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.
