[A paper read to the International Homoeopathic Congress, London, 1950.]
The selection of a homoeopathic remedy in childhood is made in the same way as in adults. The difference lies mainly in case taking and in interpreting the symptoms against the normal pattern of behaviour at any particular age. The history is supplied to greater or less extent by the mother or nurse, at any rate by someone other than the patient himself. In formulating a plan of case taking it is therefore necessary to concentrate on symptoms which can readily be observed by someone other than the patient. The mother is usually by far the best person to give the history especially when the patient is an infant. Not only is the mother a keen observer of her infant, but she can often give us an account of the family history, and a first- hand account of the period of gestation and labour.
INTRA-UTERINE ENVIRONMENTAL FACTORS
The recent discovery that German measles in the mother can produce deformity in the foetus has focused attention to this important and easily forgotten part of the child’s life.  Over six hundred cases of deformity associated with German measles have now been published. Microcephaly, congenital heart disease, cataract, and deafness are the most common abnormalities.
The period of most danger to the foetus is in the early months of gestation. When the mother became infected during the first two months of pregnancy the chances of foetal deformity were 100 per cent. In the third month the figure dropped to 50 per cent. Viruses can readily pass through the placenta.
In the influenza epidemic of 1918 a high proportion of infected mothers aborted. It is well known that syphilis and occasionally other infections may be transmitted to the foetus causing injury or death.
The use of lead as an abortifacient can cause foetal abnormalities especially congenital heart disease and skeletal defects. The therapeutic use of X-rays and radium can cause foetal defects, especially microcephaly. Dennis Browne has demonstrated how intrauterine pressure can cause talipes and other deformities.
If there were any doubt that the foetus can be adversely affected by its environment in utero, there are instances recorded of deformity of one of similar twins. .
Dr. Landtman of University College Hospital sums up as follows:
“Various observations have shown that environmental principles play an important part in the aetiology of congenital malformations. Foetal abnormalities result, but not of any characteristic type, in relation to the various causes. The most important factor appears to be the stage at which foetal development is disturbed. Due to lack of teratogenetic characteristics, malformations caused by environmental agents may simulate abnormalities of genetic origin”.
Drugs taken by the mother can undoubtedly affect the foetus in some cases. Practically all textbooks on obstetrics condemn the use of alcohol during and immediately after pregnancy, suggesting it as a possible cause of sterility, abortions, still-births and a high foetal mortality..
There is experimental evidence that alcohol tends to concentrate in the reproductive organs, and it is freely diffusible through the placenta. Carpenter has shown that in hens with immature eggs that were exposed to the fumes of alcohol for periods of two to twenty nine hours, the concentration of alcohol in the egg was often equal to or greater than the concentration in the blood stream.
The evidence about smoking during pregnancy is contradictory. There is, however, some evidence strongly suggestive that smoking may affect the foetus. The effect of nicotine in breast milk will be referred to later.
The placenta is also permeable to chloroform, ether, morphia, hyoscine, atropine, physostigmine, pilocarpine, arsphenamine, the barbiturates, sulphonamides; penicillin and various salts of sodium, potassium, copper and bismuth. Marked emotional disturbance may affect the unborn child, and no homoeopathic history is complete without a record of any such episodes.
THE EFFECTS OF LABOUR
In the process of birth the infant is exposed to trauma of varying degree, to anoxia, and sometimes to anaesthetics. These observations have been made as a reminder of environmental influences before or during birth, rather than to stress unduly the risks encountered by the foetus during gestation and labour. Occasionally some outstanding event of pregnancy or labour is of the utmost value in prescribing.
It is obvious that we should consider specially the events of pregnancy and labour in children who have never thrived. Faulty milk teeth also suggests an enquiry into pregnancy, as these teeth are formed in the second half of gestation. It is, of course, impossible to rule out hereditary influences in this connection.
THE HOME ENVIRONMENT IN RELATION TO SYMPTOMS.
Even in infancy children are acutely aware of, and absorb the mental atmosphere of the home or the people around them.  The nervous child has almost inevitably been brought up in an atmosphere of fear and worry. The effects of a “broken home” where father and mother have separated, or are mentally incompatible, are highly damaging. It has been noticed in child guidance clinics that the “broken home” is a frequent cause of juvenile delinquency. One of the basic needs of childhood is a sense of emotional security. In the “broken home” he does not feel secure. When a young child, under the age of five years, is removed from his mother for a period of six months or longer there is statistical evidence to show that this child has a greater tendency to develop into a juvenile delinquent than average. .
Almost equally damaging to the child is a feeling of insecurity engendered by ambitious parents who make the child feel he is valued for his achievements rather than for himself. If it is forgotten that children tend to react in a similar way to their mental environment, mental symptoms may be evaluated too highly, as being characteristic of the individual. Also in such cases the environment may be too strong for the child to overcome even if the correct homoeopathic treatment is given.
FEEDING IN RELATION TO SYMPTOMS
In this country infant feeding is now well supervised. Mistakes still occur, however, and in infancy the amount and nature of the feeds should be ascertained. The technique of feeding must also be considered carefully. If this is overlooked symptoms arising from mismanagement may easily be mistaken for constitutional ones. We have to remember the possibility of contamination of food, and this applies to breast milk also. Many drugs are excreted in the milk but advances effects on the infant are few. Nicotine is excreted in the milk of mothers who smoke during lactation. Moderate smoking (up to seven cigarettes per day) appears to have no ill effects on the breast-fed infant. The amount of nicotine excreted in the milk in mothers who smoke over fifteen cigarettes per day is considered potentially harmful to the infant. Dr. W. H. Thompson writing in the American Journal of Obstetrics and Gynaecology states “When one considers the statements of Cushney that nicotine is about as poisonous as prussic acid, it seems logical to consider that even minute quantities of nicotine administered through breast milk might upset digestive processes to the extent of endangering the early growth of delicate babies. .
The preparation of food in aluminium pans may cause harm. Copper cooking utensils are much less widely used. They can cause symptoms if not kept clean. . Many babies of mothers who smoke or use drugs, and many children fed on food cooked in aluminum seem perfectly well. It seems to be largely a matter of sensitivity whether the individual suffers or not, particularly when only small amounts of toxins are ingested.
The mother can usually supply us with an accurate list of acute illness, reaction to immunization, trauma, mental or physical, and any drugs given to the child in chronological order. The mother usually gives some valuable clues to the nature of the child, in addition to that which we can observe for ourselves. It is useful, however, to have some plan of interrogation in mind, based on the symptoms of high value which the mother is in a position to observe.
GENERATIONS WITH SPECIAL REFERENCE TO CHILDHOOD
From earliest infancy there are signs of individuality. The infant spends most of its time in feeding and sleeping. Observation in any children’s ward will show that during sleep many children tend to take up characteristic positions. A large proportion of children do so during the first year. In many children the tendency disappears or may alter later. In some it persists. Kent’s Repertory lists only one remedy for the knee elbow position. “Sleep position, on the knees with face forced into the pillow”, Medorrhinum. Enquiry of the position adopted in sleep suggests that Lycopodium or Sepia, Tuberculinum, Calcarea phos. and probably other remedies also have this symptom. The value of it is that the mother can usually give a definite answer to the question and it is obviously a generality.
Occasionally, the infants response to being picked up and especially to being laid down may be useful. Aversion to downward motion, as when the baby is laid down in its cot may confirm the selection of Borax for example.