Then you get a skin condition under Psorinum which is not unlike the Graphites skin, that is to say, there is a tendency for fissures to develop about the hands and in the folds, but you do not get the honey like discharge of Graphites, you get a watery discharge or you get a purulent discharge, and it is always offensive; and in all the Psorinum skin conditions you get intense irritation.
Many of these Psorinum kids suffer perfect torture because they are intensely chilly, feel the cold very badly – they are upset by it, and yet they have this horribly itchy skin and they are driven nearly dotty by being put into woollen clothes.
Then the next thing about them is that with this dirty looking gray, rough skin the Psorinum kids are very generally upset by washing, and the irritation of their skin is vastly increased by washing.
The next thing about them is that practically all the Psorinum kids, in spite of their thinness, have got abnormal appetites, and one of the constants of Psorinum kids is that any lack of food brings on a violent headache, very often a definite sick headache.
Then, if you see a typical Psorinum skin child you very often have it coming in practically bleeding, the skin irritation is intense, you find the kid scratching its face until it runs blood, in between the scratches there is a filthy pustular eruption, very often associated with a generalized blepharitis. In the acute condition you might think it a Graphites, but it is much more acute, often with the eyelids a bit everted looking almost like raw beef. You get the kid stripped and you find the same scratches all over the body, and again the same purulent condition.
You get exactly the same kind of eruption on the scalp; you find the Psorinum kids never at peace, nearly driven distracted, rubbing their heads against the pillow, and with that you get a yellow, purulent nasal discharge, excoriating the upper lip, and very often you will get a purulent otorrhoea which simply stinks.
Well, that is the kind of intensely irritant skin condition which you will only cover with Psorinum, and for which you are tempted to give all sorts of other things.
“Do you always give Graphites to cases where asthma has developed after eczema has been cured?”.
I have never yet seen an asthma child with a skin history who responded to Graphites. I have tried it but without result. These suppressed skins with asthma developing afterwards are frightfully difficult. My experience is that Graphites fails altogether. It is in Kent I know. But it has not worked in my hands. All sorts of other things have been successful, such as Psorinum, Antimonium crud., Natrum mur., Sulphur. Thuja has quite frequently, and I think if I had no other lead I should probably start on Thuja.
Incidentally, associated with the Psorinum nasal discharge, Psorinum is much the most commonly curative drug, in the interval, for hay fever cases. There you have got a very similar hyperaesthesia in the mucous membrane as you have on the surface in Psorinum kids, and a dose in the spring I have seen repeatedly wipe out hay fevers of long standing. I have never seen it help in the acute condition, but given in the spring – Psorinum gets a spring aggravation – I have seen it stop hay fever altogether.
I think we finished up Psorinum last day. Well, there are two more of these common skin eruption drugs which we have got to consider, and it doesnt matter which order we take them in. I think possibly the best is to take Antimonium crud. first and then Petroleum: and the reason is that the Antimony crud. children with skin eruptions have got just as marked aggravation from washing as the Psorinum cases.
The Antimony crud. kids are very interesting. They are always fat, rather over-weight, usually pale, and they have a very marked tendency to get a redness round about the eyes, very often moist eruptions behind the ears, and 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 kid that will cry if anyone looks at it and the more you attempt to soothe it the worse it gets.
You very often get a history of the Antimony crud. kid having night terrors, cross and irritable, and the more the mother attempts to nurse it the worse it becomes, walking it up and down like a Chamomilla kid drives it nearly distracted.
Then, as a contrast to that, there is the other side of the kid. They are very impressionable children, sensitive, they are 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 very liable to faint.
Then the next thing is that with these Antimony crud. kids in their skin eruptions they tend to get very large, crusty, smelly eruptions – the typical crusty impetigo that you see on a childs face. I think I have seen more cases of impetigo in children clear on Antimony crud. Than on any other drug in the Materia Medica. And in adults I should think nine out of ten cases of acute impetigo do clear on Antimony crud.
There is another point about them, and that is that all their skin eruptions, no matter what they are, are made very much worse from water, application of water in any form, and they become very inflamed and painful from exposure to radiant heat, sitting in front of a fire will simply blow them up.
Then the next thing in the Antimony crud. kids is that they are very clumsy, and they get very jerky in their movements and you may get an actual chorea.
Practically all these children suffer from warts on their fingers, you may get one or two small ones, or you may get masses of warts; they are usually flat; they are not usually very painful. Associated with their watery condition, most of these Antimony crud. children tend to have rather deformed nails – thickened and unhealthy looking.
Then there are two other points about the Antimony crud. kids which you always get, and one of them is that you are very liable to get digestive upsets from any acids, sour fruits, sour drinks. And the other point about them is that you always in the Antimony crud. children get a soft, flabby, coated tongue – it is a white coating as a rule. It is much like a Mercury tongue with a white coating.
I think that pretty well covers the outstanding points of the Antimonium crud. and you will see it is not unlike the Petroleum, at least as far as the skin conditions are concerned.
But in the majority of cases where you have got indications for Petroleum you will get a thin child rather than a fat one. And associated with this loss of weight in the typical Petroleum case you have got a good appetite, very often a plus appetite, and very often there is a history of the childs being hungry between meals.
Then the next thing about the Petroleum children is that they are just about as irritable as the Antimony crud. kids, but it is from a quite a different cause; they are much more quarrelsome, and they easily take offence. You will very often get a history from the parents that the child is quite bright mentally, and yet is lazy at school, it doesnt want to work, and is inattentive and forgetful.
They are practically always sensitive to noise and quite scared from any sudden noise, loud noise, which they dont understand. They are very liable to be nervous of crowds – crowds of people. Then they are just as sensitive to cold as the Antimony crud. kids or the Psorinum kids.
Then, in appearance you practically always find some signs of skin eruption in the Petroleum children, and much the commonest is an eruption at the back of the ears, deep cracks which are oozing a yellowish, watery fluid. And very often these cracks tend to split and bleed.
But you will get the same sort of cracks any place in the Petroleum child, particularly in any fold, you get similar cracks at the corners of the mouth, you get cracks at the angle of the nose, and very commonly you get similar cracks round about the anus, in the groins, or in the axillae; and the fluid that oozes out of them tends to crust up and they get thick crusts which are always very sensitive.
Then practically all the skin eruptions in Petroleum itch. They are very liable to be more irritable, I think, during the day than the night, which is sometimes a help because it is occasionally a little difficult to distinguish them from Sulphur.
Then the next thing about the Petroleum children is that they are very liable to catch cold, and with their colds they get an acute nasal obstruction, with an excoriating discharge, tendency for the nose to get crusty, sensitive, bleeding, and very often crusts on the upper lip and round about the sides of the nose.
And with these nasal discharges you almost always get some deafness, very often with acute pain in ear, and a sensation as if the eustachian tube was blocked up. They do quite frequently have an otitis, with the same kind of watery, yellow discharge, and very marked redness of the external ear, an acute eczematous condition, again with the irritation and the tendency to bleed.
Then another thing that you can link up with their itching is that they get very definitely itchy eyes, and very often you get a blepharitis, reddened margins, but they particularly tend to get cracks at the inner canthus, and they are quite liable to get an infection spreading down the lachrymal duct – you may even get an abscess in the lachrymal sac. You can very often squeeze pus out of the lachrymal duct and you get excoriation running down the side of the nose, raw and bleeding. With that, of course, you may get an acute conjunctivitis.
Then, with the amount of infective processes you have got going on in the throat and nose it is very common in these Petroleum children to get an enlargement of the submaxillary glands.
Then another thing that you very commonly get in the Petroleum children is a history of some bladder irritation; it is very often an enuresis, but it is much more commonly an acute irritation, it may be an acute cystitis, and again you get the same description of the sensation of rawness and smarting.
Another very common feature in the Petroleum kids is that after any exposure to cold they are liable to develop acute abdominal colic and diarrhoea. And with their diarrhoea they always get a degree of inflammation about the anus and perineum, with again he burning, red, raw eruption.
Then, another point about the Petroleum kids is, that 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, and they get quite deep fissures, which again split open and bleed easily.
Then, of course, all these Petroleum kids have the typical Petroleum aggravation from motion, that is to say, they get train-sick and sea-sick; and there is one other point which is sometimes very helpful and that is that you quite frequently get a history from the parents or the school that with that rather poor mentality 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, and Petroleum sometimes helps you out.
By the way, incidentally if you ever get a case of sea-sickness and you are in doubt between Petroleum and Tabacum, which is the other common drug for sea-sickness, you almost always get that occipital headache as well as the sea-sickness in Petroleum and the Tabacum people have not got it at all. So if you get sea- sickness with occipital headache give Petroleum every time. You quite frequently get patients coming in for prophylactic treatment against sea-sickness and it is very difficult to spot if they are going to be Tabacum or Petroleum, and if you remember the occipital headaches of Petroleum kids it puts you on to the Petroleum sea-sickness at once.
Well, of course, there are various other drugs which come in the skins in children but I think these are much the commonest. Of course you immediately think of the possibility of Sulphur because Sulphur is almost automatic in skins, but I think it is better to take the question up with Sulphur in general under the next group.
THE way I usually group the next crowd are the warm-blooded drugs, that is to say, starting off with Pulsatilla which is the most commonly indicated warm blood drug in children, and following on from that.
Well, it really seems like a waste of effort to attempt to describe a Pulsatilla child to you because you all know them as well as I do. They are very typical. I think they run into two types, you either get the very small, fine Pulsatilla type, with a fine skin, fine hair, an unstable circulation, liable to flush up from any emotion, very often going pale after it, definitely shy, sensitive, always affectionate, very easy to handle, and always definitely responsive.
Or you get the other Pulsatilla type, which is much fatter, with definitely more colour, usually rather darker hair, a little more sluggish in reaction, a little more tendency to weep rather than to bright and gay as the smaller fine Pulsatilla is, rather craving for attention without so much response to it, always asking for a little more. And if you get one picture clear you are apt to forget the other one.
The thing that is common to both of them is their temperature reaction, all the Pulsatilla children are sensitive to heat, they flag in hot weather, they lose their life, they lose their sparkle, their energy, they hang about, they either get tearful or irritable, and they are very liable to get digestive upsets. But they are much more liable to get digestive upsets.
But they are much more liable to be upset by a to get an attack of acute sickness from being chilled in hot weather, they are liable to get an attack of diarrhoea from being chilled in hot weather, they are liable to get cystitis, they are liable to et earache; but it is the sudden chilling during the heat; they are flagging in the hot weather, no energy, no life, but their acute conditions are much more liable to be brought on by chilling. In exactly the way they are liable to be upset by taking ice cream in hot weather; it is quite as common as the ordinary Pulsatilla aggravation from too rich food.
Then I think sometimes one misses a Pulsatilla case because of their odd reactions when they have got a feverish attack. These Pulsatilla kids very often get acute colds in their head acute coryza, and very often with their acute colds in the head these Pulsatilla kids get shivery, they feel very chilly, they very often, with their coryza, get a certain amount of gastric catarrh too, a feeling of nausea, and they may actually vomit; and yet, in spite of their chilliness, their sense of blockage in the head is better in the open air, it is worse in a stuffy room, and you will never get a Pulsatilla cold that hasnt got a bland discharge.
Then again, with these colds you sometimes get an apparent contradiction too, because with their colds they are very apt to get a conjunctivitis, and it is pretty marked in Pulsatilla, and in the Pulsatilla conjunctivitis the eyes are very sensitive to any cold draught, they simply stream water in the open air. There is usually pretty definitely photophobia in Pulsatilla and a good deal of itching of the eyelids, and of course the Pulsatilla kids are always apt to get styes, particularly affecting the lower lid-the lower lid rather than the upper.
Then there is one point that is sometimes a help in the Pulsatilla earaches which are very intense, and, as I say, are usually brought on from exposure to cold; they get very violent pain, which seems to spread all over the side of the face, as well as into the throat, and if the condition has gone a little farther you often get the Pulsatilla patient describing the condition as a feeling of absolutely bursting out of the ear. The other thing that helps you, of course, is again the amelioration from cold-their earaches are better from cold applications.
Then there is one other thing about the Pulsatilla kids and that is that you very often find them tired and edgy and sleepy during the day, and yet they seem to become more lively as the day goes on, they are liable to get the Pulsatilla nervousness just about sunset, the ordinary sunset aggravation of Pulsatilla, and then become very lively towards bedtime, slow of going to sleep, and once they have they tend to get nightmares, night terrors, usually some kind of strife drams, it may not be particularly being chases by the black dog of Pulsatilla, but is is always something worrying, terrifying. And, of course, most of these Pulsatilla kids are afraid of the dark, afraid of being left alone, just the sort of thing you would expect in that shy, nervous type of child.
There one thing that will produce a night terror in the Pulsatilla child, and that is telling them ghost stories in the dark before they go to bed; you can practically bank on that Pulsatilla child having a nightmare that night.
Then there is one other tip which is sometimes useful in spotting the Pulsatilla children, and that is they are awfully liable to become giddy from looking up at anything high. The only other drug that I know that has it so marked is Argentum not., it has an aggravation from looking down, but it has also an aggravation from looking up, but I think Pulsatilla has it very much more marked than Argentum nit.
Then the other thing that is sometimes a help, although it is by no means constant, is the position that the Pulsatilla child takes up in sleep, that is to say, lying with the hands up above the head.
I think that gives you a fairish sketch of the type of child you are dealing with.
And on to the Pulsatilla kid, the hot-blooded child of that type, the next thing you always consider is the possibility of whether it is Pulsatilla or Kali sulph. Well, Kent says that Kali sulph. is merely an intensified Pulsatilla. Personally I dont think it is. The Kali sulph. temperature reactions are identical with the Pulsatilla ones, that is to say, the child is sensitive to heat and it flags in the hot weather, cant stand stuffy atmospheres, is better in the open air, tends to stagnate if keeping still, and is better moving about.
It has got an aggravation from rich food. It is liable to be upset by sudden changes of weather. But I think there is a definite difference, I think the Kali sulph. child is much more flabby than the Pulsatilla child, it certainly does not approach the thin fine type of Pulsatilla 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 it has got a much more sluggish reaction generally. And there is much more obstinacy in the Kali sulph. than in the typical Pulsatilla. Pulsatilla may be irritable, it may flare up in a temper but it is over; Kali sulph. is much more liable to be obstinate.
Then then Pulsatilla kids are shy, but the the Kali sulph. children tend much more to have a lack of confidence in themselves-it isnt shyness. And they are lazy, they dislike work and you dont get the keenness and interest that you get in the Pulsatilla children. And the Kali sulph. kids are not bright, they get tired out by mental exertion, whereas the Pulsatilla kids are very often bright and sharp and do quite well at school.
Then there is a certain amount of similarity again, they are both nervous, they are both afraid of the dark, they are very easily frightened, easily startled at strange noises, strange surroundings.
Then, I think the typical Kali sulph. child tends to be more sickly than the typical Pulsatilla child; the Pulsatilla kid may not be strong, but the Kali sulph. kid tends to have less colour and if they are flushed it is much more a circumscribed flush on the cheeks rather than the variable circulation of the Pulsatilla.
Then another thing that very often helps you to spot a Kali sulph. rather than a Pulsatilla is that in practically all the Kali sulph. children you get a yellow coated tongue, particularly the root of the tongue, although the coating may spread right over.