Then various other points which are pretty common in the Sepia children are that you practically always get constipation, and associated with the constipation you practically always get a tendency to enuresis. And there you have one thing which is very constant in children, and that is that the enuresis takes place early in the night; as a rule if these Sepia children are lifted about 10 p.m. they remain dry the rest of the night; it is in their first sleep that they lose control.
Then, as the kids get older, in that sort of sallow, dull, greedy, locked-up child, you are very liable to get a history that they are developing fainting attacks,and these fainting attacks are induced by standing, or really taking up any fixed position in a close atmosphere-standing in school, standing in church, kneeling in church-the Sepia child is very often liable to faint.
Then, all these Sepia kids, of course-like very Sepia patient- are sensitive to cold; and in children they are particularly sensitive to weather changes, and the typical Sepia child will develop a cold from change in the weather apparently without any contact with infection.
Then there is another thing that is a useful lead towards Sepia in children, and that is that they are upset by milk very often; they get a digestive upset and you put them on milk diet and the Sepia child will be certain to be constipated.
The, associated with their s allow, greasy skin Sepia children usually tend to sweat pretty profusely, and they are very liable to develop very itchy skins without much sign of an eruption, and without much comfort from scratching.
There is one other drug I want to tack on there before we finish, because it comes in after Sepia better than anywhere else that I know, and that is where you meet with this sallow, dispirited, sluggish type of child-where you meet with that depressed, negative attitude you have always got to consider the possibility of Gold or one of the Gold salts. The typical Gold child is always an undeveloped child.
It isnt so much a question of undersize and underweight as it simply doesnt grow up. The typical Gold child of 5 years of age is probably about the level of 3. The majority of cases in which I have seen Gold indicated have been in boys, and in the majority of these cases there has been some failure of development- an undescended testicle, a very poorly developed-an undescended testicle, a very poorly developed scrotum-something which made you feel that child was slow in developing of developing satisfactorily; again the sort of thing one thinks of Baryta carb. for.
Next thing, the Gold child always gives the impression of being lifeless. They are always low spirited, rather miserable, lifeless, and for a boy they are absolutely lacking in to; they have no initiative at all, and they give you the impression of finding everything a frightful effort. Then you always get the report from school that they are backward, and that they have very, very poor memories. One of the odd things about them is that, in spite of this dull, depressed, miserable, lifeless sort of creature the thing that they do respond to is contradiction; you think he is a kid with no go in him, and he makes some statement and is contradicted and he flies into an absolute rage; it is the thing that does stir them up.
Then, another thing that is constant, and is rather surprising in the type of child as they give the impression of being sluggish, is that they have a weird hyperaesthesia to pain; they are terrified of it and horribly sensitive to it. And, in spite of their sluggishness, they are very sensitive to noise and they have a very acute sense of taste and smell.
They are very liable to get very persistent, very troublesome catarrh; they have very definitely infected hypertrophied tonsils, and always practically with a lot of offensive secretion struck in the tonsillar crypts. They get hypertrophied adenoids, again with a very offensive nasal discharge. And with the tonsils and adenoids they are very liable to get attacks of acute otitis with perforation of the drum, and very often a stinking, purulent ear discharge.
Another thing about them is that if they are forced to exert themselves they very easily get out of breath, and they may get suffocative attacks where they have acute difficulty in breathing, without any obvious physical cause.
Another odd characteristic of the Gold child is that they are frightfully sensitive to any disappointment; they will grieve over it for days, quite out of all proportion to the normal childs reaction. And associated with that you can always tack on the other typical Gold symptom, which is that the parents will often tell you that the child sobs in his sleep, without waking up and apparently without having been distressed the night before.
I THINK last week when we finished up we had just run through Aurum met. with its usual depressed outlook, and there is another drug which has got a very definitely sluggish condition which is sometimes a little like Aurum and that is CARBO VEG., although you have got an entirely different cause for it. In Carbo veg. kids the thing that strikes you about them is that they are definitely sluggish, but it is more a physical sluggishness than a mental and results from physical stagnation not from any lack of brain capacity.
They are slow in thinking; they are dull mentally; they have a slow reaction time; and they are lacking in go of any kind. They are very easily discouraged, rather dispirited and miserable sort of kids, and if they are pushed they become peevish, but it is a futile sort of peevishness without much bite about it. Then, associated with that general mental sluggishness, there is always sluggishness of circulation. They are very often heavy, sallow complexioned children, and they always tend to have bluish extremities, bluish fingers, bluish toes, and the extremities are always cold.
Then the next thing about them is that if they are pressed at all at school, made to work, they are almost certain to develop a dull, occipital headache. And they are very liable to get the same kind of headache they get a complete inability to work, to concentrate, almost to think. And very often you get a history that the child has been pushed at school, is developing headaches like that, seems dead tired in the evening, and yet it gets the most violent nightmares, so much so that the kid is almost terrified to go to bed, particularly to go into the dark.
The kind of nightmare they get is they see ghosts, they see faces, all sorts of terrifying spectres. Associated with that you can link up the other thing that these cold sluggish kids are very liable to get very hot and sweaty at night, particularly the extremities, but it is pretty general, and the Carbo. veg. kids are awfully liable to have a sour smelling sweat.
Then another thing that you can always link up with the Carbo. veg. sluggishness of circulation is that they tend very easily to get a pretty persistent epistaxis; you very often get a history of these kids having a severe epistaxis in the night.
Then another thing associated with their general sluggishness is that they are mostly constipated. They mostly have digestive difficulties and tend to have big bellies; they get a lot of flatulence. They very easily, in spite of their constipation, get attacks of diarrhoea – a very offensive, watery, diarrhoea – and then they return to their constipated state again.
And with their digestive difficulties they very often have pretty marked likes and dislikes in the say of food. They like sweet things – which very often upsets them – they like to have their appetite tickled with something with a bit of taste so they like salt stuff. With their general sluggish digestion they are upset by fat things, rich food of any kind, very often they develop a definite aversion to fats, and very often they have a marked aversion to milk.
Then the other thing that is pretty constant about all these Carbo. veg. kids is that they are not primarily Carbo veg. children, that this condition has developed as the result of some preceding illness, sometimes it is a case of measles, sometimes an illness like bronchitis or pneumonia very often influenzal in origin, and it very often dates from an attack of whooping cough.
Well, I think that pretty well finishes the group of sluggish drugs. That is how I always classify them in my own mind.
The next group that I wanted to take up is the group that is headed by GRAPHITES. This third group I think I tend to associate with definite skin eruption kids. You may require practically any of the other drugs we have mentioned for skin eruptions, for instance Carbo veg. kids have a very obstinate eczema of the scalp, Calcarea kids have eczema of them scalp, Causticum kids have a lot of skin eruptions.
You may get a very obstinate eczema of the scalp with Sepia indications. But this Graphites group is the group that I tend to think of when a child comes up with a definite skin history. I think there is a tendency with children wherever you get an irritant skin to push in a dose of Sulphur, and I have seen so many cases where that dose of Sulphur has done hard that now I am chary of starting with Sulphur in these skins with children.
The typical Graphites child is a fat, heavy child. It is usually pale, very little colour, it is always chilly, and it is practically always constipated. Well, in the majority of instances where you have got that obstinate constipation in the small child you get the enlarge abdomen, but that is so constant that one does not stress it.
The next thing about the Graphites kids is that they are always timid. They are rather miserable, and they have a complete lack of assurance. You find in the slightly older kids that they hesitate over what they are going to reply to any questions you give them; you get the report from the school that they are indefinite, there is the same hesitation there; and most of these Graphites children are lazy, they have an aversion to work.
And then you get a queer contradiction in the Graphites children. With that uncertainty and hesitation. laziness, general physical sluggishness, you always get an element of anxiety in the Graphites kids. They always tend to look on the hopeless side of things; if they are going to a new school, say, they dread it. They are always looking for trouble.
Then the next thing that you notice under the Graphites kids is that, associated with their pallor, under any stress at all they flush up-they have got a definitely unstable circulation. And under stress, when they are excited, with this flushing you very often get a history of not awfully profuse but troublesome epistaxis; but it comes on under excitement- that is the diagnostic point.
Then the next thing that is pretty constant about the Graphites kids, and at once distinguishes them from the Calcarea children who look not unlike them, is that, instead of the soft sweaty Calcarea skin, in Graphites you have a harsh dry skin which tends to crack, particularly on exposure to cold, and you find if these Graphites kids have been playing in water in cold weather they come in with their hands absolutely chapped and bleeding. Then, associated with that dry harsh skin, you get the Graphites skin eruptions, and the type of skin eruption is pretty constant no matter where it is.
You get, as I say, cracked fingers which tend to bleed, but they also ooze a sticky thick yellow serous discharge. You get exactly the same kind of condition in any of the folds in Graphites, the back of the ear, canthus of the eye, angles of the mouth, in the groins, bends of the elbows, round the wrists, and particularly about the anus and there you get deep painful fissures oozing a thin, sticky yellowish discharge. Then the next thing about them is that as the discharge dries it forms thick crusts which simply pile up and they go on secreting stuff underneath them; the crusts come off and you get the same kind of gluey yellowish discharge, very often streaked with blood.
Then you can link that on to one or two other typical Graphites symptoms in children. They are very liable to get a very persistent purulent nasal discharge. You are very liable to meet them with a chronic otitis, maybe with a perforation of the drum, and again the same kind of yellowish excoriating discharge, with an irritating eczema of the external ear wherever the discharge runs over.
And, associated with the purulent nasal discharge, many of these Graphites kids have got marked hypertrophy of the tonsils, with a lot of offensive secretion locked up in them, and they often complain of difficulty in swallowing in consequence.
Then, you very commonly see these kids with a chronic blepharitis and the history you get is that the childs eyes are completely stuck in the morning with the same sort of gluey discharge. And when you see them you find that discharge dried across the edges of the lids.
Then another thing about them is that, in spite of their apparent fatness, they are flabby, and there is a general muscular weakness. They are very easily tired out. They are sensitive to motion of any kind; they stand travelling very badly. And you are very liable to get a history of rheumatic pains, particularly, in kids, affecting the neck and the lower extremities.
Then there is another Graphites symptom which is sometimes useful in that sort of flabby kid – they are very liable to get attacks of abdominal cramp; and if you consider their constipated state you are not surprised. The thing about the abdominal cramp is that in Graphites the mother will often tell you that they can relieve the abdominal pains by giving the child some hot milk to drink.
Then, as regards the constipation in the Graphites child. In the majority of cases, with the constipated stool they pass a quantity of mucus-stringy, adherent mucus. It links up quite well with the type of discharge you get from the skin surfaces, though it isnt commonly yellow.
Then the other thing that is useful when you get it, and again it is pretty common, is that these Graphites kids have big appetites; they are hungry children; they are upset if they go long without food; they are better for eating. And yet, in spite of their appearance of fatness and flabbiness, there is often a very marked aversion to sweets, it is surprising when you look at them.
And where you are dealing with an adolescent Graphites it is still more surprising because there you have the same sort of flabby, fat, soft adolescent with, instead of the ordinary cracks behind the ear or cracks at the corners of the mouth or blepharitis, you get an acute acne, and one of the question you always asks is “do you eat many sweets”? and if it is a Graphites you are told, “no, I cant stand them at all” which is sometimes a very useful tip.
Then another point about their appetite which you can very often get in the young children is that they have a definite dislike of fish. You know it is part of the normal constituent of a young childs diet, so you can very often find it if there is anything of the kind; and most of these Graphites kids have a very definite dislike of fish.
Then, where you are considering these children with chronic ears, chronic discharge from an old perforation, possibly with an eczema of the external ear, there is another drug which always has to be considered, and that is CAPSICUM.
Well, the typical Capsicum child to my mind is again a fat, rather lazy, somewhat obstinate child who is very definitely clumsy in his movements – I have never yet seen a neat Capsicum child. The next thing about them is that mostly they have got an appearance of rather reddish cheeks, but that is by no means constant, they may be pale and flush up much like the Graphites child.
The next thing about them is that they tend to be very forgetful. They will be sent on an errand and will come back without what they have been sent for. It is partly lack of attention. And the next thing is that they are always touchy, easily offended easily irritated. And then a thing comes in which always strikes me as odd in the Capsicum children, and that is that they have a strange dislike of being away from home. I think it is partly their feeling that they are not appreciated, partly their touchiness, and partly laziness-they have to make an effort if they are away from home, they have to be more or less agreeable and at home they are very often quite unpleasant.
Then always the Capsicum children are rather dull; they are slow at learning in school, and their memories are poor.
Then next thing about them is that they tend to have local hyperaemias. If you get a typical Capsicum child with a mild earache you find the whole external ear a bright crimson. You get a Capsicum child with a rheumatism, it is usually one or other joint that is affected, and you get a localized blush over the affected area.
If you get a Capsicum child with a cold they get very much enlarged tonsils and they are very hyperaemic-bright crimson – and associated with that the child complains of a burning heat in the mouth with pretty intense thirst. There is one odd symptom in Capsicum which you sometimes meet with in these kids with sore throats running usually a pretty high temperature, the child very flushed, cross, sleepless and thirsty; they want cold drinks, and yet you find them shivering after they have taken something cold to drink.
I have seen that repeatedly in a child with a sore throat who is gong on to a definite mastoid symptoms. And where you get a mastoid in Capsicum – and it is probably the most commonly indicated drug for mastoid – you always get marked tenderness over the mastoid, and you get a blush on the skin surface long before you have got a definite mastoid involved.
One of the nuisance of these mastoids in Capsicum kids is that they usually blow up at night; the child becomes extremely irritable, sleepless, worried, the mother can do little or nothing wit it, it is as obstinate as a mule, and they send for you and you have to look at it in artificial light and you cant see the blush. Time and again I have seen these Capsicum kids and couldnt make out the blush at all, but when I saw them next morning in day-light there it was perfectly obvious.
Then, associated with the tenderness over the mastoid, I usually link up the general hyperaesthesia you find in Capsicum; they are sensitive to noise, sensitive to touch, and they have a hyperesthesia to taste.
Then in the majority of Capsicum kids in their acute illnesses you will get some degree of urinary irritation. You may get an a cute cystitis with an acute burning pain, intense irritable pain on passing urine, and it is always of the same burning character; but even without the acute cystitis in the majority of their acute illness they get some urinary irritation, and it is always of a smarting nature.
Then where you meet with a child of that type, clumsy, rather red cheeked, rather sluggish, backward, with a chronic hoarseness and a history of having had acute sore throats-not quinsies, just acutely inflamed throats – very often with transitory attacks of earache, not going on to a mastoid, but with chronic hoarseness, in the majority of cases you find that is a Capsicum child.
Well, that comes in there because of its association with the ear condition, but the next of the skin drugs in the children is PSORINUM.
The Psorinum children are pretty common. I think the majority of Psorinum children tend to be thin rather than fat. They are always sickly children; they have got very little stamina; they are easily exhausted by any effort physical or mental; they are very liable to become mentally confused under stress; they are rather dispirited, hopeless youngsters, and like all kids when they are out of sorts they become peevish and irritable.
Then I think the next thing that strikes you about them is that they are unhealthy looking. They look dirty and unwashed. You will practically never see a Psorinum child who hasnt got a pustule of some sort somewhere about the body. The skin condition – I think more commonly in the children – is a very rough, dry skin. In the adolescent Psorinum I think it is much more commonly greasy. But whether in the child or the adolescent on exertion the Psorinum kids tend to sweat, and they are always unhealthy, smelly.