I thing last day we finished up with Chamomilla, and the next one is Cina, which is a very interesting comparison with Chamomilla because I thing 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 obstinate as 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 for handling in the Cina children they are quite peaceful, they allow you to carry them about, it will quiet them down; where as in 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 had 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 and ordinarily the abdomen; if it has got a colic it will turn over on to its tummy. It it is being carried about while it has 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.
Then as far as their temperature reaction. The Cina kids are always chilly; they are sensitive to any draughts of air, and they are very liable to get irregular muscular twitchings particularly after any excitement, and very often you will notice it particularly in the muscles of the face.
Then in the slightly older children there is another mental characteristic of the Cina child, and that is that they are frightfully touchy, they have got a complete inability to see a joke of nay kind particularly if it refers to themselves.
Then there is another thing that is worth remembering about the Cina children, and that is that they all have a hyperaesthesia of the head the head is sensitive to jarring, and they have a hyperaesthesia of the scalp. So that if you are ever wanting to soothe down a Cina child dont go and stroke its hair, otherwise you will know that you have got a Cina kid.
Then there is one other point about them which I have noticed quite frequently, and that is that they have a most inordinate habit or yawning; they yawn, and yawn, as if they would dislocate jaws. And I have seen several of these Cina children now who have been brought to me with a definite history of acidosis, which I always tend to link up with their yawning tendency.
Then there are two other points which always make me think of the possibility of a childs being Cina. On in that with their intestinal up-sets they become very restless, very liable to get meningeal irritation, with constant agitation of their head, rubbing it into the pillow, and without definite meningitis they tend to develop a squint-an internal squint.
And the other point which always makes me think of the possibility of Cina is that all these Cina kids appear to develop an irritation of the nose, it is red, itchy, and they pick at it-and that is quite apart from getting thread worms or anything of the kind. It I get a yawning child coming in and picking its nose I always explore the possibility of its being a Cina, and very often it is. So you see there are pretty definite distinguishing points between Cina and Chamomilla, and you shouldnt have to try one and then the other.
The the real reason why I put Mag. carb. in after Cina, was in connection with the diarrhoeic attacks. Mag. carb. and Cina are the two most commonly indicated drugs for diarrhoeic attacks accompanied by these peculiarly white stools. And apart from that Mag. carb. is an interesting drug in kids.
The ordinary Mag. carb, child is a sensitive nervous type of child, and as a rule one come across them either as very young children or round about ten years of age. And think the most outstanding feature of the Mag. carb. children is their lack of stamina. They have got-some of them are quite well nourished-but they have got very poor muscular power. You know you handle an ordinary healthy child, the muscles are quite firm; whereas the Mag carb. child has got soft, flabby muscles, and any physical exertion tries them out.
You will get exactly the same sort of mental reaction. The older child at school gets mentally tired out; it will come home with a violent neuralgic headache. And the neuralgic headaches of the Mag. carb. school child are pretty definite; they are pretty violent pains, maybe any part of the head, and they tend to come on at night. They are accompanied by very marked sleeplessness, the child cant get to sleep at all, and strangely enough they are better if the child is up and going about.
Then the next thing about Mag. carb. children is that they always have very definite likes and dislikes in the food line. All these Mag. carb. children have a very marked craving for meat, and anything with a meaty taste. And I have never met one yet who didnt have an absolute aversion to vegetable of any kind.
Then, in the small child you are liable in the Mag. carb, kids to get an intolerance of milk; they get sour vomiting, and they get pasty, pale, undigested stools, which are usually white and soft and putty-like. Then, if the digestive disturbance goes further excoriating. And that is the type of child who is very liable in an acute enteritis to develop a bronchitis attack as well. I have seen a lot of them in the wards here and I think the majority of them developed some bronchitis with their diarrhoea, several of them a definite broncho-pneumonia.
Then another characteristic of the Mag. carb. kids is that they tend to have a very dry skin. In the small child, it is particularly noticeable; they get a dry, almost scaly skin, and they are very liable to get a peculiar dry, almost coppery colored, scaly eruption of the scalp. I remember, going round the wards, that whenever I used to see that coppery, scaly eruption I always thought of the possibility of Mag, carb baby. It almost looks as if it had been painted on to the scalp; it sticks rather.
Then another constant feature about the adolescent Mag. carb. kids is that they are always dead beat in the morning, even though they have had a fairly decent nights sleep; it is an awful job to get them off to school.
And there is one other point that is sometimes useful is the Mag carb. kids, and that is that they are awfully easily startled by any unexpected touch.
Then there is one other point about them, and that is that with this very inert sort of skin, after taking any hot food or drink they are liable to flush up and sweat about the head and face.
These kids are all sensitive to cold, yet they are rather better in open air, and are usually aggravated by changes in the weather.
By the way, in their bronchial attacks the Mag. carb. children tend to get a very stringy, difficult sputum, which is very difficult to spit out; it isnt unlike a Kali bic. sputum in appearance, but they have great difficulty in expectorating it at all.
Then the next of our Nervy drugs is Ignatia. I think it is unfortunate that Ignatia has been distorted as it has been in the homoeopathic textbooks, because it has come to be looked on as the hysterical female. Well, I think using it like that you are missing a great deal of the value that you can get from Ignatia in other cases which are not hysterical females at all.
If you have a child with a highly developed nervous system, a highly strung, sensitive, bright, precocious child, who is doing very well in school and who is being pushed-be it a boy or a girl and their nervous system is getting overtaxed, you are very liable to get Ignatia indications.
Then first indication you will get is the child will begin to develop headaches, and it is a sort of nervous, third head, coming on at the the end of the day, coming on after a period of stress.
The next thing is that they begin to become slightly shaky-their writing is not so good as it was, their finer movements begin to suffer.
And the next thing you will spot about them is a rather strained expression. And that strained expression is one of the key notes that lead me to Ignatia in the non-hysterical type more than anything else. It may anything from a mere tension of the muscles to definite grimaces when the child is speaking, and it may go on from that to anything-facial chorea, generalized chorea, difficulty in speaking, difficulty in articulation.
Then the next thing that you will get is the story from the parents that the child is becoming unduly excitable-is is either up in the air, or down in the dumps. And another thing is that the poor youngster has become incredibly hyperaesthetic to noise; if the kid is attempting to do home work after school any noise nearly drives it crazy; it is liable to blow up into a rage and then relapse into tears. And then after any stress of that kind you will find the child quite incapable of working, its brain simply will not function, cant take it in, cant remember, and cant think.
In these school children coming home with their headaches you get very definite indications for Ignatia in the peculiar modality of their headaches. They come home with a congestive headache, and the odd thing about it is that it is relieved by hot applications.
Then if their nerves begin to get frayed these kids get scared. They have probably been up against the stress of examinations, they lose their nerve altogether, and they are in constant dread of something unpleasant going to happen, and they may get to the stage where they are scared of doing anything on their own initiative-they may be even scared of going out alone.
Then, as you would expect with a child in that state, you get all sorts of digestive upsets, and you get the typical Ignatia hysterical stomach developing, that is to say the child who is upset by the simplest food and can digest the most indigestible stuff. I am sure time and again you have had the story in outpatients; the mother says the child cant digest the simplest, plainest food, and is quite right on the toughest old cheese. And the queer thing about it is that it is true.
You get exactly the same kind of disturbances when the the Ignatia child gets a bad throat, and acute inflamed throat, and the only relief the child gets is from taking something solid, something to press on it, and the pressure relieves it for the time being.
Then with that over-stressed child, of course they get all sorts of disturbances. If they are in any confined place, particularly if there are a lot of people about, they get nervous, distressed, choky, and they are liable to faint. But it all keys in with the general picture of nervous stress.
Then, as you would expect in a child of that type, who has been very bright, clever, successful who is now rather going to bits, they are awfully apt to blame themselves for it; it is very often a child of poorer parents, who is doing quite well on scholarships, and now cant do as well as it used to; it often starts to reproach itself, thinks that the failure is due to lack of effort on its own part. gets thoroughly depressed, almost melancholic.
Then there is one other thing that you sometimes come across in the Ignatia children, which you can link up with the choreic tendency, and that is that they are very liable to get troublesome. irritating. spasmodic coughs. These coughs always come on at inconvenient times, and once they start coughing they go on, and on, and on. That is the one type of Ignatia cough in that stressed child. The other type that they get is a very definite, acute laryngitis, with a liability to laryngeal spasm.
Then, as you would expect with their choreic history, you are very liable to get rheumatic pains in these children, you may even get an acute rheumatism; and most of the rheumatic pains are better having definite firm pressure.
The last of these drugs is Zinc. and you tack it one to Ignatia because of the choreic tendency.
The typical Zinc, child is very nervous, sensitive excitable kind of kind. But it is quite easy to distinguish them from Ignatia children. The Ignatia child to begin with is a very bright, quick reacting child ! whereas the typical Zinc. child has a slow reaction time.
When you get the Ignatia children tired out they may not be able to take things in, they have difficulty in learning, difficulty in remembering, but the Zinc. children are slow of grasping what you are saying, slow in answering. and they are much more docile, less unstable than the Ignatia children.
As a rule you will meet the Zinc, child about the same age, possibly a shade older, and you will very often get a history of delayed development, a delayed puberty very often gives you indications for the Zinc. child.
The impression you get of the child is that it is tired. tired mentally and tired physically-just generally weary. And in spite of that, they are restless, twitchy, fidgety. And one of the almost constant things that I have come across in the Zinc. children is that when they are tired they get a very persistent, aching pain in the lower cervical region, very often with burning pains going right down the back. And another thing that you often meet with in these Zinc. kids, particularly in the very fidgety ones, is that they are liable to get cramp in bed at night, and it is much more likely to be in the hamstring muscles than in their feet.
Then another thing about them is that they are very sensitive to cold; they are always chilly, and they are very liable to get inflamed eyes from exposure to cold. I have seen several of these Zinc. children with definite thickening of the margins of the lids, a chronic blepharitis, and a chronic conjuctivitis; and with their inflamed eyes they develop the most intense photophobia.
They another thing about them is that they are intensely sensitive to noise, they are as sensitive as the Ignatia kids, but one thing that worries them out of all proportion is talking, and I have quite frequently had the statement from the parents of a Zinc. child that if the child is attempting to do any work and there is anyone talking in the room it is very much worse than the noise of other children playing, people talking drive them nearly distracted. Incidentally it is completely exhausted by people talking to them; it is very often a definite lead for Zinc.
Then another well-marked indication for Zinc is where you have a history of a well-marked, generalized skin eruption in childhood, early childhood, and a chorea developing about adolescence, always think of the possibility of it being a Zinc.
Then there are just two points that I want to mention. One is that many of these Zinc. children develop an acute hunger about eleven oclock in the morning. The other point is that you will very often get a statement from the parents that these children simply bold their food-either food or drink.