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.
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.
