SYMPTOMS.- Vomiting; pain and flatulence after food; Diarrhoea, often of pale pasty motions, often “lienteric” (i.e. coming on immediately after or even during, a meal), often alternating with the passage of constipated mucus-coated lumps; appetite capricious, sometimes poor, sometimes ravenous, sometimes for unnatural articles such as coat and chalk; furred tongue; progressive wasting; languor and irritability; pallor of the face; disturbed, restless sleep, often accompanied by incontinence of urine; and lastly evidence of “tonsils and adenoids” at one end and “worms” at the other.
CAUSATION.- Possibly an inherent defect of assimilating power. Whatever the essential cause is, a main exciting cause is sugar and starch in the diet; where the stools are pale it may be inferred that the milk is not properly digested. Whether the “tonsils and adenoids” stand in a causal relation to the “Mucous Disease” or are themselves caused by it, is not easy to say. The worms undoubtedly are due to the unhealthy condition of the bowel.
INDICATIONS FOR TREATMENT
Arsenicum.- Bluish or white tongue; excessive, unquenchable thirst; vomiting; detention of, and pain in, the abdomen; Diarrhoea worse after food, especially after midnight; motions watery, slimy black, green, whitish, or bloody, and frequent and scanty; weakness and emaciation; distressing restlessness, sleeplessness; pale face; coldness of the extremities.
Calcarea Carbonica.- Diarrhoea in weakly, pale-faced, emaciated, scrofulous children, who are liable to glandular swellings on taking the least cold; undigested, sour, papescent, frothy, foetid, or involuntary stools; thread-worms; pains during a motion, and faintness afterwards.
Carbo Vegetabilis. – Offensive Diarrhoea; thirst after a motion; much flatulence, acidity, and ill-humour.
Cina.- Diarrhoea associated with worms; starting and crying out in sleep, and other worm symptoms.
China.- Diarrhoea, worse after eating; yellow, watery, undigested, blackish, or putrid motions, flatulence; loss of appetite; debility.
Croton Tiglium.- Thin, yellowish-brown, putrid evacuations, expelled suddenly, and induced by eating; involuntary stool during sleep.
Iodium.- Thin, foetid evacuations, with distention of the bowels; emaciation from unassimilated food; hectic symptoms. It is especially suited to the Diarrhoea of strumous children.
Mercurius Iodatus.- Chronic Diarrhoea, with hardness and enlargement of the abdomen; the glands may sometimes be felt on pressing the hand upon the bowels, which impart a knotty feeling. This remedy is most suitable for the stunted and ill-nourished children of weakly parents, particularly when scrofulous enlargements or Abscesses exist.
Mercurius Sol.- Frequent evacuations of frothy mucus, or whitish, green, offensive, or bloody stools; excoriation of the anus; violent pain; Jaundice. If there is severe straining, with other dysenteric symptoms, MercuriusCor. is preferable.
Phosphorus.- Chronic Diarrhoea in children having a consumptive tendency; yellow tinge of the eyes and skin; great prostration; chest complications.
ACCESSORY TREATMENT.- What has been said under “Causation” indicates the chief non-medicinal line of treatment. The starch and the sugar in the diet must be severely restricted. The eating of “sweets” must be stopped. If the stools are pale, milk should be limited. Tepid abdominal compresses and general massage are useful. An abdominal belt of flannel is often efficacious. Children should be protected against atmospheric changes by warm clothing. Lastly, change of air is often necessary and promptly curative. If no other end be served, it may remove the little patient out of the range of some undetected and un-thought of cause of the disease, which exists in the air or water.
68. Appendicitis.
DEFINITION.- An infective inflammation of the appendix vermiformis of the caecum.
SYMPTOMS.- Pain and Colic, nausea and Vomiting, a temperature from 100o to 102o, and tenderness in the appendix region, that is round about McBurney’s spot, which lies at the junction of the middle and outer thirds of a line joining the navel to the right anterior superior spine. The pain usually begins in the epigastric (stomach) or umbilical (navel), region, but after a little while shifts to, and becomes fixed in, the appendix region. Pain is the first symptom; Vomiting comes on soon afterwards.
In the case of an appendix which hangs down into the pelvis, no tenderness nay be elicited until a rectal examination is made. This should never be omitted. In the ordinary course the temperature after remaining up for three or four days gradually subsides, the pulse rate declining coincidentally. A sudden drop of the temperature to normal is a bad sign, suggesting perforation or gangrene of the appendix. Decline of the temperature, accompanied by a steady rise of the pulse rate, is extremely ominous. But the temperature and pulse may both fall and the patient may lose his pain and say that he feels much better, and yet the appendix may at the same time be absolutely gangrenous.
The course of a case of appendicitis is so incalculable, a patient who has not seemed very ill may so rapidly reach death’s door, that probably the only safe course is to operate as soon as the diagnosis is clear. The anxious, haggard countenance, board-like rigidity in the right groin, secondary Vomiting (Vomiting coming on again after it has stopped), indicate an infection of the peritoneum and call for immediate operation.
In Chronic Appendicitis there may be few if any localizing signs, there may be little or no appendicular tenderness, nothing in fact but somewhat vague indigestion symptoms – pain, sickness, flatulence, or symptoms which are often labelled “bilious”; but if the history is carefully investigated, it is generally possible to find that there has been at some time in the past an acute or subacute attack of Appendicitis. Recurring “bilious” attacks in a child or a chronic indigestion that does not yield to dieting and carefully chosen remedies should always be carefully scrutinized from the “appendix” point of view. The right treatment for chronic Appendicitis is operation; the “latent,” chronic” or “quiescent” appendix has been proved by abundant and most tragic experience to be no safer than a latent, chronic or quiescent volcano.
DIAGNOSIS.- This is not always easy. The commonest mistake in the case of children is to mistake acutely inflamed glands, often tuberculous, is the appendix neighbourhood for Appendicitis. No particular harm is done by operating on such cases; indeed, even when the glands are not removed, the patients are often curiously better for having daylight let into their abdomens.
CAUSES.- The real cause is microbic. Exciting causes may be chill, excessive muscular strain, a heavy indigestible meal, etc.
TREATMENT
Belladonna and Mercurius-Cor.- Should be used alternately every hour or every half hour according to urgency, pending the preparations for operation. Hot fomentations should be applied to the abdomen. Where for any reason it is decided to postpone operations until the appendix is “quiescent,” Silicea will often usefully follow up Belladonna and MercuriusCor.
69. Prolapsus Ani – Falling of the Bowel
DEFINITION.- A protrusion of the mucous lining of the rectum through the anal orifice, after the action of the bowel, which goes back of itself, or is easily replaced.
CAUSES.- Long-continued Constipation or Diarrhoea; purgatives straining excited by the irritation of worms, or of stone in the bladder; laxity and delicacy of constitution. Although not confined to them, it is most frequent in children.
INDICATIONS FOR TREATMENT.
Arsenicum.- When there are hot, loose motions preceded by colicky pains and thirst.
Calcarea carb.- In chronic cases in scrofulous children.
Lycopodium.- Inflamed rectum, much flatulence in lower bowel.
Mercurius-Cor.- Much tenesmus, with blood in stools.
Podophyllum.- Prolapsus of the rectum; loose motions, of a brownish hue, hot, and having an acrid odour.
ACCESSORIES.- When prolapsus occurs after the action of the bowel, the protrusion should be reduced by placing the child across the lap, and making pressure on the protruded part with the fingers, previously lubricated, and carried beyond the contracting ring of the muscle around the anus. Prolapsus occasioned by straining from thread-worms is usually corrected by the treatment prescribed in the Section on Worms. Bathing the parts with cold water every morning, and injections of water, are useful.
The child should lie down for a short time after the action of the bowels. Constipation should be prevented by the measure elsewhere prescribed (Section 71). The diet should be wholesome and unstimulating.
70. Worms (Entozoa)
The worms that most commonly infest children are of three varieties – the thread-worm (Oxyuris vermicularis); the round- worm (Ascaris lumbricoides); and the tape-worm (Taenia mediocanellata). The first two are most common, the tape-worm being vary rare in children under three years of age.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."