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.