Then you will get the other Arsenicum type who get a very mild coryza of the same type; without any hoarseness at all, without any sign of bronchitis, they suddenly develop an acute asthmatic attack. And the asthmatic attack in the Arsenicum kids is very typical, because it is usually a very tight, dry, spasmodic asthma. And it is always in these children accompanied by acute terror. It is rather terrifying for a kid to get asthma, but these Arsenicum kids are almost beside themselves with terror.

And the other thing about them is that they are liable to get their asthmatic attacks either early in the afternoon about 1 oclock to 3 oclock, sometimes after lunch at least, or else early in the morning, again any time after midnight. And the other typical asthmatic characteristic is that as the attack subsides the dryness seems to disappear and their chests get flooded with mucus and they bring up quantities of white, frothy sputum. Quite frequently I have heard the parents say that they know the attack is subsiding because the dry whistle is disappearing and the chest is getting moister.

“If you give Arsenic in that stage will it have any effect ? I mean in the moist stage ?”.

Yes, you can it then and it will clear up the whole thing.

Then the other thing about the Arsenicum kids is that they are very sensitive to cold, and exposure to cold is almost certain to upset them; it either gives them an acute respiratory attack, or give them an acute digestive attack. And the Arsenicum kids do get digestive upsets very easily; they get them from exposure to cold, and they are equally liable to get them from over indulgence in any watery fruits, melons in summer, strawberries, any of the juicy fruits are liable to give the Arsenicum kid an acute gastritis.

And if they get a gastritis they are very liable to get diarrhoea with it. And there is one thing you have always got to remember about the Arsenicum children-they are extremely chilly, in most of their chest conditions, in most of their general conditions you get a thirsty condition with a desire for cold drinks, butt where you are dealing with a gastritis or gastroenteritis you find the gastritis is aggravated by cold drinks; you may get it brought on by taking ice creams, and these ice cream Sundaes that they sell now-a-days are particularly dangerous for Arsenicum kids, that is to say the mixture of fruit and ice cream.

During their acute gastritis the pain-they usually have pretty acute pain-is eased by warmth, either warm fluids or external heat applied to the abdomen. One tends to get the impression of the Arsenicum incessant thirst for cold water, you get the child who likes warm drinks and they make it easier and you are rather apt to be thrown off Arsenicum, but dont be.

The other things about acute abdomen attacks is that you have rather a delicate child to deal with, and they can go down hill awfully rapidly; an Arsenicum child with an acute diarrhoea will get into a state of collapse in a few hours. And in their collapse they are restless, they are worried, they are anxious, and they are liable to have constant small stools-just little spurts of diarrhoea and a marked aggravation of the exhaustion after each stool; very often the child looking absolutely gray and cold and sweaty.

I have see them brought in here in summer after over indulgence in strawberries or something of that sort, the child having been perfectly well they day before and brought in here the next morning absolutely collapsed, simply been purging all night practically. And it perfectly astonishing how quickly they recover if they are Arsenicum children and you give them Arsenicum. I have seen a child brought in here to the childrens ward with an acute gastritis of that type, who looked practically moribund, the only sign of the restlessness that you could see was the child constantly moving its head backward and forward-about all it was fit to do.

I have seen the child in a couple of hours perfectly well, colour come back, diarrhoea stopped, and the sing of acute collapse, which you would say was a sing of acute dehydration, simply gone. I should have said child was absolutely drained of fluid, it had the typical skin of the dehydrated child, and yet without replacing all that fluid the child was absolutely well in a couple of hours.

How would you of hours.

Give every 15 minutes in an acute case like that. I always give cms when they are like that, with violent onset, and it simply wipes them out right away. I want to get as potent a thing as I can to stop it. And I may say I have seen cases of that kind treated with Arsenicum low and we have lost them. They didnt seem to have enough vitality to respond to the lower potency, and yet they did to the high. I have never seen satisfactory results under a 10m in these violent cases.

Then there is another thing you have got to remember about the Arsenicum kids, and that is that you have got a general hyperaesthesia in the Arsenicum. They are over sensitive to everything; they are over sensitive to smell, to touch, to noise, to excitement; smells will make them sick, noise will make them all jumpy and nervy, excitement will give them a nightmare that night, they are the highly strung type of children that you want to keep quite.

If they are pushed at school you head for trouble, they are very liable to get a chorea if over-stressed at school; and if they are not very gently, quietly handled you are almost certain in the Arsenicum child to get the development of periodical headaches, headaches recurring once in 7 days, once in 14 days, most violent sick headaches lasting anything up to 24, 48 hour, or they may last two or there days even and the child is completely prostrated.

And it is always an intense congestive headaches, with intolerance of noise, light, disturbance of any kind. And there again you have got one of the Arsenicum contradictions; in these congestive headaches they want their heads as cool as possible. The child may be feeling rotten, its body may be could and sweaty and damp, the child feeling horribly sick, it is restless, frightened, wants to be fairly well covered, and yet it wants its head cold, cold cloths, Eau de Cologne applications, something of that sort to keep it cool.

Well, there is one other point I ought to have mentioned, and that is in connection with their diarrhoeas. Practically always in the Arsenicum diarrhoea you will get an offensive stool.

Well, I think that sketches the typical nervy child.

“What is their colour ?”.

They are usually a variable colour, they tend to be rather pale but they flush on excitement.

“Are they sallow ?”.

No, they are not sallow. It is rather a fine skin, and when flushed like that they very often get hot heads and cold hands and feet on excitement or over-exertion.

“It it useful in skin conditions ?”.

It is less valuable than I would have expected. I think it is very valuable in some of the more chronic skin condition rather than in the acute dermatitis. I f you picture the secondary syphilitic eruption, that is the kind of condition in which you find Arsenicum indicated. But I have not seen it of much use in the acute dermatitis. That may be a purely personal experience;but I find it far more useful in the more chronic, rather than the acute skins.

And I must say, watching some of the skin cases here who have had Arsenicum in various salts I dont think the results have been good in the skin department-certainly not in the acute conditions. Where you have alternation of asthma and skins there you will have very definite Arsenicum indication- there you have a chronic thing. And where you have asthma and diarrhoea alternating, there I have seen it useful. And I have seen a case if recurring headaches, and asthma developed which cleared on Arsenicum. Arsenicum does very definitely have these alternations, but that you are more liable to meet with in the adult than in the child.

Well, if you take that as a starting point for the highly strung, nervous child, you can practically repeat the symptoms out of the Materia Medica and label them all CHAMOMILLA. I mean as I read through the symptoms of Chamomilla you wouldnt know whether it was Arsenicum or Chamomilla; and yet they are entirely different drugs, and entirely different children. If you saw my notes here, I have almost exactly the same notes under Arsenicum as Chamomilla. The first thing I have is hyperaesthesia, oversensitiveness to noise, pain, peoples; you have exactly the same hyperaesthesia in Chamomilla.

I have the note of restlessness under Arsenicum, moving from one person to another, never still. You have exactly the same in Chamomilla, it goes from one person to another, never still, never at peace. And yet you have only got to see the two children and they are as different as night from day. In Chamomilla you have got the most incredible hyperaesthesia, the Chamomilla pains are more intense probably than any other pains that patients suffer from; but the reaction is entirely different.

In Chamomilla you get an absolute frenzy of rage; they resent it; they resent having it; and they are perfectly furious that you havent cleared it off at once. You are doing your best for a Chamomilla child and it is liable t strike you because it is hyperaesthetic.

The intense restlessness of the Chamomilla child, going from one person to another; each time it is dissatisfied with the person it goes to, and as it leaves them it is quite liable to strike at them. It is quite different from the Arsenicum soothing that the child gets from each one. The Chamomilla child who is over sensitive to noise, you dont get the nightmare the following night, you get the child wrought up into a perfect frenzy, liable to scream and stamp when disturbed. You see their reaction is quite different. .

Then, in the Arsenicum case you have got the child who is restless, always moving about. In the Chamomilla you have a child who is better from motion, but particularly better for being carried about-it is passive motion. You start to jog an Arsenicum child about and you will probably terrify it. You start jogging a Chamomilla child about and it will probably stop its yelling and being to crow. You stop and it wants you to go on; and if you dont do it it will pull your hair. You see, the symptoms stuck down on paper are almost the same.

Then the Chamomilla kid is never still, it is never satisfied with anything it is doing. But it isnt a question of passing from one occupation to another; it is a question of getting tired of one thing and throwing it away. It never puts away its toy in a cupboard, it just chucks it down. It picks up something else, and if you tell it to put the first toy in the cupboard it is liable to yell.

The other thing about the Chamomilla kids which is pretty constant is that they very definitely tend to get more excitable as the day goes on, more irritable, more difficult to manage; and they are liable to be particularly troublesome about 9 oclock in the evening. Very often you get a story that the Chamomilla child is perfectly impossible after it is put to bed till about midnight, then it appears to wear it self out and falls off to sleep.

Then, of course, all these kids who get into a fury tend to get flushed; they get red faced,k they get hot heads; but the Chamomilla particularly tends to get flushed on one side of the face, it is flushed generally but one side will be redder than the other.

Then, you know that Chamomilla is practically universal for the teething child: but I think it is a mistake to give Chamomilla to any teething child, the indications for it are so awfully definite. And where you have a teething child who needs Chamomilla the child tends to get much more fractions at night, it tends to have very swollen, inflamed, tender gums, and they tends to be one-sided with a marked flush on that side of the face.

The tender gums are made much worse by any application of heat; they are very much better from cold applications. They are liable to be very much worse in a hot room, and as I say the attack is liable to subside about midnight. It is worth while remembering that the toothache pains of Chamomilla have entirely different modalities from the other pains.

Chamomilla kids are awfully liable to get attacks of acute colic. I thank mostly they get attacks of acute colic because they are give to by their parents; they see something that they want and scream until they get it, and that evening they come down with acute abdomen colic-mostly the fault of the parents. And with these attacks of colic you always get a lost of wind in the Chamomilla children, and these attacks of colic are very much relieved by hot applications. And with their attacks of colic they are very liable to get bouts of diarrhoea, with the typical green Chamomilla diarrhoea stool.

If you ever come across a Chamomilla child with a colic and diarrhoea you get the best illustration of Chamomilla irritability; they fairly yell the place down. Of course it does hurt, it is pretty colic, but there is not doubt about the childs being in pain, in fact the neighbors will probably know as much it as you do.

Then there is another contrast with the Arsenicum children, and that is the Chamomilla children are usually hot-blooded, very liable to have very hot heads, very often hot and sweaty, and they are very liable to have burning hot feet and stick out of bred at night.

There is one difficulty in dealing with the Chamomilla children. They are ungoverned children, and they have mostly been allowed to get out of hand; but the Chamomilla child in a tantrum of temper can go on to such a state that it gets blue in the face and starts convulsions from pure rage. So do be a little careful about the handling of the true Chamomilla child.

I remember seeing one, she was about there years of age, and was a typical Chamomilla child. In a rage she was liable to beat her head against the wall, merely because it distressed her mother. And I saw that child one night about 10 oclock and she had been just perfectly impossible for the last hour, and her mother had left her to scream, and she had gone into a convulsion. When I saw her she was practically unconscious, dusky in the face, and twitching all over. So do be a little careful about the Chamomilla stage.

And I have seen quite a number of Chamomilla babies who were teething, with acutely inflamed gums, who did develop convulsions. So evidently you have got an explosive nervous system in the Chamomilla child, and you have to be a little chary about letting it go too far.

“What potency do you give to a teething child ?”.

Teething children do quite well on low potency. A few doses usually stops all the disturbance, 12 or 30, two hourly, in the average case. But where you have a violent attack, give possibly every half-hour until they quiet down.

There is one other condition for which you commonly need Chamomilla, and that is the acute otitis in children. It is a frightfully painful condition, and in most of these acute otitis cases the child doesnt want to be touched, and it is intensely irritable, very often yells with the pain; and if you get a history that has been brought on from exposure to cold, I think Chamomilla is one of your greatest standbys in the small child, particularly if you have got the one-sided flush with it. I should think when I was in general practice I cleared more acute otitis in small children with Chamomilla than with any other single drug.

And you can clear it up quite well without any puncture of the drum or anything of that sort; the whole thing simply subsides. But you have got to have the Chamomilla make-up as well as the otitis, otherwise Chamomilla does not work. In other works, their nervous system has to be all the fret, and they have got o be irritable and touchy, otherwise Chamomilla does not do it. In other words, you get the Pulsatilla from the same cause, exposure to cold, again with otitis media, and one- sided flush; but it is a Pulsatilla child, not a Chamomilla one, and Chamomilla wont do it any good. I think they are the two commonest drugs-at least they were in the practice I was doing.

Again in CINA you can practically duplicate the symptoms on the notes, and yet it is and entirely different patient one is dealing with.

No. 6.

WELL, we have got to try and finish this to-day, because we dont meet again, and I think thee are still four of these drugs to get through so I will try and cut them as short as possible. I will try and give you the salient features of them without any unnecessary padding.

I think last day we finished up with Chamomilla, and the next one is CINA which is a very interesting comparison with Chamomilla because I think you will agree that most people start with a dose of Chamomilla and if it doesnt work they give a dose of Cina, and it isnt a very scientific way of proceeding, and I think it is better to have a clear idea of what Cina is like and where the difficulties arise.

I think the outstanding mental distinction between the Chamomilla child and the Cina child is that in Cina you have got a degree of obstinacy that you never meet with in the Chamomilla. The Chamomilla kid is always unstable; the Cina child can be as obstinate as a mule. I think that is the main mental distinction.

Then there are various other points which are a help. I think the first one is that in Chamomilla you are likely to get an irregular flushing-flushing of one cheek and pallor of the other. You may get the whole face red, but you are more likely to get the irregular distribution. In the Cina child you much more commonly get a circumscribed red patch on the cheeks, and very often a noticeable pallor about the mouth, the mouth and nose.

Then I think the next thing about them is-I mean the next distinguishing thing about them-is that both dislike to be handled, they both resent interference, but in the Chamomilla it is much more mental resentment, whereas the Cina child is definitely tender to touch.

You will very often find that you get the same description of the two, that they will yell when you handle them, but you find that once you get over the preliminary discomfort of handling in the Cina children they are quite peaceful, they allow you to carry them about, it will quiet them down; whereas in the Chamomilla they are wanting distraction all the time, if you stop walking about with them they are likely to strike at you, they are always wanting to be doing something new. You do not get that reaction in the Cina. But the Cina kid will want you to go on carrying it; in other words, the steady, passive motion does soothe them down.

Then there is another distinguishing point in Cina which you do not get in Chamomilla; the Cina children are very apt to be sick, and so are the Chamomilla ones, but you will commonly find that in the Cina children, after they have vomited, and almost immediately after, they are hungry. And you will very often find the Cina children are crying out for more food immediately after a meal. And in the Cina child you are very likely to get a story of nightmares, night terrors, if the child has had a late meal.

Then, another thing that will help you when you are distinguishing between Chamomilla and Cina is in their diarrhoeic upsets. They both get diarrhoea. The typical Chamomilla green stool is noticeably absent in Cina. The typical Cina stool is a white stool-a very white, watery stool.

And there is one constant characteristic about the Cina child, both in its digestive upsets and ordinarily too, and that is that it gets relief from pressure on the abdomen; if it has got a colic it will turn over on to its tummy. If it is being carried about while it has a colic it will turn over the nurses arm so as to get pressure on its tummy; if it is restless at night, again it turns over on to the abdomen and is at peace.

D M Borland