Then, as you would expect, with that kind of extending catarrhal infection, you very often get these Iodine children with a degree of deafness, and it is usually associated with a chronic eustachian catarrh.

Then another thing that you often come across in these Iodine kids that type, where they are getting catarrhal infections, is an involvement of their larynx, they are very often hoarse, and they have a painful larynx, which is painful on pressure. And with their laryngitis they are very apt to get acute croupy attacks which are extremely painful. And one of the distinguishing points about their croupy attacks is that they get very hot, and they have an intensely hot, dry skin.

And very often in these croupy attacks the kid is terrified. You are rather liable to mistake them for an Arsenical croup; there is the same feeling of heat, burning in the larynx, thee is the same kind of choking feeling. But your Arsenic kid is chilly; the Iodine kid is hot and wants air. The Arsenic will perspire a bit; the Iodine kid will be dry and hot.

Then another common disturbance in these Iodine kids is a digestive disturbance. They have got abnormal appetites, they are very liable to get all sorts of abdominal disturbances, and most of these abdominal disturbances are associated with very typical diarrhoeic attacks, with very frothy, fatty, whitish stools. You may get that associated with an abdominal Tabes, enlarged mesenteric glands; I have seen it associated with pretty general enlargement of the liver and spleen without any very definite blood change. You may get it associated with definite pancreatic dysfunction, with the typical pancreatic fatty stool, and you may get definite glycosuria.

Well, that is the one common disturbances that you meet with. There is another that you quite commonly meet with in the Iodine child, particularly the Iodine children with a fair amount of colour, they sometimes have quite bright red cheeks, and in these highly coloured Iodine kids you are very liable to get rheumatic symptoms. It is usually pretty acute rheumatism, pretty violent pains which are more comfortable for moving, and are very much worse from heat. The pains are usually very definite sharp, stabbing pains in character, and I have seen two Iodine rheumatisms who got a definite dry pericarditis with very acute sharp pericardial pain.

There is one thing about the pericardial cases which is apparently a contradiction to the ordinary Iodine restlessness and relief from motion in their chest pains they have an aggravation from moving, the pains are brought on, they are made more acute, by movement. And if you thing of the rather dark skinned, flushed type of patient, rather depressed, with sharp, stabbing pains which are worse from motion, you are awfully apt to confuse it with a Bryonia case.

They are both worse for heat, but you dont get the typical Bryonia tongue in the Iodine patient, and you dont get the intense thirst as a rule. And most of the Bryonia cases are rather more dull, heavy, and the Iodine patients are apt to be more mentally alert. You will practically always have a complete aversion to food in the Bryonia ones, and you very often have a surprising amount of hunger even in the acute Iodine conditions.

I think that pretty well covers the typical Iodine child, sand you see it has a certain amount of similarity to the Bromine child but you are dealing with an entirely different type of child, and yet if you just contrast the various symptoms they are very much alike, but once you spot the child the type of child you cant ever confuse them. You can very easily confuse it with Sulphur, but you dont usually get the intense irritability of skin, the intense itching, that you almost always get in a similar type of Sulphur.

There is one other thing that I have seen crop up in Iodine in these rheumatic cases, and that is that you quite frequently get a history of an acute diarrhoeic attack immediately preceding the rheumatic attack.

Then, the next drug I want to touch on is ABROTANUM, and I only want to touch on it. I think the reason why I only want to touch on it is that I dont know an awful lot about it, but there are one or two conditions in which I have found it immensely useful. I think the clinical picture that always stands out in my mind as characteristic of the Abrotanum small baby is quite characteristic. It is the picture you get with a congenital pyloric stenosis. In other words, you have got the child who is emaciated, with a deadly hydrated skin wrinkled, you can pinch it up and it does not return to its normal state.

It has an inordinate appetite, because it is vomiting all its food. It is hungry all the time: probably has a comparatively big abdomen and spindly legs, it is always cross and peevish because the poor little devil is being starved. It is usually chilly, and it is very often sensitive when handled, it is tender to touch. I think that is the typical small Abrotanum baby, and in these you not infrequently find a delay in the healing of the umbilicus after the cord has dropped off again lack of vitality, lack of nourishment probably. I have seen three of these now, who either had a pyloric stenosis or spasm, who got perfectly well on Abrotanum.

And I know another who had pyloric stenosis who lost all his symptoms for a period of our weeks after Abrotanum, then relapsed and was operated on and had a typical pyloric stenosis and completely recovered. So whether the others were really a spasm, not true stenosis, I cannot tell you, but I have seen three in whom I had given a diagnosis of pyloric stenosis and they did recover, and that is the type of small baby that I look on as typical Abrotanum.

There is another older type of Abrotanum child that I do recognize, and that again is a hungry child, a child with an inordinate appetite, and again it is a thin child, but it is always a child who has tendency to recurring attacks of diarrhoea, usually attacks of diarrhoea alternating with rheumatic pains, and always with a certain amount of numbness in the hands or feet or legs; you very often get the statement from the parents that they cant trust the child with any valuable china or it will knock it over or drop it in other words, it is verging on a chorea.

They are usually rather peevish, bad tempered kids, and you very often get a history that they have got a strangely cruel streak in their make up. Then these kids are definitely chilly; they are not like the other drugs I have mentioned, they are aggravated by cold, and they are aggravated by damp, and their rheumatic pains are liable to be very much worse at night than during the day.

Well, as I say, I do not know very much about the drug but these are two sides of it which I have seen and which are very useful. I cannot tell you any more about it but it is one of the drugs that is very difficult to spot, and it is difficult to remember, and yet it has a very definite clinical picture if you get it.

“Do you use it for T.B. glands of abdomen .?”.

I have never seen it. Iodine does, but Baryta carb. is the commonest for the cold ones; the hot blooded ones are usually Iodine. Abrotanum is recommended for hydrocele in small children, but I must say I have tried it without any success. I merely give you the things I know; you can dig the rest of the things out of the text-books for yourselves.

No. 5 .

The, the last of the hot-blooded drugs I was to take up was FLUORIC ACID. I think the majority of the Fluoric acid people, both children and adults, that I have seen have been fair haired and fair skinned. And at first sight they are not unlike the Silica children to look at. They are rather thin, under-weight, usually fairly fine, boned, fine skeleton. And they have not unlike the Silica yielding disposition.

But they have none of the Silica irritability, they are very often astonishingly patient, and unlike most of the drugs in the Materia Medica they very often have a strange enjoyment of life, they find, it very pleasant indeed, and quite simple things seem to give them an excessive amount of pleasure. That is their normal peaceful state.

Mentally they are not unlike the Silica kids in that they are very easily tired with mental concentration, they are liable to get headaches of brain fag at school, they are not exceptionally bright as far book work is concerned.

Then the other thing that crops up, and which is very surprising very often in the type of child, and that is that they are liable to get quite unreasoning hatreds of one or other individual in school. It seems to be quite pointless and without reason; a kid who has never offended them, they simply take an absolute loathing to them, and they cant bear them at any price. It is such a weird difference from the ordinary kids make-up that it strikes you whenever you get it. I have met it in adults too.

Then the next thing about them is that, unlike the Silica kids, they are better from physical exertion. Playing games does them good, it wakes them up, they are better for it. The Silica kid will be tried out by it. Then, quite like the Silica kids, they are awfully bad standers, if they are kept standing at school for any length of time they get faint, they get headachy, they get tired out.

Then again unlike the Silica kids, they usually have quite a good appetite, they very often get hungry between meals, and they are very liable to get hunger headaches, with quite a number of these Fluoric acid kids I have told their parents to give them extra food at school inn the middle of the morning because they would finish up the morning with a headache otherwise. They are very liable to wake up hungry in the middle of the night unable to sleep unless they have something to eat, and in spite of the amount of food they put away they are still fairly thin.

But I would not stress the thinness of the Fluoric acid, because I have seen quite a number who were not markedly thin, they werent under-weight, they were small and fine but not definitely under-weight, I mean for the type of child.

Then the next thing about them is that with their big appetites; they have got a desire for highly seasoned food, it doesnt matter very much what it is a long as it has got a strong taste.

They, all the Fluoric acid patients are sensitive to heat; they are worse from hot rooms, they are worse from hot sun, they are worse from too many clothes, they are worse from too many blankets at night. And if you get a Fluoric acid kid coming home from school with a bit of a head, rather a flushed face, feeling horribly hot, it can very often get rid of its headache by sticking its head into a basin of cold water, or even bathing its face with cold water.

Another thing you are constantly told about these Fluoric acid kids is that they are always liable to get a headache if they get at all constipated-unless their bowels are action freely they will get headachy and, of course, in these children you get the typical Fluoric acid headache from being unable to get out of school to pass urine; the kid kept too long in school and not getting out to pass urine will finish up with a headache-and again it is the same type of congestive headache.

Then I have seen one or two of these Fluoric acid who had the fine hair that one associated with the Silica child, but with a tendency to patchy bald areas, without any definite skin disease that I could make out. I think more commonly it was patchy areas of thinning of the hair rather than actual baldness.

Then another thing that one always associates with the Fluoric acid child is a very faulty dentition, very poor enamel of the teeth, liability for the teeth to decay early, and very often they get abscesses at the roots of the teeth; but I have never seen a Fluoric acid child with a really sound dentition.

And associated with that I always couple up the other Fluoric acid characteristic that they always tend to have unhealthy finger nails; brittle, cracked, splintered finger nails.

Then another thing that I always tack on there is that they are very liable to get red, sweaty palms to their hands, and they are very liable to get a very offensive foot sweet, which tends to make the feet hot and sore.

Then there is one other thing that I always look for in the possible Fluoric acid patient, and that is they very often have a dry, red fissured tongue.

I think the majority of these Fluoric acid kids that I have seen have been for either a digestive upset, or a definite tendency to a breakdown at school, or for definite rheumatic conditions. And there is one outstanding point about their digestive upsets; they are liable to get attacks of diarrhoea, they are liable to get upsets they are very may get jaundice; but in all their digestive upsets they are very much aggravated by any hot drinks.

The typical Fluoric acid child with a diarrhea will get a violent attack of diarrhoea after any hot drink, which is very often quite a useful tip to put you on to the Fluoric acid case. And in their acute attacks they are liable to run a fairly high temperature, with a feeling of intense heat, a complete intolerance of any bed clothes at all.

Then in their breakdown at school, I think apart from their headache from concentration, the type of congestive headache which is better from cold bathing, the other one gets pretty constantly is that they are awfully liable to make mistakes in writing, they transpose words, they transpose letters, and they seem the most senseless mistakes; very often the teachers complain that it is pure inattention, the child couldnt ,make that mistake if were paying any attention, and the poor kid cant help it.

Then as regards their rheumatic complaints. You have got the ordinary Fluoric acid temperature aggravation, and the fact that the pains are very much worse if they are keeping still and better by moving about.

Then there is one other symptom that I have quite frequently met with in the Fluoric acid child who is tried out at school, and that is a feeling of numbness in the limbs, either arms or legs, and the old thing about the Fluoric acid numbness is that it isnt a thing that comes on from pressure at all, if the child is still the arms or legs liable to become numb.

Then with their diarrhoeic attacks in Fluoric acid you have always got an irritant diarrhoea, and you are liable to get a good deal of peri-anal irritation, and you may get quite a number of painful peri-anal fissures.

So you see you have really got a hot-blooded Silica, with the amelioration from motion, and with the cheerful outlook instead of the flat, tired outlook of the Silica.

Well, I think that covers the hot-blooded drugs, and we have got two more weeks in which I will try and over the remainder of the drugs we have got, starting with Arsenic as the outstanding nervy drug among children, and then go on to the other of that group.

“The Repertory only gives Fluoric acid for diarrhoea worse from hot drink; are there any other ?”.

Yet, there are quite a number of them. Lycopodium, Argentum nit., Secale, all have pretty violent diarrhoea, and they are all worse from hot drinks.

“If a patient is worse at the seaside for the first week and then better, do you look on that as an aggravation ?” .

Yes, the fact that they have to adjust themselves is a sign of a definite aggravation.

To-day we start on our last lap.

“May I ask a question before you start ? Fluoric acid, I have the impression it is a hot Silica, and would like to ask what differentiates it from Pulsatilla ?”.

Practically always your Pulsatillas are very much heavier in build, they very much less tension about them, they are softer both mentally and physically. You never get the activity in a Pulsatilla that you will get in the Fluoric acid, they have a slower brain, they are much more yielding, much less active. The Pulsatilla patient does get tired out with exertion, and the Fluoric acid patient is rather stimulated by it. The Pulsatilla is aggravated by exposure to cold water, they get chilled; the Fluoric acid will bathe in cold water and it will bring them awake.

It is all a question of degree very much; in one you have got a more taut patient, the other gentle, yielding, depressed. Fluoric acid will suddenly get irritable, much more violently irritable than Pulsatilla, they will strike when the Pulsatilla would probably break out into wrath and then weep. It is all a question of degree, one grades into the other. It is the same with all drugs. The Fluoric acid is very much like Phosphorus, much more intense mentally, more active, more than Pulsatilla.

In this last group of drugs I have tried to include all the outstandingly nervy children, and I think the key to the whole group is ARSENICUM. I think the Arsenicum children are possibly the most attractive children that you will come across. They are always very highly strung, usually finely made, finely built, very often with a very fine skin, fine hair, delicate looking kids. They are always very nervy, they are very easily scared, very easily frightened, anything unusual will frighten them, they are afraid of being left alone in the house, afraid of going out alone, terrified of the dark, and they always have a very vivid imagination.

You get all sorts of stories of night terrors, the kid waking up in the middle of the night, terrified, jumping out of bed, wandering though the house to get somebody to talk to, and it is always the feeling of some horrible occurrence hanging over the kid, very often she does not know what it is and is just terrified. As a rule if they are comforted, consoled, they quiet down and go to sleep again, particularly if she it taken into the parents bed and has somebody about and has the feeling she got somebody there.

Then, in spite of their delicate appearance, you will find that these Arsenical kids are always restless. They are always doing something; you never see them sitting about just looking at their fingers. They are very liable to take up one thing, do it for a little, and go on to something else.

When they are nervy you find them often going from their mother to their father, from the father to the nurse, and back to the mother. Each one gives them a certain amount of comfort, but for very long; they push on to somebody else.

Then the next thing that you pretty constantly get about them is that, in spite of their restlessness, and in spite of their activity, they do get completely exhausted. And very commonly you get the story that the child is all right for a couple of hours, busy, happy, occupied, a bit on the restless side, a bit too mentally active, then it suddenly gets completely exhausted, gets pale, tired, lies down, very often depressed, and in that state is liable to get nervy, frightened, feels that it is going to be ill, wants to have somebody about.

Then, another very common story that you get is that these kids are inordinately tidy. A small girl with a number of dolls, she keeps these dolls in a most astonishingly tidy condition. Every the small boy breaks his toys and leaves them lying about on the floor, the Arsenicum kid puts them away and is distressed, not because the toy is broken but because it is in a mess. You often find them very distressed if they spill jam over themselves and get into a mess, they are distressed out of all proportion to what has happened.

Then the next thing that is very definite about them is that they are very liable to catch cold, particularly from exposure to cold, and their colds are fairly typical. They usually start as an acute coryza, with a watery, excoriating discharge, with very violent attacks of sneezing, and wit a tendency for the cold very rapidly to spread on to the chest. These Arsenicum kids, you will see them in 24 hours with the history of an acute coryza developing into a rapid bronchitis. That is only type, and with that extension you will practically always in the Arsenicum kid a history that the child has become hoarse in between the development of the coryza and the onset of the definite bronchitis.

D M Borland