CHILDREN'S TYPES

By Douglas M. Borland

A common constitutional type in children is CALCAREA, usually CALCAREA CARBONICA but sometimes CALCAREA PHOSPHORICA or CALCAREA SILICATA are more suitable to the individual case. This leads to a consideration of PHOSPHORUS and SILICEA; it is useful to know the outstanding characteristics of these remedies and those that follow on. In association with the SILICEA types consider also SANICULA and AETHUSA. A little away from the strict CALCAREA type is the possibility of LYCOPODIUM, and following from that a further possibility of CAUSTICUM. Quite apart from the above it is always wise to consider giving a dose of TUBERCULINUM when treating children of the first group.

In the second group BARYTA CARBONICA – the next drug to consider is BORAX – the same type of child with similar indications. This leads onto NATRUM MURIATICUM, which in turn raises the possibility of SEPIA. This leads on to drugs of "depression", and one of the gold salts must then be considered, either AURUM METALLICUM or AURUM MURIATICUM. When dealing with a sluggish mentality or sluggish make-up there is always the possibility that CARBO VEGETABILIS may be called for.

The third group – GRAPHITES – leads to the consideration of CAPSICUM, and if dealing with any skin condition the possibility that PSORINUM may be called for must be considered. Also when dealing with children, where there are definite skin indications ANTIMONIUM CRUDUM should be thought of and, although it is not really like the GRAPHITES picture, PETROLEUM should always be remembered as a possibility.

In the fourth group – PULSATILLA – there are also a number of possible drugs. After PULSATILLA the first possibility is KALI SULPHURICUM, and as in every sulphur compound it is necessary to consider whether the case could be a SULPHUR type. When the mentality is very similar to that of PULSATILLA, one has to consider THUJA, and as soon as the PULSATILLA – THUJA group is considered, it leads on to SILICEA. In turn SILICEA always suggests the possibility of FLUORICUM ACIDUM. If dealing with hot-blooded patients, think of BROMIUM and IODIUM. From IODIUM with its emaciation and hunger pass to consideration as to whether ABROTANUM may be called for.

In the fifth and last group – the "nervy" drugs – ARSENICUM ALBUM heads the list with all its terrors. Terrors also suggest STRAMONIUM. Then comes the hypersensitive nervous system type and CHAMOMILLA comes to mind, and then CINA, which is a little more violent. The strange digestive disturbances of CINA lead to consideration of MAGNESIA CARBONICA. Reverting to the strictly nervy type, one considers the possibility of IGNATIA, and with this nervous restless, fidgety type there is always the possibility that ZINCUM may be called for.

The foregoing is a brief survey of the various groups and these are now considered in greater detail.

GROUP I

GROUP II

GROUP III

GROUP IV

GROUP V

GROUP I

Calcarea carbonica

Calcarea phos

Phosphorus

Silicea

Sanicula

Aethusa

Lycopodium

Causticum

Calcarea carbonica

These children are typically soft, over-fat, fair, chilly, and lethargic. They often surprisingly fit but, nevertheless, do not possess much energy either mental or physical. In early life they are often very over-weight, and although they appear very healthy when examined one finds soft fat rather than muscle.

There is a tendency to rickets, with enlarged epiphyses, big head, slow closer of fontanelles, and tendency to sweat. The children are chilly, yet they get very hot on the slightest exertion. They sweat at night and very often will stick the feet outside the bed covers. This characteristic incidentally is not found only in relation to SULPHUR.

There are slightly older children of much the same type. They appear fairly healthy look well nourished but are sluggish both mentally and physically. They are slow at school slow at games, liable to sprain their ankles, have weak muscles, sweat on exertion, and constantly take fresh "colds".

They are liable to have enlarged tonsils, enlarged cervical glands, and rather big bellies. They lack stamina, are easily scared, and lack initiative. They are perfectly content to sit about and do little or nothing. Very often they are peculiarly sensitive and can't bear to be laughed at.

They are clumsy in their movements and bad at games; this tends to push them back into themselves, so that instead of sticking at it and becoming efficient they throw in their hands and give up the game altogether as they hate being scoffed at or laughed at.

They are just the same about work, very often having difficulty with one or other subject at school. They will not strive at this subject but just give in, and if they are not sure of themselves nothing will ever induce them to answer questions in class in case they are wrong and will be laughed at.

In early childhood these CALCAREA CARBONICA children nearly always tend to have diarrhoea, and usually the stools are pale, apparently lacking bile pigment. There are two or three outstanding odd characteristics, which clinch the CALCAREA CARB diagnosis. The one that is easiest to tack on to the sluggish mentality and sluggish physical make-up is that these children are much more comfortable when they are constipated and their bowels are inert. If given an aperient it upsets them; if they have an attack of diarrhoea they are ill, but when their bowels are relatively sluggish they are comfortable.

The next thing that can be added to the sluggish make-up is an aggravation from any physical or mental exertion, or from any kind of rapid movement; these children suffer from car-sickness and train-sickness.

Another characteristic is a very definite dislike of too hot food. They are quite fond of ice-cream; have an aversion from meat and, occasionally there is a definite craving for eggs – in any form. There is one other indication for CALCAREA CARB. When the children are below par they become nervous and scared. They are perfectly happy so long as there is somebody about, and they sit peacefully or play; but when it gets dark they are scared to go to bed without a light in the room.

They develop acute nightmares and wake up in the night screaming. A very common type of the CALCAREA CARB child's nightmare is seeing horrible faces in the dark.

Calcarea phos

If instead of presenting this typical picture the child is beginning to lose some fat, does not flush up so easily, shows hypertrophy of adenoid tissue rather than enlargement of tonsils and cervical glands, has a more adenoid facies; in addition if the child is becoming a little reserved, a little brighter at school, but with a tendency to headache if overworked and a dislike of being interfered with, then the probability is that the child has passed from CALCAREA CARB to CALCAREA PHOSPHORICA.

Further if the child is tending to become rather spotty, becoming thinner and beginning to suffer from growing pains, these are additional indications pointing to CALCAREA PHOS.

An important point in this connection is that in the CALCAREA PHOS child the growing pains are definitely muscular. In a similar type of child, also with growing pains but not so touchy as the CALCAREA PHOS child and locating the pains in bones especially in the shin bones, the indication is for MANGANESIUM METALLICUM.

Thus it is apparent that minor differences may suggest fresh possibilities quite outside the CALCAREA group of drugs.

Phosphorus

The child is thinning down tending to be definitely slight even a little delicate; is much brighter mentally, more nervy more excitable. In addition to being afraid in the dark is now sensitive to atmospheric disturbances, afraid of thunder; is anxious, sensitive developing a definite dislike of being alone, less shy and more capable of expressing himself.

He may flush up on any excitement or after taking hot food, is losing his desire for eggs and is increasingly fond of meat and food with a definite taste, preferably a salty taste; he is still liable to night terrors. This presents the picture of PHOSPHORUS.

He still gets colds, but these do not affect the throat, they go further down with a likelihood of bronchitis supervening. He is very sensitive to sudden changes in temperature. This is an example of the way drugs grade into one another.

Silicea

Then there is another type of child who has fined down slightly; he is still chilly very much thinner, has not grown nearly as much as the PHOSPHORUS child, is very much paler, and has a fine-textured skin. He has not the coarse curly hair normally associated with the CALCAREA type but rather finer hair, without the reddish glint of the PHOSPHORUS; it is becoming rather sandy. This child is becoming much more touchy, more difficult, he resents interference and is more inclined to retire into his shell. He is fairly bright mentally, very easily tired out physically; liable to sweat, particularly about the extremities or about the head and neck. Often he has developed a dislike of, or intolerance to milk and the cervical glands may be enlarged. This is the picture of the typical SILICEA child.

Sanicula

But never think of SILICEA without considering the possibility of SANICULA, for the indications of these two remedies are almost identical. The SANICULA child is perhaps more irritable, and definitely more unstable mentally. Attacks of laughter and tears follow each other much more readily in the SANICULA child and he has much less staying power than the SILICEA type.

The SANICULA child never sticks long at anything; he is more obstinate and more difficult to control. There is likely to be a row if you interfere with the typical SANICULA child. But it is very difficult to distinguish between the SILICEA child and the SANICULA child, the physical symptoms are almost identical, and in most cases of this type, I have given SILICEA in the first instance and only on failing to get a full response have I gone on to SANICULA.

Aethusa

One considers AETHUSA here because of the notorious susceptibility to milk of the AETHUSA type. Wherever there is a severe aggravation from milk in acute attacks, always consider the possibility that AETHUSA will control these attacks. It is the first drug to think of. Also, whenever there is a milk aggravation consider the possibility of one of the milk remedies being indicated to control an acute condition, either LAC DEFLORATUM or LAC CANINUM.

Lycopodium

Reverting to the PHOSPHORUS type of child – that is the CALCAREA type that has thinned down into a PHOSPHORUS type. This in turn leads to the LYCOPODIUM type.

The child has grown a little, lost weight become thin but instead of having the fine skin and the unstable circulation of the PHOSPHORUS child, it has become rather sallow. The tendency to sweat easily is disappearing and the skin is getting rather thicker.

These children appear to be independent but it is not quite the shyness of SILICEA. They seem to lack assurance but give the impression that basically they have a fairly good opinion of themselves.

They are liable to digestive upsets, and although they have good appetites and often eat more than the average, they are not putting on weight. The abdomen may be rather enlarged but there are no enlarged palpable mesenteric glands. Instead of the PHOSPHORUS desire for meaty and tasty things, these children are developing a definite desire for sweet things.

Instead of the CALCAREA desire for ice-cream, they prefer hot food. Very like the CALCAREA types they get headaches from overwork at school and it is a dull type of headache. They are still chilly but much more sensitive to stuffiness than any of the types we have yet considered. This is the picture of the LYCOPODIUM type developing.

Causticum

Another drug, which is not nearly sufficiently used in the treatment of children and which is a counterpart of LYCOPODIUM, is CAUSTICUM. These children are not unlike the LYCOPODIUM types but are a little more sallow.

The CAUSTICUM type of child is definitely more sensitive than LYCOPODIUM types. They are not sensitive to pain but are particularly sensitive to any emotional disturbance. Often these children will cry because they think you are hurting another child. It is idea of pain, which affects them rather than the actual pain to themselves, and they often stand pain quite well, but cannot bear to see another child crying.

They have much the same sort of clumsiness as the CALCAREA children; are rather unhandy, and are liable to strain muscles, whereas the CALCAREA children sprain ankles. They are inclined to suffer from rheumatism and liable to get acute muscular rheumatism, particularly from exposure. These CAUSTICUM children often suffer from acute torticollis or an acute facial palsy after exposure to an icy wind.

Associated with this tendency to torticollis and facial palsy, the CAUSTICUM children get very definite growing pains, which are usually accompanied by stiffness in or about the joints – a feeling as if their joints were tight. And linking up with the rheumatic tendency, the CAUSTICUM child when overworked or nervously distressed, is very likely to develop choreic symptoms, and the outstanding feature of the CAUSTICUM chorea is that jerking persists during sleep.

The main distinguishing feature between the CAUSTICUM children and the LYCOPODIUM type is that CAUSTICUM children have a definite aversion for sweets whereas the LYCOPODIUM children desire them.

Two other points would confirm the CAUSTICUM diagnosis. The first is that the rheumatic troubles of the CAUSTICUM child are very much better in damp weather; and the second is that a CAUSTICUM child with any digestive upset tends to develop acute thirst after meals.

Two additional points, which are sometimes useful – CAUSTICUM children often develop endless warts; they also have a very marked tendency to nocturnal enuresis.

Family History of Tuberculosis

Wherever there is definite family history of tuberculosis no matter which drug is indicated, the child will at some time be helped by a dose of TUBERCULINUM and my practice is to give one dose about once in twelve months. An article in an American journal recommended giving two doses of 1 M, two of 10 M, two of 50 M, and two of CM, on four successive days. It was maintained that this gave better results and can produce a practical immunity to tuberculosis in a child of tuberculous parents.

There is another point in which the treatment of children appears to differ from that of ordinary practice and it applies particularly to the treatment of the CALCAREA CARBONICA type of child. Time can be lost by following the rule of never repeating the medicine so long as improvement is maintained.

Originally I would give one dose of CALC CARB 10 M and, providing the child went ahead slowly but steadily with no lessening in its improvement, I could find no reason to repeat the medicine for six months or more.

But the average young child, free from acute illness, will tend to improve even if it has no medicine at all, and the constitutional drug ought to increase the rate of that improvement. I therefore started repeating CALC CARB at much more frequent intervals whenever the child was not jumping ahead, and in many of these CALC CARB cases improvement can be speeded up by more frequent repetition of the medicine. It is a quite different matter in the case of an adult.

GROUP II

Baryta carbonicum

Borax

Natrum muriaticum

Sepia

Aurum metallicum

Carbo vegetabilis

Baryta carbonicum

The second group are all very much of the same type; they all apply more or less to the backward child, either a case of delayed development, or a definite mental defective. The outstanding drug in this group is BARYTA CARBONICA, which is more typical of the backward child than any other drug in our Materia Medica.

The characteristics of the BARYTA CARB child are very definite it is a dwarfish child, dwarfish mentally and physically. I have never seen a BARYTA CARB child who was up to standard height, but they may be up to standard weight. The next glaring characteristic is that the BARYTA CARB child is always an excessively shy child.

That shy characteristic covers quite a lot of the BARYTA CARB child. It is nervous of strangers; 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.

Another characteristic linked with that fear of people is that the BARYTA CARB children are always touchy; they do not like being interfered with; they are very easily irritated. The next thing is that throughout their lives they have been late in everything – late in speaking, late in walking, late in dentition slow in gaining weight.

Another marked feature is an exaggeration of the normal child's forgetfulness. Every child is forgetful, every child is inattentive, but in the BARYTA CARB child this is 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 hold 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 the same report comes from school – the child is inattentive, never concentrates on a lesson, appears to learn something today and has completely forgotten it tomorrow. The mother would teach the child its alphabet a dozen times over and ten minutes after it knew it, it would be allowed to go out and play and half an hour later it was all forgotten.

Another thing is that they are very easily tired out; any attempt at sustained effort exhausts them. When they are young they become cross and irritable as they get older any sustained effort brings on very troublesome headaches – usually a frontal headache with a feeling as if the forehead were bulging and sitting right down over the eyes, and it is awful effort for them to keep the eyes open.

The next point about them – and it is pretty constant to all the BARYTA CARB children is that they are liable to get colds, and their colds are characteristic. They always start as a sore throat, and most BARYTA CARB children have hypertrophied tonsils.

To the hypertrophy of their tonsils can be linked the other glandular tissues; the BARYTA CARB child very probably has enlarged cervical glands, possibly enlarged abdominal glands.

With the enlarged abdominal glands linked the fact that the child stands badly, there is often marked lordosis and a very prominent abdomen.

With the abdomen condition is the symptom that the BARYTA CARB child is usually worse after eating – more inattentive, more irritable, more touchy, and very often more tired after eating.

The next thing about them – linked with the tonsillar hypertrophy is that if that get enlarged tonsils and get cold they are very liable to develop quinsy. Here is a tip that is worth remembering. To a typical BARYTA CARB child with an acute tonsillitis it is wiser to give a dose of BARYTA MURIATICA rather than BARYTA CARB during the acute phase; and very often they will need an intercurrent dose of PSORINUM after the BARYTA MUR before reverting to BARYTA CARB.

It is quite easy to tack on the PSORINUM to the BARYTA CARB because many of these children tend to get a crusty skin eruption on the head and crusty margins to the eyelids, they may have a definite blepharitis, and most BARYTA CARB children are worse from washing – all of which are definite PSORINUM symptoms also.

They are very liable to get intensely irritable skin eruptions, but with intense irritation and that again is liable to be worse after they have been bathed.

As would be expected with that type of child with low physique, they are chilly, are if they are exposed to cold their tonsils become affected. One other feature of the BARYTA CARB children is a marked tendency to salivation; dribbling is a common characteristic of mentally defective children.

Above are the keynotes to the "mentally defective" group of drugs, and of these BARYTA CARB is by far the most commonly indicated. Following that come other drugs mentioned previously starting will BORAX.

Borax

The feature that makes one consider whether a child is a BARYTA CARB or BORAX type is the manner in which the child is frightened. They are both scared children and they are very often quite similar to look at, but whereas in the BARYTA CARB child anything strange in its surroundings scares it, in the BORAX child it is any sudden noise in its vicinity, which simply terrifies it.

The tendency to salivation and dribbling is equally marked in BORAX, but in the majority of BORAX children one is dealing with a definite stomatitis, and associated with the salivation there are white spots on the tongue pearly spots round the margins of the tongue, spots on the lips and on the inside of the cheeks.

There is a very similar history in regard to night terrors in the BORAX, child but there is usually an exciting cause in these cases; the child has been doing too much during the day, or has been overexcited in the evening, and then it is almost sure to have a marked night terror.

With the BORAX child there is not the same degree of inability to learn. The child is simply idle. If he would give his heart to it he could learn, but he is just idle. These children never settle to anything, and even at play they do not persevere but get bored and change from one thing to another.

Another thing that distinguishes them from BARYTA CARB types is that BORAX children are much more irritable, and their irritability does not end up in weeping as it very often does in BARYTA CARB, but it ends up in a violent passion the child kicks and screams.

The next point which distinguishes the BORAX child from the BARYTA CARB child is that the BARYTA CARB child tends to get a generalized skin eruption, or a very definite crusty eruption on the scalp, but the BORAX child is much more likely to get herpetic eruptions –very often herpetic spots about the lips, or a generalized rash of small herpetic spots on the body.

BORAX cases are also more liable to get acute digestive upsets than BARYTA CARB types, which have the typical chronic constipation, the hard stool. BORAX is liable to sudden attacks of diarrhoea and vomiting. Another characteristic of BORAX, which distinguishes it from BARYTA CARB, is the peculiar BORAX sensitiveness of fruit, with violent colic after eating fruit colic followed by diarrhoea.

Associated with the tendency to inflammation of the mucous membranes, acute stomatitis etc., it is very common in BORAX children to find either enuresis or pain on micturition; pain on micturition is much more common, and very often it is without any definite urinary infection.

Another thing that distinguishes the BARYTA CARB child when a little older is that the BARYTA CARB child gets depressing frontal headache from over-study; whereas the BORAX child tends to become sick, and 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 children often get train-sick BORAX children 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 of the BORAX children.

It occurs in numerous circumstances; the typical pointer is the child who screams time it is laid down in bed if the nurse does not lower is very gently; but it is equally marked in older children who scream on going down in a lift. It is the peculiar terror rather than the physical discomfort, which distinguishes BORAX from any other drug.

One useful practical tip is in connection with airsickness. There are various drugs for train-sickness and seasickness but BORAX acts in the majority of cases of airsickness, because it is the sudden dip, which upsets most people and particularly the terror of falling. Airsickness has been completely overcome by three or four doses of BORAX before travelling by air.

BORAX is like BARYTA CARB in being sensitive to cold, but it has much more sensitiveness to damp than BARYTA CARB. BORAX is one of the sodium salts and immediately one considers the sodium salts one thinks of the possibility of the others, and by far the most commonly indicated of these is NATRUM MURIATICUM.

Natrum muriaticum

In children the majority of NATRUM MUR cases are rather undersized and underweight. At first sight they are a little difficult to distinguish from the BARYTA CARB child with its shyness, because the NATRUM MUR child appears to have a very definite dislike of being handled; it has a very definite dislike of being interfered with and is liable to burst into tears, which is not unlike the shy terrified reaction of BARYTA CARB child.

But on closer investigation the reaction is quite different. It is not shyness in the NATRUM MUR, it is much more a resentment at being interfered with. The NATRUM MUR child cries, but cries much more from rage than from terror. You can very often stop the

NATRUM MUR child's crying if you are sufficiently firm but try to soothe it and it gets worse.

A NATRUM MUR child will be nearly in convulsions with screaming when its mother tries to soothe it, whereas as soon as left 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 it has an entirely different mentality.

Another thing which distinguishes NATRUM MUR from BARYTA CARB is that though they both tend to be awkward in their movements the BARYTA CARB child is awkward because of incoordination it is clumsy but the NATRUM MUR child knocks things over because it is in too big a hurry.

There will be a history of delayed development in the NATRUM MUR child particularly that the child was slow in learning to speak. It may also have been slow in starting to walk but that is not nearly so constant. Often the NATRUM MUR child's speech is faulty, but it is much more a difficulty in articulation than a lack of mentality as in the BARYTA CARB child

The next characteristic of the NATRUM MUR child is that it is probably small and underweight. In contrast to BARYTA CARB where there is a mass of enlarged cervical glands, the typical NATRUM MUR child may have very small shotty enlarged cervical glands in a thin neck. The BARYTA CARB types have a chain of quite large glands running own the anterior border of the sternomastoid; the NATRUM MUR children have small shotty glands at the back of the neck and the neck itself is rather skinny.

The NATRUM MUR child does not tend to run to the same degree of crusty skin eruptions as the BARYTA CARB child. NATRUM MUR cases get an eruption restricted to the margin of the hair, rather than spreading over the whole scalp.

There is not the same tendency to salivation in the NATRUM MUR child and instead of the small patches found in a BORAX mouth in NATRUM MUR. The tongue is sensitive and is red places and white in places, not with the little white vesicles of BORAX types but with the irregular mapping which is associated with NATRUM MUR either in children or in adults.

As the NATRUM MUR children grow older, they develop school headache; when 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 the same feeling pressure down over the eyes, and they are brought on by intense effort – particularly mental effort.

The temperature reactions in NATRUM MUR are definitely different from those of BARYTA CARB. In NATRUM MUR, often the child is chilly sensitive to draughts, will shiver from a change of temperature and will start sneezing from a change of temperature; but he is very sensitive to heat-stuffiness particularly and to exposure to the sun, and is very liable to develop a sun headache.

The majority of these NATRUM MUR children have a definite salt craving. It is most unexpected that children should have the excessive desire for salt recorded in the Materia Medica. But in practice one meets case after case in which there is a very definite salt craving in these children – they will steal salt as other children would steal sugar.

Another thing to look for in children needing NATRUM MUR is a very marked tendency to develop hangnails, splits up the side of the nails, which are extremely sensitive, very painful and very difficult to heal. It is a small point, but it is quite useful in practice.

A distinguishing point is the appearance of the skin. Typical BARYTA CARB children usually have very little color, they are sallow, rather earthy looking. BORAX children often have considerably more color in the cheeks, the skin is a little more yellow, not quite so earthy looking and a shade more inelastic, thick and greasy.

NATRUM MUR children probably are a little darker still, they flush a little more easily, they perspire a little more easily and there is a slight increase of the greasy appearance.

Sepia

When considering skin, the next 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 children. The outstanding feature of SEPIA children is their negative attitude to everything. They tend to be depressed, moody, indolent, disinclined for work, and not even interested in their play. If pushed they are liable to sulk or weep.

They are usually nervy children, scared of being alone, very often afraid of the dark, and yet they dislike being handled. Very often they have a definite dislike of going to parties, and there is a point which is sometimes confused with BARYTA CARB – a dislike of playing with other children.

It is the thing that later develops into the typical SEPIA dislike of meeting friends, and is often confused with the BARYTA CARB dislike of people altogether, but mostly it is pure indolence in the SEPIA children, and once they get to a party they are perfectly happy.

The next point is that these SEPIA children although so lazy and indolent are definitely greedy, and SEPIA should always be considered for a definitely greedy child. Another thing common to SEPIA children is that although they loathe to go to a party, when they get there and start dancing they wake up at once and are perfectly happy. It is astonishing – the effect of dancing on SEPIA children. The heaviest, dullest child when dancing at a party will become an entirely different being will suddenly come alive. It is a useful tip and the parents may give it when asked.

Another odd symptom, which appears occasionally in children and is a definite SEPIA lead, is that these slow-developing children very often acquire the habit of head nodding. When faced with a head-nodding child always think of the possibility of SEPIA, do not dash off at once to one of the typical chorea drugs.

Various other points are fairly common in the SEPIA children. For instance, they are nearly always constipated, and associated with this is usually a tendency to enuresis. And one thing, which is very constant in SEPIA children, is that the enuresis takes place early in the night. Usually if these SEPIA children are lifted about 10 pm, they remain dry the rest of the night; it is in their first sleep that they lose control.

At the later age, in the sallow, dull, greedy, locked-up child, there is a history that she is developing fainting attacks, and these are induced by standing, or by 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.

All these children – like all SEPIA patients – are sensitive to cold children are particularly sensitive to weather changes, and the typical SEPIA child will develop a cold from changes in the weather apparently without any contact with infection.

Another useful lead towards SEPIA in children is that they are very often upset by milk. If a SEPIA child gets a digestive upset and is put a milk diet he will certainly become constipated.

Associated with their sallow, greasy skin, SEPIA children tend to sweat profusely, and are liable to develop very itchy skins without much sign of an eruption and without comfort from scratching.

Aurum metallicum

With this sallow, dispirited sluggish type of child, with that depressed, negative attitude one should always consider the possibility of gold, AURUM METALLICUM, or one of the gold salts. The typical AURUM child is always an undeveloped child. It is not so much a question of undersize and underweight as that it simply does not grow up.

The typical Aurum child of 5 years of age is probably about the level of a 3 year old. The majority of cases needing AURUM are boys and in majority of these cases there has been some failure of development – an undescended testicle, a very poorly developed scrotum, something which indicated that the child was slow in developing even if developing satisfactorily. It is type of symptom for which one might consider BARYTA CARB.

AURUM children always give the impression of being lifeless. They are always low-spirited, rather miserable, lifeless, and they are absolutely lacking in go. They have no initiative at all and give the impression of finding everything a frightful effort.

The report from school is that they are backward and that they have very, poor memories. One of the odd things about them is that, in spite of being dull, depressed, miserable, lifeless sort of creatures they do respond to contradiction; the child has no go in him and he makes some statement which is contradicted and he flies into an absolute rage; it is the one thing that stirs them up.

Another constant factor, which is rather surprising in this type of child despite the impression of being sluggish, is that has a weird hyperaesthesia to pain, they are terrified of it and extremely sensitive to it. And, in spite of their sluggishness, they are very sensitive to noise and have a very acute sense of taste and smell.

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

If they are forced to exert themselves they very easily get out of breath and suffocative attacks with acute difficulty in breathing, without any obvious physical cause.

Another odd characteristic of the AURUM children is that they are frightfully sensitive to any disappointment; they will grieve over it for days, quite out of all proportion to the normal child's reaction. And associated with that is the other typical AURUM symptom that the child sobs in his sleep without waking up, and apparently without having been distressed the night before.

Carbo vegetabilis

A drug, which also has a very definitely sluggish condition and is sometimes a little like AURUM, is CARBO VEGETABILIS although the cause is entirely different. CARBO VEG children are definitely sluggish but it is more a physical than mental sluggishness 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 sore of children and if they are pushed they become peevish, but it is a futile sort of peevishness without much bite in it.

Associated with the general mental sluggishness there is always sluggishness of circulation. They are very often heavy sallow complexioned children, and they have bluish extremities bluish fingers, bluish toes, and the extremities are always cold.

The next thing about them is that if they are pressed at all at school made to work, they are almost certain to develop of a dull, occipital headache. They may get the same kind of headache from wearing a tight hat. With these dull, occipital headaches there is complete inability to work, to concentrate, almost to think.

Often the child has been pushed at school, is developing headaches, seems dead tired in the evening, and gets the most violent nightmares, so much so that the child is almost terrified to go to bed, particularly in the dark.

In these nightmares they see ghosts, faces, all sorts of terrifying spectres. These cold, sluggish children get very hot and sweaty at night, particularly the extremities, but it is mainly general, and the CARBO VEG children usually have a sour smelling sweat.

Another thing linked with the CARBO VEG sluggishness of circulation is that they very easily get a pretty persistent epistaxis; very often these children have a severe epistaxis in the night.

Another symptom associated with the general sluggishness is constipation. They mostly have digestive difficulties and tend to have big bellies; they get a lot of flatulence. In spite of being constipated they very easily get attacks of diarrhoea – a very offensive, watery diarrhoea – and then they return to their constipated state again.

With these digestive difficulties they have marked likes and dislikes of food. They like sweet things – which often upset them – and they like to have their appetite stimulated with something tasty, so they like salt things. With their general sluggish digestion they are upset by fat things, rich food of any kind; very often they develop a definite aversion to fat and frequently have a marked aversion to milk.

A fairly constant feature of all these CARBO VEG children is that they are not primarily CARBO VEG children; 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 often dates from an attack of whooping cough.

GROUP III

Graphites

Capsicum

Psorinum

Antimonium Crudum

Petroleum

Graphites

The third group is headed by GRAPHITES. This group is associated with children who have definite skin eruptions. Almost any of the other drugs already mentioned may be required for skin eruptions; for instance, CARBO VEG children have a very obstinate eczema of the scalp; CALCAREA children have eczema of the scalp; CAUSTICUM children have a lot of skin eruptions.

There may also be a very obstinate eczema of the scalp with SEPIA indications. But the GRAPHITES group is the one to think of when a child has a definite skin history. There is a tendency when treating children with an irritant skin to give a dose of SULPHUR, and there have been many cases where that dose of SULPHUR has done harm and I am chary of starting with SULPHUR in these children with skin trouble.

The typical GRAPHITES child is fat and heavy. It is usually pale, always chilly, and nearly always constipated. In the majority of instances with obstinate constipation in a small child the abdomen is enlarged, a factor so constant that one does not stress it.

GRAPHITES children are always timid. They are rather miserable, and have a complete lack of assurance. The slightly older children hesitate over what they are going to reply to any questions put to them; the school report states that they are indefinite – there is the same hesitation here; and most of these GRAPHITES children are lazy; they have an aversion to work.

There is a queer contradiction in the GRAPHITES children. With the uncertainty and hesitation, laziness and general physical sluggishness, there is always an element of anxiety in the children. They always tend to look on the hopeless side of things; if they are going to a new school, they dread it. They are always looking for trouble.

The next thing about the GRAPHITES children is that, associated with their pallor, under any stress at all flush up – they have a definitely unstable circulation. And under stress, when they are excited, with this flushing up there is a tendency to troublesome but not very profuse epistaxis, which comes on under excitement that is the diagnostic point.

A constant feature of the GRAPHITES children, which at once distinguishes them from the CALCAREA children who look not unlike them, is that instead of the soft, sweaty CALCAREA skin, they have a harsh dry skin which tends to crack, particularly on exposure to cold. If these GRAPHITES children have been playing in water in cold weather they come in with their hands chapped and bleeding.

Associated with the dry harsh skin, are the GRAPHITES skin eruptions and the type of eruption is constant, no matter where it is. Cracked fingers, which tend to bleed, also ooze a sticky thick yellow serous discharge.

The same kind of condition arises in any of the folds in GRAPHITES types, the back of the ear, canthus of the eye, angles of the mouth the groins, bends of the elbows, round the wrists and particularly about the anus; in this site are found deep painful fissures oozing a thin, sticky, yellowish discharge.

As the discharge dries it forms thick crusts which pile up as secretion of matter continues beneath; and the crusts come off to reveal the same kind of gluey yellowish discharge, very often streaked with blood.

In my experience children suffering from asthma who have a history of skin troubles are not helped by GRAPHITES. These cases of suppressed skin troubles, which develop asthma, are extremely difficult and I have found that GRAPHITES fails altogether. Many other remedies have been successful such as PSORINUM, ANTIMONIUM CRUDUM, NATRUM MUR, SULPHUR, THUJA has helped quite frequently, and with no other lead it would be wise to start with THUJA.

That can be linked to one or two other typical GRAPHITES symptoms in children. They are liable to get a very persistent purulent nasal discharge, a chronic otitis with a perforation of the drum and again the same kind of yellowish excoriating discharge, with an irritating eczema of the external ear whenever the discharge runs over.

Associated with the purulent nasal discharge, many of these GRAPHITES children have marked hypertrophy of the tonsils, with offensive secretion in them, and as a result they often complain of difficulty in swallowing.

They often suffer with a chronic blepharitis and their lids are completely stuck in the morning with the same sort of gluey discharge; dried discharge adheres to the edges of the lids.

In spite of apparent fatness, they are flabby, and there is general muscular weakness. They are very easily exhausted; are sensitive to motion of any kind; and stand travelling very badly. There is a history of rheumatic pains, particularly affecting the neck and the lower extremities.

There is another GRAPHITES symptom which is sometimes useful in these flabby children – they are liable to attacks of abdominal cramp; this is not surprising in view of their constipated state. But in these GRAPHITES cramps the abdominal pains are relieved by giving the child hot milk to drink.

In the majority of cases, with the constipated stool they pass a quantity of mucus-stringy, adherent mucus. It links up with the type discharge from the skin surfaces, although it is not commonly yellow.

Another useful symptom, which is common, is that these GRAPHITES children have big appetites; they are hungry children and are upset if they go long without food; they are better for eating. But in spite of their fatness and flabbiness, there is often a surprising and very marked aversion to sweets.

In typical GRAPHITES adolescents it is still more surprising because there is the same flabby, fat, soft adolescent with, instead of the ordinary cracks behind the ear or cracks at

the corners of the mouth, they have an acute acne, and one of the questions to ask is whether they eat many sweets, and if it is a GRAPHITES case the reply is that they cannot stand them at all, which is sometimes a very useful tip.

Another point about the appetite in the young children is that they have a definite dislike of fish. Fish is a normal constituent of a young child's diet, and it is easy to find out if they dislike it. Most of these GRAPHITES children do have a very definite dislike of fish.

Where considering children with chronic otitis, chronic discharge with an old perforation possibly with eczema of the external ear, another drug that must be considered is CAPSICUM.

Capsicum

The typical CAPSICUM child is again a fat, rather lazy, somewhat obstinate child who is very definitely clumsy in his movements – I have never seen a neat CAPSICUM child. Mostly they have rather reddish cheeks, but that is not constant; they may be pale and flush up much like the GRAPHITES child.

They tend to be very forgetful. They will be sent on an errand, and will come back without what they have been sent to get. It is partly lack of attention. They are always touchy, easily offended, easily irritated.

An odd feature in CAPSICUM children is 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.

The CAPSICUM children are always rather dull; they are slow at learning in school, and their memories are poor.

These children tend to have local hyperaemias. In a typical CAPSICUM child with a mild earache the whole external ear bright crimson. A CAPSICUM child with rheumatism has usually one or other joint affected, with a localized blush over the affected area.

A CAPSICUM child with a cold gets very enlarged tonsils, which are very hyperaemic –bright crimson, and the child complains of a burning heat in the mouth with intense thirst.

An odd symptom sometimes met with in these children with sore throats running a fairly high temperature, is that the child is very flushed, cross, sleepless an thirsty; wants cold drinks, and yet shivers after taking a cold drink. This has been seen repeatedly in a child who has a sore throat and is going on to definite mastoid symptoms.

Where there is mastoid involvement in a CAPSICUM case – and it is probably the most commonly indicated drug for mastoiditis there is always a marked tenderness over the mastoid process, and a blush on the skin surface long before there is fully developed mastoiditis.

One of the nuisances of these mastoid cases is that they usually blow up at night, the child becomes extremely irritable, sleepless, worried, the mother can do nothing with it; it is as obstinate as a mule; she sends for you, and you have to examine it by artificial light and cannot see the blush.

Time and again I have seen these CAPSICUM children at night and could not make out the blush at all, but next morning in daylight it was perfectly obvious.

Associated with the tenderness over the mastoid area is the general hyperaesthesia of the CAPSICUM case; they are sensitive to noise; sensitive to touch, and they have a hyperaesthesia to taste.

In the majority of these children with acute illnesses there is some degree of urinary irritation. It may be an acute cystitis with 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 acute illnesses there is some urinary irritation, and it is always of a smarting nature.

In a child of this 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 mastoid involvement, the majority of these cases will need CAPSICUM. The next of the skin drugs in children is PSORINUM.

Psorinum

PSORINUM children are fairly common. The majority tends to be thin rather than fat. They are always sickly children; have very little stamina; are easily exhausted by any effort, physical or mental; very liable to become mentally confused used stress. They are rather dispirited, hopeless youngsters, and, like all children when they are out of sorts they become peevish and irritable.

They are unhealthy looking; they look dirty and unwashed. A PSORINUM child is hardly ever without a pustule of some sort some – where about the body. The skin in the child is very rough and dry. In the adolescent PSORINUM case it is much more commonly greasy. But whether in the child or the adolescent, on exertion, PSORINUM youngsters tend to sweat and they are always unhealthy and smelly.

The skin condition of PSORINUM is not unlike the GRAPHITES skin. There is a tendency for fissures to develop about the hands and in the folds, but there is not honey-like discharge of GRAPHITES. The discharge is watery or purulent, and it is always offensive.

In all PSORINUM skin conditions there is intense irritation. Many of these children suffer utter torture because they are intensely chilly, feel the cold very badly and are upset by it, but they have an intensely itchy skin and are driven nearly crazy by wearing crazy by wearing woollen clothes.

With this dirty-looking grey, rough skin, PSORINUM children are upset by washing, which greatly increases the irritation of their skin.

Most PSORINUM children, in spite of their thinness, have abnormal appetites; one of the constants of PSORINUM children is that any lack of food brings on a violent headache, very often a definite sick headache.

In a typical PSORINUM child with a skin condition the skin irritation is intense, and the child scratches its face until it bleeds. Between the scratches is an unhealthy pustular eruption, very often associated with a generalized blepharitis.

In the acute condition it resembles the GRAPHITES type, but it is much more intense than GRAPHITES, often with the eyelids slightly everted looking almost like raw beef. The child scratches all over the body, and again there is the same purulent condition.

There is the same type of eruption on the scalp, and PSORINUM children are never at peace, always rubbing their heads against the pillow. There is also a yellow, purulent nasal discharge, excoriating the upper lip and often a purulent foul-smelling otorrhoea.

This is the intensely irritant skin condition, which only PSORINUM will cover, and for one may be tempted to give all sorts of other things.

For hay fever, associated with the typical nasal discharge PSORINUM is much the most commonly curative drug given in the interval. There is a very similar hyperaesthesia in the mucous membrane to that on the surface in PSORINUM children and a dose in the spring will wipe out hay fever of long standing. It does not help in the acute condition, but a dose given in the spring before the hay fever season starts, can stop fever altogether. PSORINUM has a spring aggravation.

There are two more common drugs to consider for skin eruptions. Firstly, ANTIMONIUM CRUDUM and then PETROLEUM, as the ANTIMONIUM CRUD children with skin eruptions have the same marked aggravation from washing as the PSORINUM cases.

Antimonium Crudum

ANTIMONIUM CRUDUM children are very interesting. They are always fat, rather over weight, usually pale, and they have a very marked tendency to redness round the eyes, and moist eruptions behind the ears.

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 child that will cry if anyone looks at the more you attempt to soothe it the worse it gets.

The ANTIM CRUD child has night terrors, and is cross and irritable; and the more the mother attempts to nurse it the worse it becomes. Walking it up and down drives it nearly distracted. They, in contrast to that, they are very impressionable children, sensitive, 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 liable to faint.

ANTIM CRUD children with skin eruptions tend to get very large, crusty, smelly eruptions –the typical crusty impetigo seen on a child's face. More cases of impetigo in children clear on ANTIM CRUD than on any other drug in the Materia Medica. In adults also, nine out of ten cases of acute impetigo clear on ANTIM CRUD.

All their skin eruptions are very much worse from the application of water in any form, and become very inflamed and painful from exposure to radiant heat.

ANTIM CRUD children are very clumsy, and very jerky in their movements and may have an actual chorea.

They suffer from warts on their fingers, either one or two small ones, or masses of warts, which are usually flat not very painful. Associated with the warty condition most of these ANTIM CRUD children tend to have deformed nails – thickened and unhealthy looking.

Two other constant points about the ANTIM CRUD children. Firstly they are very liable to get digestive upsets from any acids, sour fruits, or sour drinks. Secondly they have a soft, flabby, coated tongue usually with a white coating. It is like a MERCURIUS tongue with a white coating.

The outstanding points of ANTIM CRUD are not unlike PETROLEUM as far as the skin conditions are concerned.

Petroleum

But the majority of children with indications for PETROLEUM will be thin, rather than fat. Associated with the loss of weight in the typical PETROLEUM case the child has a very good appetite, and is very often hungry between meals.

PETROLEUM children are as irritable as the ANTIM CRUD children are but from quite a different cause they are much more quarrelsome and easily take offence. The child is often quite bright mentally but is lazy at school does not want to work and is inattentive and forgetful.

They are almost always sensitive to noise and scared by any sudden loud noise, which they do not understand. They are just as sensitive to cold as the ANTIM CRUD or PSORINUM children.

There are often signs of skin eruptions in the PETROLEUM children and the commonest is an eruption at the back of the ears, deep cracks oozing a yellowish, watery fluid very often these cracks split and bleed.

But the same type of crack appears in any place in the PETROLEUM child particularly in any fold at the corners of the mouth, at the angle of the nose, and very often there are similar around the anus, in the groins, or in the axillae; the fluid that oozes out forms thick crusts which are always very sensitive.

Almost all the PETROLEUM skin eruptions itch. They are more irritable during the day than the night, which is sometimes a help to distinguish them from SULPHUR eruptions.

PETROLEUM children are very liable to catch cold, and to have acute nasal obstruction, with an excoriating discharge, a tendency for the nose to get crusty, sensitive, bleeding and very often crusts form on the upper lip and round about the sides of the nose.

With these nasal discharge there is also some deafness, with acute pain in the ear, and a sensation as if the Eustachian tube were blocked. They frequently have an otitis, with the same kind of watery, yellow discharge and very marked redness of the external ear an acute eczematous conditions with irritation and tendency to bleed.

Another link with the itching is very definitely itchy eyes. Often there is blepharitis with reddened margins, and cracks at the inner canthus, and an infection spreading down the lachrymal duct – they may even get an abscess in the lachrymal sac. Pus forms in the lachrymal duct and an excoriating discharge runs down the side of the nose, raw and bleeding, accompanied by acute conjunctivitis.

With the infective processes in the throat and nose these PETROLEUM children often have enlargement of the submaxillary lymph nodes.

Another thing very common to PETROLEUM children is a history of bladder irritation. It is often an enuresis, but much more commonly an acute irritation, it may be an acute cystitis, with the same sensation of rawness and smarting.

Another feature common to the PETROLEUM children is that after any exposure to cold they may develop acute abdominal colic and diarrhoea. And with the diarrhoea there is always a degree of inflammation about the anus and perineum, with a burning red raw eruption.

In cold weather the skin of their hands tends to crack, particularly on the fingertips, and these cracks are very sensitive, very painful to touch, with deep fissures, which split open and bleed easily.

All these children have the typical PETROLEUM aggravation from motion that is to say; they get train-sick and seasick. 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, but PETROLEUM sometimes meets the case.

In cases of seasickness where there is doubt between PETROLEUM and TABACUM, which is the other common drug for seasickness, there is almost always that occipital headache as well as the seasickness in PETROLEUM, and the TABACUM types do not have it at all.

Seasickness with occipital headache calls for PETROLEUM every time. In prophylactic treatment against seasickness it is very difficult to decide between TABACUM or PETROLEUM, but the occipital headache of PETROLEUM children indicates PETROLEUM.

There are various other drugs for skin conditions in children but these are much the commonest. There is the possibility of SULPHUR because it is almost automatic in skin affections, but it is better to take SULPHUR under the next group.

GROUP IV

Pulsatilla

Kali Sulphuricum

Sulphur

Thuja

Bromium

Iodium

Abrotanum

Fluoricum Acidum

Pulsatilla

These are the "warm-blooded" drugs starting with PULSATILLA, which is the most commonly indicated drug in children of this type.

PULSATILLA children are very typical. There are two main types. One is the very small, fine type, with a fine skin, fine hair, unstable circulation, liable to flush up from any emotion very often going pale afterwards; definitely shy, sensitive; always affectionate very easy to handle, and always very responsive. The other PULSATILLA type, is much fatter with definitely more color, usually rather darker hair, a little more sluggish in reaction, a little more tendency to weep than to be bright and gay as the smaller, finer type, craving for attention without much response to it, always asking for a little more.

If you get one picture clear you are apt to forget the other. The factor common to both types is their temperature reaction, all PULSATILLA children are sensitive to heat, they flag in hot weather lose their liveliness, lose their sparkle and energy.

They hang about, become either tearful or irritable, and are likely to get digestive upsets. But they are much more liable to be upset a sudden change to cold in a hot spell – that is to say they often get an attack of acute sickness or diarrhoea from being chilled in hot weather.

They tend to get cystitis, or to get earache. Sudden chilling during hot weather causes their troubles. Whilst generally they flag in hot weather, their acute conditions are much more liable to be brought on by chilling. In the same way they are upset by taking ice cream in hot weather, this factor is quite as common as the ordinary PULSATILLA aggravation from too rich food.

Something one misses a case because of the odd reactions in a feverish attack. The PULSATILLA children get acute colds in the head, acute coryza, and with this they are shivery, and very chilly. With the coryza, there is a certain amount of gastric catarrh, a feeling of nausea, and they may actually vomit.

But, in spite of their chilliness, their sense of blockage in the head is better in the open air and worse in a stuffy room. A PULSATILLA cold always has a bland discharge.

There is sometimes an apparent contradiction they are very apt to get conjunctivitis, and in the PULSATILLA conjunctivitis the eyes are very sensitive to any cold draught, and water profusely in the open air. There is usually marked photophobia with itching of the eyelids, and PULSATILLA children are apt to get styes, affecting the lower rather than the upper lid.

A point that is sometimes a help in PULSATILLA earaches, which are very intense and usually brought on from exposure to cold, is a very violent pain, which spreads all over the side of the face as well as into the throat.

If the condition has gone a little further, there is feeling as of something bursting out of the ear, as if something were pressing right through the eardrum. Another thing is amelioration from cold – their earaches are better from cold applications.

PULSATILLA children are very often tired, edgy and sleepy during the day, and they become more lively as the day goes on, they are liable to get the PULSATILLA nervousness about sunset the ordinary sunset aggravation of PULSATILLA.

They become very lively towards bedtime, are slow in going to sleep, and once asleep tend to get nightmares, night terrors usually some kind of strife dreams – not necessarily being chased by the black dog of PULSATILLA – but always something worrying, terrifying. Most of these PULSATILLA children are afraid of the dark, afraid of being left alone, as one would expect in the shy nervous type of child.

One thing that will almost always produce a night terror in these children is listening to ghost stories in the dark before going to bed; you can be sure that will give a PULS child a nightmare.

Another useful pointer is that these children are very liable to become giddy from looking up at anything high. The only other drug that I know in which this is so marked is ARGENTUM NITRICUM which has an aggravation from looking down, but it has also an aggravation from looking up, but this is very much more marked in PULSATILLA.

The PULSATILLA child often lies with the hands above the head and this is a useful pointer, although it is by no means constant.

Kali Sulphuricum

When considering the hot-blooded child of PULSATILLA type, the next thing to consider is whether it is PULSATILLA or KALI SULPHURICUM. Kent says that KALI SULPH is merely an intensified PULSATILLA. I do not think it is.

The KALI SULPH temperature reactions are identical with the PULSATILLA ones, the child is sensitive to heat it flags in the hot weather, cannot stand stuffy atmospheres, is better in the open air, tends to stagnate if keeping still, and is better moving about. It has an aggravation from rich food; and is liable to be upset by sudden changes of weather. But there is a distinct difference.

The KALI SULPH child is much flabbier than the PULSATILLA child, it certainly does not approach the thin fine type of PULSATILLA although 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 has a much more sluggish reaction generally.

There is more obstinacy in the KALI SULPH type than in the typical PULSATILLA. The PULSATILLA child may be irritable, it may flare up in a temper but it is over; KALI SULPH is much more liable to be obstinate.

Also the PULSATILLA children are shy, but the KALI SULPH children tend much more to have a lack of confidence in themselves - it is not shyness. They are lazy, they dislike work and there is not the keenness and interest of the PULSATILLA children.

The KALI SULPH children are not bright they get tired out by mental exertion, whereas the PULSATILLA children are very often bright and sharp and do quite well at school.

There is a certain similarity in that they are both nervous, both afraid of the dark, are very easily frightened, easily startled at strange noises, strange surroundings.

The typical KALI SULPH child tends to be more sickly than the typical PULSATILLA child. The PULSATILLA child may not be strong, but the KALI SULPH child tends to have less color and if flushed it is much more a circumscribed flush on the cheeks rather than the variable circulation of the PULSATILLA.

Another thing that indicates KALI SULPH rather than PULSATILLA is that nearly all KALI SULPH children have a yellow-coated tongue, particularly the root of the tongue although the coating may spread right over.

Another point, which helps, is that there is a slight difference in the type of discharges. The typical PULSATILLA discharge is a thick, creamy, non-irritating discharge. The typical discharge in KALI SULPH is a much more watery, stringier, yellowish discharge.

As far as liability to actual acute illness is concerned, PULSATILLA is more often needed for acute gastric catarrh, acute gastritis, acute colic and diarrhoea; but if the gastritis has gone on to a jaundice in a PULSATILLA child the indications are more for KALI SULPH than for PULSATILLA.

With a PULSATILLA type of child who has caught cold and developed bronchitis, which has gone on to a bronchopneumonia 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, with a yellowish, watery sputum and probably patches of consolidation at the left base – left base more commonly – the response is better from KALI SULPH than from PULSATILLA.

With a PULSATILLA child who has whooping cough with a lot of rattling in the chest, and the ordinary PULSATILLA modalities, KALI SULPH does more good than PULSATILLA.

That is perhaps what Kent means by saying KALI SULPH is PULSATILLA intensified – in these acute conditions the symptoms are very similar and yet the more severe the condition the more definite are the indications for KALI SULPH.

It is sometimes useful to remember that the heavy PULSATILLA child is liable to go on SULPHUR whilst the finer PULSATILLA child is much more liable to become chilly and go on to SILICEA or PHOSPHORUS.

I usually give PULSATILLA in low potency in chronic cases. They are mostly sensitive children, and where you are dealing with the sensitive type you do not want a high potency. When dealing with bovine types I go high, but in a sensitive type like PULSATILLA they blossom on 30 potency. PHOSPHORUS is exactly the same, PHOSPHORUS children respond beautifully to lower potencies.

I have found very good results from ANTIMONIUM CRUDUM 12, repeated three times a day for two days, in impetigo. With CALC CARB or GRAPHITES I would give a high potency every time – a 200, or higher, as one is dealing with an insensitive type.

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