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 which must be considered is 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 localised 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 children are fairly common. The majority tend 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 generalised 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 hey 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. [Ant-c]
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 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 eruption 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 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.
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 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 finger tips, 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 sea-sick. 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 sea-sickness where there is doubt between PETROLEUM and TABACUM, which is the other common drug for sea- sickness, there is almost always that occipital headache as well as the sea-sickness in PETROLEUM, and the TABACUM types do not have it at all.
Sea-sickness with occipital headache calls for PETROLEUM every time. In prophylactic treatment against sea-sickness 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.