Then another point that is sometimes a help is that there is a slight difference in the type of discharges you get in Kali sulph. and Pulsatilla. The typical Pulsatilla discharge is a thick, creamy, non-irritating discharge; the typical discharge in Kali sulph. is a much more watery, more stringy, yellowish discharge.

The, as far as their liability to actual acute illness, I think you are much more likely to want Pulsatilla for the acute gastric catarrh, the acute gastritis, the acute colic and diarrhoea; but if you have a gastritis that has gone on to a jaundice in a Pulsatilla type of child you are much ore liable to get indications for Kali sulph. rather than Pulsatilla.

And again, if you have got a Pulsatilla type of child who has caught cold, who has developed a bronchitis and the bronchitis has gone on to a broncho-pneumonia with the ordinary Pulsatilla indications, that is to say aggravated from stuffy room, relief from air, sense of suffocation, possibly a loss of voice, very dry mouth without much thirst, and where you have got a yellowish, watery sputum, probably patches of consolidation at the left base-left base more commonly-you get better response from Kali sulph. than you will from Pulsatilla.

And again, if you have got a whooping cough in Pulsatilla child, with a lot of rattling in the chest, of the ordinary Pulsatilla modalities, Kali sulph. does you much more good than Pulsatilla.

You see, that, I think, is what Kent means by saying Kali sulph. is Pulsatilla intensifies-in these acute conditions their symptoms are very similar and yet the more severe the condition the more definitely you get indications for Kali sulph. But where you are prescribing on the type of child I think there are very definite difference between the two.

“What potency of Pulsatilla would you use usually?”.

Usually low in chronic case; they are usually sensitive kids, and where you are dealing with the sensitive type you dont want high potency. Where you are dealing with bovine types I go high. But where it is sensitive type like Pulsatilla they simply blossom on a 30. Phosphorus is exactly the same thing, Phosphorus children respond beautifully to lower potencies.

“What potency do you give for impetigo?”.

I have found very good results from Antimony curd. 12, repeated three times a day for two days, or something of that sort.

“What about Calc. carb. or Graphites?”.

Calc. carb. or Graphites I would give high every time-a 200, or higher.

WELL, for my sins, you asked me to talk about Sulphur to-day, and it is a little difficult to know where to begin and how to tackle it. But you have got to remember that here we are talking about the drugs that apply to children much more than the general picture of the drug, which does make it much more simple.

From the point of view of children, I think there are two definite Sulphur types that you can recognize. I think much the commonest Sulphur child that you see at least that we see here is a fairly well-nourished, well-grown child, always with a definitely big head. They are usually fairly heavy in build and rather awkward and clumsy in their movements. They are apt to have a very coarse, strong hair, and they always have a fairly high colour. Their skin tends to be roughish, it will roughen in a cold wind, and they tend to have rather red extremities, red hands and very often red feet.

Then the next thing about them is that they always have very red lips, very often red ears, and they easily run to redness of the margins of the lids. That is one of the places that you do get the exception to your coarse hair, because that type of Sulphur child very often has poorly developed eyelashes; they have had repeated attacks of blepharitis, they have crusty eruptions about the eyelids which they have picked and scratched, and consequently the eyelashes tend to be undeveloped or poor.

Well, that is much the commonest type in appearance. I will go into a little more detail in a moment, but that is the commonest type we see here.

There is another Sulphur type, which is thin usually, with a fairly big head but rather spindley legs, very often with a biggish abdomen, rather a poorly developed chest, very often not so much colour, tending to be paler, with a definitely rougher skin the other type of Sulphur tends to sweat pretty easily, this is a dryer skin, coarser skin, a very marked tendency for the skin to split, to crack, on exposure, and the child is rather more miserable generally. The child looks more seedy, it has got less vitality, it is more easily tired, and it always stands badly.

Then the next thing that is pretty definite about the Sulphur kids again I think they differ in type, where you are dealing with the heavier Sulphur type I think you get much more bite about them, they tend to be quarrelsome, impatient, rather critical, fault-finding, discontented, very often generally dissatisfied, they are apt to feel they are not getting a fair deal, very often feel they are being underestimated, and they are lazy.

But it is very difficult often to say whether it is real laziness or lack of stamina, because they do get tired out on exertion. Another thing that you will commonly come across in that type of child is they have a great dislike of interference, they think they know how to do a thing, they know what they want to do, and they very definitely resent their parents butting in, they would make a better show of it if they were left alone they think.

Then the thin Sulphur type, I think, are much more inclined to be miserable, low spirited, much less vitality, much less bite about them; but there is the same sort of resentment of outside interference; it shows itself differently, these thin Sulphur kids are liable to weep, and any attempt to comfort them is apt to annoy them, then they will spit I dont mean literally, but figuratively! and these thin Sulphur kids have got even less stamina than the fat ones, they are more easily exhausted and, like all the Sulphur patients, it is exaggerated in that type of child that they cannot stand for any length of time; they stand badly in the ordinary instance, and if they are kept standing they simply go to bits. .

Then there is one outstanding characteristic of all Sulphur patients, whether children or adults, and that is that they have got a pretty hefty appetite it doesnt matter whether they are fat or thin and their appetite is pretty definite in its likes and dislikes. You will find all Sulphur patients with a desire for something with a taste; they like highly seasoned, spiced foods. And the other thing that you will get in all Sulphur patients is they have got a very marked desire for sweets.

You occasionally get a Sulphur patient craving for salt, but it isnt really salt they are craving for, it is much more something with a taste. And another point which I think you will always find in the Sulphur children is that they have an almost perverted desire for out-of-the-ordinary food, the unusual dish that the average child jibs from the Sulphur child mops up with avidity. That is one constant feature.

Another constant feature that you meet in children and adults is that they are always very sluggish after meals, they get heavy and sleepy, they want to lie about, and they are irritable if they are disturbed.

And, in connection with their food, there is one very useful point in children Sulphur children and that is that they are very liable to get digestive upsets from milk. The small Sulphur baby very often gets sickness, it may get diarrhoea and vomiting, from milk, and it is one of the drugs that one tends to forget as having the marked milk aggravation.

Then the next thing that is constant to all Sulphur patients is their skin irritation. You practically never come across a Sulphur patient who has not got irritation of the skin somewhere, and there are one or two characteristics features of the Sulphur skin at least of the Sulphur irritation. The first thing is that it is very much worse in warmth of any kind, warm room, warm bed, warm sun, warm clothing, all set up the Sulphur irritation.

The next thing is that when the irritation is present they do get definite comfort, and they sometimes get a peculiar sensation of pleasure, from scratching, and occasionally the scratching does relieve the irritation. Then the next thing about it is that it always tends to be much more troublesome at night, and that is apart from being hot; very often when they are about, active and occupied, during the day the irritation does not worry them much but when they are at rest in the evening or at night the irritation tends to become much worse, and much more worrying. Then, of course, you link on to the irritation all the Sulphur skin conditions.

Well, Sulphur has every skin eruption that is known to the dermatologist. And the only point that does distinguish it as a Sulphur eruption is its reactions to temperature, and the fact that it always irritates. It is an intense irritation that they cant leave alone; they describe it in all sorts of ways itching, feeling of animals crawling over the skin, sensation of stinging of nettles, any description that describes an intense irritation of the skin.

Another point that you tack on to the general surface irritability is that in Sulphur kids you tend to get very marked irritation of all the orifices, nose, ears, mouth, urethra, anus, any orifice tends to be congested, red, hot and itchy.

Then there is another point which is sometimes helpful in the Sulphur children. You know, of course, that the Sulphur patients are aggravated by heat, but one of the things one is apt to forget is that the Sulphur patients have an unstable heat mechanism; they are very liable certainly in feverish conditions to get waves of heat and waves of chilliness.

You very often get them becoming horribly hot, breaking out into a sweat and getting shivery very much the sort of condition that you associate with Mercury. You cover them up and they get hot and beastly uncomfortable; you uncover them and they get a draught on the surface and they are immediately chilly. So dont always be put off from Sulphur by the fact that the kid does not necessarily want to be uncovered all the time.

Then the next thing about the Sulphur patients which is constant no matter what their condition, whether it is a skin eruption, or a child with rheumatism, the child with a tummy upset, no matter what it is, it is aggravated by bathing. And, as you know, practically all these Sulphur kids look dirty.

Associated with that, there were several kids that we used to see in out-patients who at first sight were not unlike Calcarea kids, that is to say, they were heavy, had big heads, were rather pale with a tendency to flush, rather big bellies, clumsy; and yet they hadnt the Calcarea chilliness, they were hot-blooded, and they had a very marked tendency to the development of blackheads all across the forehead. These kids were practically all Sulphurs. They had rather paler lips than the average Sulphur children, and at first sight one wouldnt have spotted them, but, with these blackheads scattered about over the forehead particularly, always look out for the possibility of the child being a Sulphur child.

Then there is another contradiction that one sometimes meets with in the Sulphur kids. You except them to be horribly hot, but you will meet Sulphur children who have disturbed areas of heat; they have hot heads and cold hands, or they have hot hands and cold feet, or they have hot feet and cold heads very often cold, damp heads so that you get local disturbances of heat and cold just as you get the general disturbances of heat and cold. So that again if you get a child with cold feet dont automatically rule out Sulphur because it does not put its feet out of bed.

Then there is another typical Sulphur characteristic, and that is that they are sluggish. They are better for exertion, they are better when they are stimulated, and they are better when they are moving about. I know quite a number of Sulphur patients who can be the most lethargic, dull, uninteresting people and yet if they are stimulated in the proper kind of society they wake up; they are clever; and you wouldnt recognize them as the same beings. You get exactly the same with Sulphur children; badly handled they are dull, heavy, cross, irritable; and properly handled they can be bright, interesting, quite friendly, and very often clever. I have seen some of these Sulphur children with the most astonishing command of language not necessarily unprintable!.

You see how you just tack all the things on together.

Then there is another pretty constant characteristic of all the Sulphur children, and that is constipation; the majority of these Sulphur kids suffer from more or less constipation, very often it is quite extreme. And associated with that constipation, you tack on the enlarged abdomen, very often big liver, the abnormal appetite, the sleepiness after meals, and the very definite tendency to get attacks of colic. I think all the above applies more to the heavier type of Sulphur; I think the thinner type of Sulphur are more liable to get attacks of diarrhoea; they very often suffer from a chronic diarrhoea with the ordinary Sulphur modalities, that is to say, a diarrhoea tending to come on early in the morning, any time after four oclock, with any kind of stool provided it is offensive.

And when you are there you tack on the other constant Sulphur characteristic which is that they all smell; their discharges smell, any eruption smells, their perspiration smells, and the Sulphur child is very difficult to get clean and wholesome.

Then there is another feature that one often meets with in these Sulphur children, and that is that they are often heavy and lethargic and sleepy during the day, and very sleepless at night, and they are liable to get most terrifying nightmares. It is always a terrifying nightmare of some kind, but it isnt constant in its character, but the kid is always being frightened, very commonly being terrified of fire or something of that sort.

Then there is one other point which one occasionally comes across in a Sulphur child. It is pretty lively in the evening, slow of going off to sleep, gets off to sleep, gets off to sleep, and wakes up in fits of laughter; it is an odd symptom, and I have come across it several times, and always it has been in Sulphur children.

Well, in a general way I think that is about as much as I can give you, with possibly the exception that they do get a hungry period about eleven oclock in the morning, and that all the Sulphur children are liable to be seedy, headachy, irritable, tired-out, if they have to wait for their meals.

“Are there any special acute conditions in Sulphur children?”.

There are all sorts of acute conditions from which the Sulphur children may suffer. Oh, there is one other condition which might be worth mentioning, and I think you can tack it on to the redness of lips and orifices, and that is that in acute or chronic conditions they tend to have a red coated tongue, with a very red tip, and very often a red margin running along their sides. It isnt unlike a Rhus tongue. And most of these Sulphur patients have a dry mouth, a hot mouth, and are thirsty. Of course you meet that more in the acute conditions than in the chronics.

As regards the actual things from which they suffer acute diseases practically all of them are associated with, as I say, some skin irritation. You will very commonly get Sulphur indicated in acute styes with intense irritation of the lid margins, the lids very hot and burning, aggravated by heat, and particularly aggravated by bathing they smart and sting if you give them an eye bath.

You very commonly get indications for Sulphur in chronic nasal discharges; and in Sulphur children with a nasal discharge you will always get the same old Sulphur offensiveness. The discharge is always excoriating, there is a redness about the nose, again with intense irritation, the kids tending to pick at it until it is raw and bleeding.

You will very often get Sulphur children with a chronic tonsillitis, a deeply injected throat, very much swollen, feeling very hot, with a very offensive breath. And practically all these Sulphur kids with their tonsillitis tend to get masses of glands in their neck far more than the ordinary tonsillar gland enlargement, it tends to spread right along and particularly involves the submaxillary glands. And with their tonsillitis, of course, you will get the irregular heat and cold, shivering attacks, sweaty attacks, and the thirst for cold water.

You very often get indications for Sulphur in chronic conditions, chronic ear discharge. And again you get the Sulphur characteristics, the excoriating, offensive discharge, the redness about the external ear, the intense irritation, the aggravation of any pain from hot applications, particularly hot fomentations.

Then you get all sorts of Sulphur chest conditions in Sulphur kids, anything from a mild bronchitis up to an acute pneumonia; and there again you get certain Sulphur constant features, you get a tendency to waves of heat and sweat, very often occasional shivers, very often with burning extremities, and a very definite heavy smell about the child.

Then there is one constant feature that runs through all the Sulphur chest conditions, and that is a very definite sensitiveness, extreme sensitiveness, to lack of oxygen they cant stand a stuffy atmosphere, they want plenty of air, and yet they are chilly in draughts. I think, on the whole, in chest conditions you more commonly get indications of some disturbance on the left side of the chest rather than the right, but it is so slightly more common on the left than the right that I dont think it matters very much.

Then, of course, Sulphur is one of your most commonly indicated drugs in jaundice of children acute catarrhal jaundice particularly with the marked intolerance that Sulphur has got to milk in its acute conditions, intense skin irritation, feeling of burning heat on the surface, very often with attacks of colic, frequently with attacks of diarrhoea.

And where you have got a Sulphur diarrhoea again you have got an excoriating discharge, you are likely to get redness and rawness all about the buttocks, intense irritation, scratching. You see you have constant characteristics all throughout the Sulphur conditions no matter what they are.

Then you very often get the thin type of Sulphur patients running to acute rheumatic conditions. And again you get the Sulphur characteristics, that is to say you get the irregular sweats, feeling of heat, thirst, red tip to the tongue. The actual painful condition is worse from heat, it is rather more comfortable from cold, it is very much better from movement, although it is painful when they start to move; and you are very liable to get a red blush of the affected joint; and you are very liable to get a history of the attack having been precipitated by bathing, either seabathing or swimming.

And so on you go; you can go right through the whole dictionary of medicine and you can find Sulphur in all of them, but the Sulphur characteristics have got to be there otherwise it does not fit. .

“What about the desire for fat?”.

That is very variable in children. It is very common in adults; you find practically all adult Sulphurs want fat with hot roast beef for instance, but it is by no means as constant in kids. I have seen a lot who do not like fat; if you get it it is a help, but it is by no means constant so I dont stress it nowadays. A fair number of adults also dont want it.

“What about butter?”.

I dont think butter comes into the fat craving at all, because you get the majority of your Pulsatilla patients with a definite aversion to fat and they like butter and they like cream; the thing that they dislike is meat fat, and particularly hot fat. Quite a number of Pulsatilla patients will eat cold fat, but they will jib from hot fat. But most Pulsatilla patients will take butter, and very often they take it in large quantities.

“Is the tendency to sweating constant in Sulphur?”.

Particularly the fatter type of Sulphur; the thinner ones usually have a dry harsh skin and dont tend to perspire in the same way.

One other things sometimes is a help about Sulphur kids, and that is that they are frightfully pleased with their possessions; the Sulphur childs toys are the best that could be, and the Sulphur childs family is the best there ever was, and the Sulphur childs motor car is the last word in motors which is sometimes quite a useful tip.

D M Borland