THE President of the British Homoeopathic Society has asked me to provide some material for discussion, at your Congress, connected with the branch of work in which I happen to be specially interested-that of children’s disorders. I have rashly acceded to his request, and have now to ask your kind indulgence for a very mediocre and “half-cooked” paper on a point of detail. The time at my disposal is short, and I am very hard worked in my professional duties. This will, perhaps, plead for me.
The Homoeopathic treatment of headache in children is subject. I think that the therapeutic treatment of headache, either in adults or children, is a point where Homoeopathy has most signally triumphed over Old-School treatment. In treating adults for headache, we have an instance of the great value of purely subjective symptoms, and at the same time we are obliged to run the risk of being led astray by our patient’s account who can accurately describe and locate his headache, with all its attendant effects, is even more rare than the man who, in proving a drug, can give a true account of the head sensations produced.
This latter rarity brings about another difficulty, for we have such a glut of head symptoms under almost every proved drug that to select a remedy becomes an appalling task.
I have been inquiring into the therapeutics of Allopathy in headaches recently, and my Allopathic friends tell me that besides the mere narcotics, which they agree with me can only smother the symptoms, they have a few new drugs, which are what they call specifics in some forms of headache. They have been lighted on “quite empirically,” but I note that very pretty pathological theories have subsequently been produced to fit the facts of the success attending the use of these drugs. It will interest us as Homoeopaths to learn from our friends something new. The drugs are: Aconite, Belladonna, Gelsemium, Phosphorous, and Nitro-glycerine.
In dealing with children, we have not the difficulty of the patient’s inability to be exact in recounting the symptoms, to to accept our suggestion as to the nature the pain if they be only sufficiently expressive of great sufferings; but we have the still greater difficulty that our little patient gives us no verbal and personal description at all of his feelings. Where the child is old enough to give us a hint, we find the description generally more truthful than the average sick adult, less exaggerated, and often very picturesque, as in one case I have in mind, where a little girl said her head had “eyes worked with a lead weight, like dolly,” and this weight was out of gear, and scraped inside her forehead.
But, as a rule, we are forced to depend chiefly upon objective symptoms with children, and I submit that this fact accounts for our comparative non-success in the therapeutics of headache in children. We are tempted to build too much upon pathological theories, a fault which is not common in Homoeopathy, for, on the whole, it is probable that we neglect pathological considerations too much in our therapeutics.
I will not attempt a classification of headache in children; such would be only arbitrary and artificial; but there are some general points which experience has led me to think of value. I have formed an opinion, perhaps on too slight reasons, that frontal headaches in children are more generally the result of some distant affection, or of a constitutional or blood disorder; whilst occipital headaches are often local, and more often than not they are ocular, or the result of injuries. Hereditary headaches seem to tend to one circumscribed spot, generally unilateral, and supra orbital or temporal.
One of the most common grounds of error in therapeutics, in these affection (speaking for myself), is that of founding treatment upon the supposition that the pain is due either to cerebral hyperaemia or the reverse condition, anaemia. We often meet with children who have headache accompanied with flushed face, bright eyes, and restlessness, who are usually anaemic; and my experience tells me that these children are not successfully treated with Belladonna or Aconite. More frequently remedies which are homoeopathic to their usual constitutional state, such as Ferrum or Arsenicum, will prove valuable.
In anaemic children, with apparently hyperaemic headaches, it will usually be found that hot, nourishing food, such as hot milk or soup, will relieve the pain, whereas in true hyperaemic headache such a course would perhaps increase the pain.
I think that the examination of the urine prove valuable in most cases of headache in children. Many anaemic children will be found to pass excess of phosphates or urates during their headaches, and we may draw valuable indications for diet from such facts.
I had a very painful case of persistent headache in a child under my care, in which great quantities of phosphates were passed whilst the urine was copious. The child was depressed and stupefied; had severe pain over the region of the kidneys; vomited his food, and his face was flushed, with photophobia; he had vertigo, so that he staggered. Many remedies were tried unsuccessfully, but the rather unusual one, Helonias, proved curative given in the sixth potency.
Another case I have notes of is, perhaps, instructive. A child, 9 years of age, a boy, who had epistaxis with his headache; but this symptom could not be taken as an indication of cerebral hyperaemia, for the child was pale and markedly anaemic; he had palpitation of the heart, and auscultation revealed a mitral insufficiency. Lachesis 12 proved the remedy. I mention this case as an example of the error of taking symptoms which often point to cerebral hyperaemia as always indicating that state in children. I venture to say that we too often look upon epistaxis as a proof of abnormal fulness of the cerebral vessels.
In children we can usually afford to neglect the possibility of the bleeding being due to disease of the coats of the vessels, as it may be in adults; but we should be on our guard, and remember that epistaxis in children ma be a sign even of constitutional anaemia or of a passive or of a passive congestion due to valvular disease of the heart.
What are called “school headaches,” bring great responsibility upon us; we are called upon to advise as to the nature and extent of the education which some children can bear, and if we decide wrongly we may do much harm to the children in their future life. There is grave responsibility attaching to any man who causes a child to be withdrawn from its lessons, and to miss that period of life when habits of thought and memory may be most easily required; and, on the other hand, great errors have been made in the opposite direction; school-headaches have been neglected, and the child’s brain powers undermined by suffering, and its normally happy child-time rendered very miserable.
My experience is, that under the modern system of education, which recognizes the facts of evolution in these matters, and leads a child up by gradual steps from play to “play-work,” and so on to exercise of memory and perception by slight and easy stages, we see less of genuine school-headaches; by which I mean, headaches which are actually the result of overstrain of brain-powers, and yet, children at school do very often suffer from headache; after errors of “cramming” have been eliminated, and all the hygienic surroundings of children at school have been reformed to the modern scientific standard, we yet have too many of these cases to deal with.
Our children-of course I mean English children only-are very glad at times to get out of school before the regulation hours, and if they choose malingering as the means to this end, they are clever enough to select maladies which are diagnosed by subjective symptoms only, for obvious reasons; and this kind of school-headache is the first to claim our attention.
I would not be so discourteous as to suggest that the American child ever shams; but there are English children in your schools; and if these should be frequently away from school, with headache, it is sometimes found that it is a headache which comes on very early in school-hours; is vague in its situation, and then youngster is able to read books of amusing stories, or engage in other occupations requiring considerable concentration both of eye and memory, without a return or increase of the headache; I have found that isolation from the class in which the child is placed at school, and the use of special large type, not interrupting the usual school-hours of work, is worth trying as treatment here; children will not hold out for long if they are malingering when thus kept apart from their follows.
But the fact that children know that there is such a thing as headache from reading point, shows this is no uncommon form of the affection; and I think that a large proportion of school headache are due to eye-strain.
Headache due to eye-strain are, I have noticed, more often occipital than frontal or vertex; considerable success in their treatment is gained by simple attention to the general health; but so-called “tonic treatment” is never more than palliative; the headache may be kept away so long as artificial stimulation is kept up, but will return when it is removed; when the child is in exceptionally good health, the headache may be absent, as after the holidays; but as the school term progresses, the trouble returns; in such cases it will generally be found that the vision is apparently normal, unless the child is, at the moment of examination, suffering from pain; but when tired, or when under the influence of Atropine in the eye, the refraction will be found at fault; the child is able, under ordinary conditions, to produce accommodation by an effort which is unconscious, but in excess of what should be demanded of the child; and, under ill-health or prolonged application, this strain is evidenced b headache.
I have seen one case, that of a girl of 12 years of age, who suffered from severe neuralgic pain in the neck, radiating down the cervical nerves on both sides, which was caused entirely by eyestrain, and was cured by the use of the proper glasses. .
I here no doubt that the Homoeopathic therapeutics of such conditions are well known to all present, but they will be of little avail if the help of properly-adjusted glasses is neglected; not “Pincenez,” which sometimes provoke fresh headache in a sensitive child by their pressure on the bridge of the nose, but light-framed spectacles. There are three drugs which I have been led to use, of which the first, Acid picric., is perhaps not sufficiently valued; the pathogenesy of this drug points to both the headache and the ocular symptoms; I have used it in the higher potencies, by which I mean from 12 to 30; NItrate of silver and Cimicifuga are the other two; these I mention as being, possibly, outside the general run of headache remedies, and because they have served me well. I use the two latter in varying doses, but the Cimicifuga in lower potencies, 3x, or thereabouts.
I think that the headaches of girls at approaching puberty are becoming more general in our times; the new physical regime has not been universally adopted as yet, though in families where it has been practical of from childhood, I find less suffering among the girls as menstruation comes on; the cause of a girl’s headache at this period of her life is generally well recognized by mothers, who are awake to then necessity of physiological rest at these times; I need not detain you with therapeutics here, but drop a word to attract your attention to the tendency of Homoeopathic mothers having a fancy for Pulsatilla in all these troubles of their girls; it seems very apt to act upon the ovaries rather too freely, for the tendency in most girls is to rather free less of blood at the first few periods, more often than the opposite (in my won experience), and Pulsatilla increases this tendency unduly; Coffea and Ferrum seem often useful.
The “genital headaches” of boys at puberty often cause much suffering, and in all cases of intractable headache in boys the possibility of approaching puberty should receive attention. Other genital irritation in boys also seem to play a prominent part in causing headache, and in my own experience I have found that phymosis is not seldom a cause of headache in boys, as it is of many nervous symptoms; and you, no doubt, will all remember cases where circumcision has cured such troubles. I have known, in several cases, the most happy results from circumcision in boys headaches.
I will not deal with the headache of febrile states, since our attention in such cases in turned to the fever rather than the headache alone; but there are headache accompanied by fever, and due to malaria, which are instances of the headache being the main guiding symptom. I think they are usually intermittent; they are either very vague and general in the locality they affect, or occasionally will be truly neuralgic, the pain being fixed in one or other of the cranial nerves, or at least being felt over the surface where the nerves are distributed, and perhaps the supra- orbital region, comes before us, we have the true sphere for Quinine to be used Homoeopathically.
I may, perhaps, be at variance with others when I state that I do not think that true “migraine” is often seen in children. In the case of the children of parents who are sufferers from migraine we certainly often see headache, but I find them usually to be coincident with some digestive upset, and the vomiting, if presents, to be more often controlled by remedies acting upon the stomach than by such as are chosen upon the cerebral supposition. I recognize that these pathological suppositions are alien to the Homoeopathy held by many, but I think that in most cases it will be found that a remedy, chosen first on the ground of the totality of the symptoms, turns out, on further examination, to be also the pathological similar.
Still, there are cases of headache in children in which, before the onset of pain, we hear of various warning symptoms, such as flashes of light before the eyes, or sensations of dimness of sight, or, in some cases, temporary weakness or paralysis of an arm or leg, either motor or sensory, or both. Then the pain in the head, localized generally in a definite4 spot on one side of the forehead, comes on, and is followed by vomiting. Such headaches, if frequent in onset, are probably true migraine, not coincident with dyspeptic trouble, and they may be hereditary. The first point is to eliminate the possibility of eye strain, for this is more frequently the cause of migraine than is sometimes supposed. In such cases of true migraine in children, Coffea 6 and Acid carbolic 12 have served me well.
I need scarcely mention the importance of headache where the pain is felt near the mastoid bones or round the ear, as indicating ear disease, but I have seen the neglect of timely surgical interference very injurious in at least three such cases. The pain is not headache, though generally described as such.
And we must always be on our guard when we meet with serious nervous symptoms, such as spasm of the muscles of the neck or spine, paralysis of muscles, twitchings or convulsions, in connection with children’s headaches. Such indications of possible cerebral mischief, tubercle or tumor, are, of course, known to us all.
Finally, I would not the headache of renal disorder. I would urge regular testing of the urine in all cases of children’s headaches, for if, as is sometimes the case, the pain is coincident with uraemia or albuminuria, our remedies will be of no use unless those symptoms are placed in the front rank when drawing up the total symptoms. .
Ladies and gentleman, I ask kind indulgence for this hurried, incomplete, and very unscientific contribution. If you have any discussion upon this matter of practical detail, you will find material in the mere demolishing of my observations.
PHOEBE J.B. WAITE., M.D.: The last paper read was especially interesting because I believe so many children suffer from headache when they ought to be made comfortable and cured, and the one thing above all others which gives suffering to children I believe to be eye-strain. As soon as they are put in schools they commence to droop. If the child a myopic, there is a request that he be put in the front of the room, but no thought is given to the hyperopic child. I believe the uses of the ophthalmoscope are going to prolong the lives of children in bringing out this infirmity. Many children suffer from headaches, but we have our Pulsatilla and kindred drugs to help them. If your child suffers with headache, don’t forget to take it to the oculist. This would be a beautiful specially for a woman.
DR. DUFFIELD: There are many cases of near sightedness which can be cured simply by having the patient accustom himself to distant objects. Take them out in the country, and in this way we get the muscles stretched, which is a good as nerve-stretching in other cases. I have cured cases of nearsightedness by having the patient go to live in the country, and so accommodate the eye to long distances.
A physician in the audience: I remember a case coming under my care several years ago of girl having epilepsy, and she had a spasm once in about eight days. I found, on inquiry, she used sugar excessively, and when she left off sugar the spasms ceased in two or three months. There is a great deal in diet. Another cause of headache is want of ventilation in the schoolroom. Most of our schoolrooms are very poorly ventilated. There ought to be a radical change in this matter. We ought to turn our attention to hygienic methods more than we do.