quite unreasoning hatreds of one or other individual in school. It seems to be quite pointless and without reason; a kid who has never offended them, they simply take an absolute loathing to them, and they cant bear them at any price. It is such a weird difference from the ordinary kids make-up that it strikes you whenever you get it. I have met it in adults too.

Then the next thing about them is that, unlike the Silica kids, they are better from physical exertion. Playing games does them good, it wakes them up, they are better for it. The Silica kid will be tried out by it. Then, quite like the Silica kids, they are awfully bad standers, if they are kept standing at school for any length of time they get faint, they get headachy, they get tired out.

Then again unlike the Silica kids, they usually have quite a good appetite, they very often get hungry between meals, and they are very liable to get hunger headaches, with quite a number of these Fluoric acid kids I have told their parents to give them extra food at school inn the middle of the morning because they would finish up the morning with a headache otherwise. They are very liable to wake up hungry in the middle of the night unable to sleep unless they have something to eat, and in spite of the amount of food they put away they are still fairly thin.

But I would not stress the thinness of the Fluoric acid, because I have seen quite a number who were not markedly thin, they werent under-weight, they were small and fine but not definitely under-weight, I mean for the type of child.

Then the next thing about them is that with their big appetites; they have got a desire for highly seasoned food, it doesnt matter very much what it is a long as it has got a strong taste.

They, all the Fluoric acid patients are sensitive to heat; they are worse from hot rooms, they are worse from hot sun, they are worse from too many clothes, they are worse from too many blankets at night. And if you get a Fluoric acid kid coming home from school with a bit of a head, rather a flushed face, feeling horribly hot, it can very often get rid of its headache by sticking its head into a basin of cold water, or even bathing its face with cold water.

Another thing you are constantly told about these Fluoric acid kids is that they are always liable to get a headache if they get at all constipated-unless their bowels are action freely they will get headachy and, of course, in these children you get the typical Fluoric acid headache from being unable to get out of school to pass urine; the kid kept too long in school and not getting out to pass urine will finish up with a headache-and again it is the same type of congestive headache.

Then I have seen one or two of these Fluoric acid who had the fine hair that one associated with the Silica child, but with a tendency to patchy bald areas, without any definite skin disease that I could make out. I think more commonly it was patchy areas of thinning of the hair rather than actual baldness.

Then another thing that one always associates with the Fluoric acid child is a very faulty dentition, very poor enamel of the teeth, liability for the teeth to decay early, and very often they get abscesses at the roots of the teeth; but I have never seen a Fluoric acid child with a really sound dentition.

And associated with that I always couple up the other Fluoric acid characteristic that they always tend to have unhealthy finger nails; brittle, cracked, splintered finger nails.

Then another thing that I always tack on there is that they are very liable to get red, sweaty palms to their hands, and they are very liable to get a very offensive foot sweet, which tends to make the feet hot and sore.

Then there is one other thing that I always look for in the possible Fluoric acid patient, and that is they very often have a dry, red fissured tongue.

I think the majority of these Fluoric acid kids that I have seen have been for either a digestive upset, or a definite tendency to a breakdown at school, or for definite rheumatic conditions. And there is one outstanding point about their digestive upsets; they are liable to get attacks of diarrhoea, they are liable to get upsets they are very may get jaundice; but in all their digestive upsets they are very much aggravated by any hot drinks.

The typical Fluoric acid child with a diarrhea will get a violent attack of diarrhoea after any hot drink, which is very often quite a useful tip to put you on to the Fluoric acid case. And in their acute attacks they are liable to run a fairly high temperature, with a feeling of intense heat, a complete intolerance of any bed clothes at all.

Then in their breakdown at school, I think apart from their headache from concentration, the type of congestive headache which is better from cold bathing, the other one gets pretty constantly is that they are awfully liable to make mistakes in writing, they transpose words, they transpose letters, and they seem the most senseless mistakes; very often the teachers complain that it is pure inattention, the child couldnt ,make that mistake if were paying any attention, and the poor kid cant help it.

Then as regards their rheumatic complaints. You have got the ordinary Fluoric acid temperature aggravation, and the fact that the pains are very much worse if they are keeping still and better by moving about.

Then there is one other symptom that I have quite frequently met with in the Fluoric acid child who is tried out at school, and that is a feeling of numbness in the limbs, either arms or legs, and the old thing about the Fluoric acid numbness is that it isnt a thing that comes on from pressure at all, if the child is still the arms or legs liable to become numb.

Then with their diarrhoeic attacks in Fluoric acid you have always got an irritant diarrhoea, and you are liable to get a good deal of peri-anal irritation, and you may get quite a number of painful peri-anal fissures.

So you see you have really got a hot-blooded Silica, with the amelioration from motion, and with the cheerful outlook instead of the flat, tired outlook of the Silica.

Well, I think that covers the hot-blooded drugs, and we have got two more weeks in which I will try and over the remainder of the drugs we have got, starting with Arsenic as the outstanding nervy drug among children, and then go on to the other of that group.

“The Repertory only gives Fluoric acid for diarrhoea worse from hot drink; are there any other ?”.

Yet, there are quite a number of them. Lycopodium, Argentum nit., Secale, all have pretty violent diarrhoea, and they are all worse from hot drinks.

“If a patient is worse at the seaside for the first week and then better, do you look on that as an aggravation ?” .

Yes, the fact that they have to adjust themselves is a sign of a definite aggravation.

To-day we start on our last lap.

“May I ask a question before you start ? Fluoric acid, I have the impression it is a hot Silica, and would like to ask what differentiates it from Pulsatilla ?”.

Practically always your Pulsatillas are very much heavier in build, they very much less tension about them, they are softer both mentally and physically. You never get the activity in a Pulsatilla that you will get in the Fluoric acid, they have a slower brain, they are much more yielding, much less active. The Pulsatilla patient does get tired out with exertion, and the Fluoric acid patient is rather stimulated by it. The Pulsatilla is aggravated by exposure to cold water, they get chilled; the Fluoric acid will bathe in cold water and it will bring them awake.

It is all a question of degree very much; in one you have got a more taut patient, the other gentle, yielding, depressed. Fluoric acid will suddenly get irritable, much more violently irritable than Pulsatilla, they will strike when the Pulsatilla would probably break out into wrath and then weep. It is all a question of degree, one grades into the other. It is the same with all drugs. The Fluoric acid is very much like Phosphorus, much more intense mentally, more active, more than Pulsatilla.

In this last group of drugs I have tried to include all the outstandingly nervy children, and I think the key to the whole group is ARSENICUM. I think the Arsenicum children are possibly the most attractive children that you will come across. They are always very highly strung, usually finely made, finely built, very often with a very fine skin, fine hair, delicate looking kids. They are always very nervy, they are very easily scared, very easily frightened, anything unusual will frighten them, they are afraid of being left alone in the house, afraid of going out alone, terrified of the dark, and they always have a very vivid imagination.

You get all sorts of stories of night terrors, the kid waking up in the middle of the night, terrified, jumping out of bed, wandering though the house to get somebody to talk to, and it is always the feeling of some horrible occurrence hanging over the kid, very often she does not know what it is and is just terrified. As a rule if they are comforted, consoled, they quiet down and go to sleep again, particularly if she it taken into the parents bed and has somebody about and has the feeling she got somebody there.

Then, in spite of their delicate appearance, you will find that these Arsenical kids are always restless. They are always doing something; you never see them sitting about just looking at their fingers. They are very liable to take up one thing, do it for a little, and go on to something else.

When they are nervy you find them often going from their mother to their father, from the father to the nurse, and back to the mother. Each one gives them a certain amount of comfort, but for very long; they push on to somebody else.

Then the next thing that you pretty constantly get about them is that, in spite of their restlessness, and in spite of their activity, they do get completely exhausted. And very commonly you get the story that the child is all right for a couple of hours, busy, happy, occupied, a bit on the restless side, a bit too mentally active, then it suddenly gets completely exhausted, gets pale, tired, lies down, very often depressed, and in that state is liable to get nervy, frightened, feels that it is going to be ill, wants to have somebody about.

Then, another very common story that you get is that these kids are inordinately tidy. A small girl with a number of dolls, she keeps these dolls in a most astonishingly tidy condition. Every the small boy breaks his toys and leaves them lying about on the floor, the Arsenicum kid puts them away and is distressed, not because the toy is broken but because it is in a mess. You often find them very distressed if they spill jam over themselves and get into a mess, they are distressed out of all proportion to what has happened.

Then the next thing that is very definite about them is that they are very liable to catch cold, particularly from exposure to cold, and their colds are fairly typical. They usually start as an acute coryza, with a watery, excoriating discharge, with very violent attacks of sneezing, and wit a tendency for the cold very rapidly to spread on to the chest. These Arsenicum kids, you will see them in 24 hours with the history of an acute coryza developing into a rapid bronchitis. That is only type, and with that extension you will practically always in the Arsenicum kid a history that the child has become hoarse in between the development of the coryza and the onset of the definite bronchitis.

Then you will get the other Arsenicum type who get a very mild coryza of the same type; without any hoarseness at all, without any sign of bronchitis, they suddenly develop an acute asthmatic attack. And the asthmatic attack in the Arsenicum kids is very typical, because it is usually a very tight, dry, spasmodic asthma. And it is always in these children accompanied by acute terror. It is rather terrifying for a kid to get asthma, but these Arsenicum kids are almost beside themselves with terror.

And the other thing about them is that they are liable to get their asthmatic attacks either early in the afternoon about 1 oclock to 3 oclock, sometimes after lunch at least, or else early in the morning, again any time after midnight. And the other typical asthmatic characteristic is that as the attack subsides the dryness seems to disappear and their chests get flooded with mucus and they bring up quantities of white, frothy sputum. Quite frequently I have heard the parents say that they know the attack is subsiding because the dry whistle is disappearing and the chest is getting moister.

“If you give Arsenic in that stage will it have any effect ? I mean in the moist stage ?”.

Yes, you can it then and it will clear up the whole thing.

Then the other thing about the Arsenicum kids is that they are very sensitive to cold, and exposure to cold is almost certain to upset them; it either gives them an acute respiratory attack, or give them an acute digestive attack. And the Arsenicum kids do get digestive upsets very easily; they get them from exposure to cold, and they are equally liable to get them from over indulgence in any watery fruits, melons in summer, strawberries, any of the juicy fruits are liable to give the Arsenicum kid an acute gastritis.

And if they get a gastritis they are very liable to get diarrhoea with it. And there is one thing you have always got to remember about the Arsenicum children-they are extremely chilly, in most of their chest conditions, in most of their general conditions you get a thirsty condition with a desire for cold drinks, butt where you are dealing with a gastritis or gastroenteritis you find the gastritis is aggravated by cold drinks; you may get it brought on by taking ice creams, and these ice cream Sundaes that they sell now-a-days are particularly dangerous for Arsenicum kids, that is to say the mixture of fruit and ice cream.

During their acute gastritis the pain-they usually have pretty acute pain-is eased by warmth, either warm fluids or external heat applied to the abdomen. One tends to get the impression of the Arsenicum incessant thirst for cold water, you get the child who likes warm drinks and they make it easier and you are rather apt to be thrown off Arsenicum, but dont be.

The other things about acute abdomen attacks is that you have rather a delicate child to deal with, and they can go down hill awfully rapidly; an Arsenicum child with an acute diarrhoea will get into a state of collapse in a few hours. And in their collapse they are restless, they are worried, they are anxious, and they are liable to have constant small stools-just little spurts of diarrhoea and a marked aggravation of the exhaustion after each stool; very often the child looking absolutely gray and cold and sweaty.

I have see them brought in here in summer after over indulgence in strawberries or something of that sort, the child having been perfectly well they day before and brought in here the next morning absolutely collapsed, simply been purging all night practically. And it perfectly astonishing how quickly they recover if they are Arsenicum children and you give them Arsenicum. I have seen a child brought in here to the childrens ward with an acute gastritis of that type, who looked practically moribund, the only sign of the restlessness that you could see was the child constantly moving its head backward and forward-about all it was fit to do.

I have seen the child in a couple of hours perfectly well, colour come back, diarrhoea stopped, and the sing of acute collapse, which you would say was a sing of acute dehydration, simply gone. I should have said child was absolutely drained of fluid, it had the typical skin of the dehydrated child, and yet without replacing all that fluid the child was absolutely well in a couple of hours.

How would you of hours.

Give every 15 minutes in an acute case like that. I always give cms when they are like that, with violent onset, and it simply wipes them out right away. I want to get as potent a thing as I can to stop it. And I may say I have seen cases of that kind treated with Arsenicum low and we have lost them. They didnt seem to have enough vitality to respond to the lower potency, and yet they did to the high. I have never seen satisfactory results under a 10m in these violent cases.

Then there is another thing you have got to remember about the Arsenicum kids, and that is that you have got a general hyperaesthesia in the Arsenicum. They are over sensitive to everything; they are over sensitive to smell, to touch, to noise, to excitement; smells will make them sick, noise will make them all jumpy and nervy, excitement will give them a nightmare that night, they are the highly strung type of children that you want to keep quite.

If they are pushed at school you head for trouble, they are very liable to get a chorea if over-stressed at school; and if they are not very gently, quietly handled you are almost certain in the Arsenicum child to get the development of periodical headaches, headaches recurring once in 7 days, once in 14 days, most violent sick headaches lasting anything up to 24, 48 hour, or they may last two or there days even and the child is completely prostrated.

And it is always an intense congestive headaches, with intolerance of noise, light, disturbance of any kind. And there again you have got one of the Arsenicum contradictions; in these congestive headaches they want their heads as cool as possible. The child may be feeling rotten, its body may be could and sweaty and damp, the child feeling horribly sick, it is restless, frightened, wants to be fairly well covered, and yet it wants its head cold, cold cloths, Eau de Cologne applications, something of that sort to keep it cool.

Well, there is one other point I ought to have mentioned, and that is in connection with their diarrhoeas. Practically always in the Arsenicum diarrhoea you will get an offensive stool.

Well, I think that sketches the typical nervy child.

“What is their colour ?”.

They are usually a variable colour, they tend to be rather pale but they flush on excitement.

“Are they sallow ?”.

No, they are not sallow. It is rather a fine skin, and when flushed like that they very often get hot heads and cold hands and feet on excitement or over-exertion.

“It it useful in skin conditions ?”.

It is less valuable than I would have expected. I think it is very valuable in some of the more chronic skin condition rather than in the acute dermatitis. I f you picture the secondary syphilitic eruption, that is the kind of condition in which you find Arsenicum indicated. But I have not seen it of much use in the acute dermatitis. That may be a purely personal experience;but I find it far more useful in the more chronic, rather than the acute skins.

And I must say, watching some of the skin cases here who have had Arsenicum in various salts I dont think the results have been good in the skin department-certainly not in the acute conditions. Where you have alternation of asthma and skins there you will have very definite Arsenicum indication- there you have a chronic thing. And where you have asthma and diarrhoea alternating, there I have seen it useful. And I have seen a case if recurring headaches, and asthma developed which cleared on Arsenicum. Arsenicum does very definitely have these alternations, but that you are more liable to meet with in the adult than in the child.

Well, if you take that as a starting point for the highly strung, nervous child, you can practically repeat the symptoms out of the Materia Medica and label them all CHAMOMILLA. I mean as I read through the symptoms of Chamomilla you wouldnt know whether it was Arsenicum or Chamomilla; and yet they are entirely different drugs, and entirely different children. If you saw my notes here, I have almost exactly the same notes under Arsenicum as Chamomilla. The first thing I have is hyperaesthesia, oversensitiveness to noise, pain, peoples; you have exactly the same hyperaesthesia in Chamomilla.

I have the note of restlessness under Arsenicum, moving from one person to another, never still. You have exactly the same in Chamomilla, it goes from one person to another, never still, never at peace. And yet you have only got to see the two children and they are as different as night from day. In Chamomilla you have got the most incredible hyperaesthesia, the Chamomilla pains are more intense probably than any other pains that patients suffer from; but the reaction is entirely different.

In Chamomilla you get an absolute frenzy of rage; they resent it; they resent having it; and they are perfectly furious that you havent cleared it off at once. You are doing your best for a Chamomilla child and it is liable t strike you because it is hyperaesthetic.

The intense restlessness of the Chamomilla child, going from one person to another; each time it is dissatisfied with the person it goes to, and as it leaves them it is quite liable to strike at them. It is quite different from the Arsenicum soothing that the child gets from each one. The Chamomilla child who is over sensitive to noise, you dont get the nightmare the following night, you get the child wrought up into a perfect frenzy, liable to scream and stamp when disturbed. You see their reaction is quite different. .

Then, in the Arsenicum case you have got the child who is restless, always moving about. In the Chamomilla you have a child who is better from motion, but particularly better for being carried about-it is passive motion. You start to jog an Arsenicum child about and you will probably terrify it. You start jogging a Chamomilla child about and it will probably stop its yelling and being to crow. You stop and it wants you to go on; and if you dont do it it will pull your hair. You see, the symptoms stuck down on paper are almost the same.

Then the Chamomilla kid is never still, it is never satisfied with anything it is doing. But it isnt a question of passing from one occupation to another; it is a question of getting tired of one thing and throwing it away. It never puts away its toy in a cupboard, it just chucks it down. It picks up something else, and if you tell it to put the first toy in the cupboard it is liable to yell.

The other thing about the Chamomilla kids which is pretty constant is that they very definitely tend to get more excitable as the day goes on, more irritable, more difficult to manage; and they are liable to be particularly troublesome about 9 oclock in the evening. Very often you get a story that the Chamomilla child is perfectly impossible after it is put to bed till about midnight, then it appears to wear it self out and falls off to sleep.

Then, of course, all these kids who get into a fury tend to get flushed; they get red faced,k they get hot heads; but the Chamomilla particularly tends to get flushed on one side of the face, it is flushed generally but one side will be redder than the other.

Then, you know that Chamomilla is practically universal for the teething child: but I think it is a mistake to give Chamomilla to any teething child, the indications for it are so awfully definite. And where you have a teething child who needs Chamomilla the child tends to get much more fractions at night, it tends to have very swollen, inflamed, tender gums, and they tends to be one-sided with a marked flush on that side of the face.

The tender gums are made much worse by any application of heat; they are very much better from cold applications. They are liable to be very much worse in a hot room, and as I say the attack is liable to subside about midnight. It is worth while remembering that the toothache pains of Chamomilla have entirely different modalities from the other pains.

Chamomilla kids are awfully liable to get attacks of acute colic. I thank mostly they get attacks of acute colic because they are give to by their parents; they see something that they want and scream until they get it, and that evening they come down with acute abdomen colic-mostly the fault of the parents. And with these attacks of colic you always get a lost of wind in the Chamomilla children, and these attacks of colic are very much relieved by hot applications. And with their attacks of colic they are very liable to get bouts of diarrhoea, with the typical green Chamomilla diarrhoea stool.

If you ever come across a Chamomilla child with a colic and diarrhoea you get the best illustration of Chamomilla irritability; they fairly yell the place down. Of course it does hurt, it is pretty colic, but there is not doubt about the childs being in pain, in fact the neighbors will probably know as much it as you do.

Then there is another contrast with the Arsenicum children, and that is the Chamomilla children are usually hot-blooded, very liable to have very hot heads, very often hot and sweaty, and they are very liable to have burning hot feet and stick out of bred at night.

There is one difficulty in dealing with the Chamomilla children. They are ungoverned children, and they have mostly been allowed to get out of hand; but the Chamomilla child in a tantrum of temper can go on to such a state that it gets blue in the face and starts convulsions from pure rage. So do be a little careful about the handling of the true Chamomilla child.

I remember seeing one, she was about there years of age, and was a typical Chamomilla child. In a rage she was liable to beat her head against the wall, merely because it distressed her mother. And I saw that child one night about 10 oclock and she had been just perfectly impossible for the last hour, and her mother had left her to scream, and she had gone into a convulsion. When I saw her she was practically unconscious, dusky in the face, and twitching all over. So do be a little careful about the Chamomilla stage.

And I have seen quite a number of Chamomilla babies who were teething, with acutely inflamed gums, who did develop convulsions. So evidently you have got an explosive nervous system in the Chamomilla child, and you have to be a little chary about letting it go too far.

“What potency do you give to a teething child ?”.

Teething children do quite well on low potency. A few doses usually stops all the disturbance, 12 or 30, two hourly, in the average case. But where you have a violent attack, give possibly every half-hour until they quiet down.

There is one other condition for which you commonly need Chamomilla, and that is the acute otitis in children. It is a frightfully painful condition, and in most of these acute otitis cases the child doesnt want to be touched, and it is intensely irritable, very often yells with the pain; and if you get a history that has been brought on from exposure to cold, I think Chamomilla is one of your greatest standbys in the small child, particularly if you have got the one-sided flush with it. I should think when I was in general practice I cleared more acute otitis in small children with Chamomilla than with any other single drug.

And you can clear it up quite well without any puncture of the drum or anything of that sort; the whole thing simply subsides. But you have got to have the Chamomilla make-up as well as the otitis, otherwise Chamomilla does not work. In other works, their nervous system has to be all the fret, and they have got o be irritable and touchy, otherwise Chamomilla does not do it. In other words, you get the Pulsatilla from the same cause, exposure to cold, again with otitis media, and one- sided flush; but it is a Pulsatilla child, not a Chamomilla one, and Chamomilla wont do it any good. I think they are the two commonest drugs-at least they were in the practice I was doing.

Again in CINA you can practically duplicate the symptoms on the notes, and yet it is and entirely different patient one is dealing with.

No. 6.

WELL, we have got to try and finish this to-day, because we dont meet again, and I think thee are still four of these drugs to get through so I will try and cut them as short as possible. I will try and give you the salient features of them without any unnecessary padding.

I think last day we finished up with Chamomilla, and the next one is CINA which is a very interesting comparison with Chamomilla because I think you will agree that most people start with a dose of Chamomilla and if it doesnt work they give a dose of Cina, and it isnt a very scientific way of proceeding, and I think it is better to have a clear idea of what Cina is like and where the difficulties arise.

I think the outstanding mental distinction between the Chamomilla child and the Cina child is that in Cina you have got a degree of obstinacy that you never meet with in the Chamomilla. The Chamomilla kid is always unstable; the Cina child can be as obstinate as a mule. I think that is the main mental distinction.

Then there are various other points which are a help. I think the first one is that in Chamomilla you are likely to get an irregular flushing-flushing of one cheek and pallor of the other. You may get the whole face red, but you are more likely to get the irregular distribution. In the Cina child you much more commonly get a circumscribed red patch on the cheeks, and very often a noticeable pallor about the mouth, the mouth and nose.

Then I think the next thing about them is-I mean the next distinguishing thing about them-is that both dislike to be handled, they both resent interference, but in the Chamomilla it is much more mental resentment, whereas the Cina child is definitely tender to touch.

You will very often find that you get the same description of the two, that they will yell when you handle them, but you find that once you get over the preliminary discomfort of handling in the Cina children they are quite peaceful, they allow you to carry them about, it will quiet them down; whereas in the Chamomilla they are wanting distraction all the time, if you stop walking about with them they are likely to strike at you, they are always wanting to be doing something new. You do not get that reaction in the Cina. But the Cina kid will want you to go on carrying it; in other words, the steady, passive motion does soothe them down.

Then there is another distinguishing point in Cina which you do not get in Chamomilla; the Cina children are very apt to be sick, and so are the Chamomilla ones, but you will commonly find that in the Cina children, after they have vomited, and almost immediately after, they are hungry. And you will very often find the Cina children are crying out for more food immediately after a meal. And in the Cina child you are very likely to get a story of nightmares, night terrors, if the child has had a late meal.

Then, another thing that will help you when you are distinguishing between Chamomilla and Cina is in their diarrhoeic upsets. They both get diarrhoea. The typical Chamomilla green stool is noticeably absent in Cina. The typical Cina stool is a white stool-a very white, watery stool.

And there is one constant characteristic about the Cina child, both in its digestive upsets and ordinarily too, and that is that it gets relief from pressure on the abdomen; if it has got a colic it will turn over on to its tummy. If it is being carried about while it has a colic it will turn over the nurses arm so as to get pressure on its tummy; if it is restless at night, again it turns over on to the abdomen and is at peace.

Then as far as their temperature reactions. The Cina kids are always chilly; they are sensitive to any draughts of air, and they are very liable to get irregular muscular twitchings, particularly after any excitement, and very often you will notice it particularly in the muscles of the face.

Then in the slightly older children there is another mental characteristic of the Cina child, and that is that they are frightfully touchy, they have got a complete inability to see a joke of any kind, particularly if it refers to themselves.

Then there is another thing that is worth remembering about the Cina children, and that is that they all have a hyperaesthesia of the head, the head is sensitive to jarring, and they have a hyperaesthesia of the scalp. So that if you are ever wanting to soothe down a Cina child dont go and stroke its hair, otherwise you will know that you have got a Cina kid.

Then there is one other point about them which I have noticed quite frequently, and that is that they have a most inordinate habit of yawning; they yawn, and yawn, and yawn, as if they would dislocate their jaws. And I have seen several of these Cina children now who have been brought to me with a definite history of acidosis, which I always tend to link up with their yawning tendency.

Then there are two other points which always make me think of the possibility of a childs being Cina. One is that with their intestinal upsets they become very restless, very liable to get meningeal irritation, with constant agitation of their head, rubbing it into the pillow, and without definite meningitis they tend to develop a squint-an internal squint.

And the other point which always makes me think of the possibility of Cina is that all these Cina kids appear to develop an irritation of the nose, it is red, itchy, and they pick at it-and that is quite apart from getting thread worms or anything of the kind. If I get a yawning child coming in and picking its nose I always explore the possibility of its being a Cina, and very often it is. So you see there are pretty definite distinguishing points between Cina and Chamomilla, and you shouldnt have to try one and then the other.

Then the real reason why I put MAG. CARB. in after Cina was in connection with the diarrhoeic attacks. Mag. carb. and Cina are the two most commonly indicated drugs for diarrhoeic attacks accompanied by these peculiarly white stools. And apart from the Mag. carb. is an interesting drug in kids.

The ordinary Mag. carb. child is a sensitive, nervous type of child, and as a rule one comes across them either as very young children or round about ten years of age. And I think the most outstanding feature of the Mag. carb. children is their lack of stamina. They have got-some of them are quite well nourished-but they have got very poor muscular power. You know you handle an ordinary healthy child, the muscles are quite firm; whereas the Mag. carb. child has got soft, flabby muscles, and any physical exertion tires them out.

You will get exactly the same sort of mental reaction. The older child at school gets mentally tired out; it will come home with a violent neuralgic headache. And the neuralgic headaches of the Mag. carb. school child are pretty definite; they are pretty violent pains, maybe any part of the head, and they tend to come on at night. They are accompanied by very marked sleeplessness, the child cant get to sleep at all, and strangely enough they are better if the child is up and going about.

Then the next thing about the Mag. carb. children is that they always have very definite likes and dislikes in the food line. All these Mag. carb. children have a very marked craving for meat, and anything with a meaty taste. And I have never met one yet who didnt have an absolute aversion to vegetables of any kind. Then, in the small child you are liable in the Mag. carb. kids to get an intolerance to milk; they get sour vomiting, and they get pasty, pale, undigested stools, which are usually white and soft and putty-like.

Then, if the digestive disturbance goes further, you will get a watery stool, which is usually rather excoriating. And that is the type of child who is very liable in an acute enteritis to develop a bronchitis attack as well. I have seen a lot of them in the wards here, and I think the majority of them developed some bronchitis with their diarrhoea, several of them a definite broncho-pneumonia.

Then another characteristic of the Mag. carb. kids is that they tend to have a very dry skin. In the small child it is particularly noticeable; they get a dry, almost scaley, skin, and they are very liable to get a peculiar dry, almost coppery coloured, scaley eruption of the scalp. I remember, going round the wards, that whenever I used to see that coppery, scaley eruption I always thought of the possibility of a Mag. carb. baby. It almost looks as if it had been painted on to the scalp; it sticks rather.

Then another constant feature about the adolescent Mag. carb. kids is that they are always dead beat in the morning, even though they have had a fairly decent nights sleep; it is an awful job to get them off to school.

And there is one other point that is sometimes useful in the Mag. carb. kids, and that is that they are awfully easily startled by any unexpected touch.

Then there is one other point about them, and that is that with this very inert sort of skin, after taking any hot food or drink they are liable to flush up and sweat about the head and face.

These kids are all sensitive to cold, yet they are rather better in open air, and are usually aggravated by changes in the weather.

By the way, in their bronchial attacks the Mag. carb. children tend to get a very stringy, difficult sputum, which is very difficult to spit out; it isnt unlike a Kali bic. sputum in appearance, but they have great difficulty in expectorating it at all.

Then the next of our Nervy drugs is IGNATIA. I think it is unfortunate that Ignatia has been distorted as it has been in the homoeopathic textbooks, because it has come to be looked on as the hysterical female. Well, I think using it like that you are missing a great deal of the value that you can get from Ignatia in other cases which are not hysterical females at all.

If you have a child with a highly developed nervous system, a highly strung, sensitive, bright, precocious child, who is doing very well at school and who is being pushed-be it a boy or a girl- and their nervous system is getting over taxed, you are very liable to get Ignatia indications.

The first indication you will get is the child will begin to develop headaches, and it is a sort of nervous, tired head, coming on at the end of the day, coming on after a period of stress.

The next thing is that they begin to become slightly shaky-their writing is not so good as it was, their finer movements begin to suffer.

And the next thing you will spot about them is a rather strained expression. And that strained expression is one of the key notes that lead me to Ignatia in the non-hysterical type more than anything else. It may be anything from a mere tension of to muscles to definite grimaces when the child is speaking, and it may go on from that to anything-facial chorea, generalized chorea, difficulty in speaking, difficulty in articulation.

Then the next thing that you will get is the story from the parents that the child is becoming unduly excitable-it is either up in the air, or down in the dumps. And another thing is that the poor youngster has become incredibly hyperaesthetic to noise; if the kid is attempting to do home work after school any noise nearly drives it crazy; it is liable to blow up into a rage and then relapse into tears. And then after any stress of that kind you will find the child quite incapable of working, its brain simply will not function, cant take it in, cant remember, and cant think.

In these school children coming home with their headaches you get very definite indications for Ignatia in the peculiar modality of their headaches. They come home with a congestive headache, and the odd thing about it is that it is relieved by hot applications.

Then if their nerves begin to get frayed these kids get scared. They have probably been up against the stress of examinations, they lose their nerve altogether, and they are in constant dread of something unpleasant going to happen, and they may get to the stage where they are scared of doing anything on their own initiative- they may be even scared of going out alone.

Then, as you would expect with a child in that state, you get all sorts of digestive upsets, and you get the typical Ignatia hysterical stomach developing, that is to say the child who is upset by the simplest food and can digest the most indigestible stuff. I am sure time and again you have had the story in out-patients; the mother says the child cant digest the simplest, plainest food, and is quite and right on the toughest old cheese. And the queer thing about it is that it is true.

You get exactly the same kind of disturbances when the Ignatia child gets a bad throat, an acute inflamed throat, and the only relief the child gets is from taking something solid, something to press on it, and the pressure relieves it for the time being.

Then with that over stressed child, of course they get all sorts of disturbances. If they are in any confined place, particularly if there are a lot of people about, they get nervous, distressed, choked, and they are quite liable to faint. But it all keys in with the general picture of nervous stress.

Then, as you would expect in a child of that type, who has been very bright, clever, successful, who is now rather going to bits, they are awfully apt to blame themselves for it; it is very often a child of poorer parents, who is doing quite well on scholar- ships, and now cant do as well as it used to; it often starts to reproach itself, thinks that the failure is due to lack of effort on its own part, gets thoroughly depressed, almost melancholic.

Then there is one other thing that you sometimes come across in the Ignatia children, which you can link up with the choreic tendency, and that is that they are very liable to get troublesome, irritating, spasmodic coughs. These coughs always come on at inconvenient times, and once they start coughing they go on, and on, and on. That is the one type of Ignatia cough in that stressed child. The other type that they get is a very definite, acute laryngitis, with a liability to a laryngeal spasm.

Then, as you would expect with their choreic history, you are very liable to get rheumatic pains in these children,you may even get an a cute rheumatism; and most of the rheumatic pains are better having definite firm pressure.

The last of these drugs is ZINC. and you tack it on to Ignatia because of the choreic tendency.

The typical Zinc. child is very nervous, sensitive, excitable kind of kid. But it is quite easy to distinguish them from the Ignatia children. The Ignatia child to begin with is a very bright, quick reacting child ! whereas the typical Zinc. child has a slow reaction time. When you get the Ignatia children tired out they may not be able to take things in, they have difficulty in learning, difficulty in remembering, but the Zinc. children are slow of grasping what you are saying, slow in answering, and they are much more docile, less unstable than the Ignatia children.

As a rule you will meet the Zinc. child about the same age, possibly a shade older, and you will very often get a history of delayed development, a delayed puberty very often gives you indications for the Zinc. child.

The impression you get of the child is that it is tired, tired mentally and tired physically-just generally weary. And in spite of that, they are restless, twitchy, fidgety. And one of the almost constant things that I have come across in the Zinc. children is that when they are tired they get a very persistent, aching pain in the lower cervical region, very often with burning pains going right down the back. And another thing that you often meet with in these Zinc. kids, particularly the very fidgety ones, is that they are liable to get cramp in bed at night, and it is much more likely to be in the ham string muscles than in their feet.

Then another thing about them is that they are very sensitive to cold; they are always chilly, and they are very liable to get inflamed eyes from exposure to cold. I have seen several of these Zinc. children with definite thickening of the margins of the lids, a chronic blepharitis, and a chronic conjunctivitis; and with their inflamed eyes they develop the most intense photophobia.

Then another thing about them is that they are intensely sensitive to noise, they are as sensitive as the Ignatia kids, but one thing that worries them out of all proportion is talking, and I have quite frequently had the statement from the parents of a Zinc. child that if the child is attempting to do any work and there is anyone talking in the room it is very much worse than the noise of other children playing, people talking drives them nearly distracted,. Incidentally it is worth remembering for adult people too who are completely exhausted by people talking to them; it is very often a definite lead for Zinc.

Then another well-marked indication for Zinc. is where you have a history of a well-marked, generalized skin eruption in childhood, early childhood, and a chorea developing about adolescence, always think of the possibility of it being a Zinc.

Then there are just two points that I want to mention. One is that many of these Zinc. children develop an acute hunger about eleven oclock in the morning. The other point is that you will very often get a statement from the parents that these children simply bolt their food-either food or drink.

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