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.
