- Email: [email protected]
Calcarea carbonica, a study
Calcarea carbonica, a study D. M.
GIBSON,
M.B., B.S.LOND., F.R.C.S.EDIN., F.F.HOM.
PHARMACOGNOSY
This extremely important remedy can be classified as of animal source in association with Sepia and Murex, its aquatic confreres. Just as Sepia is prepared from the dark fluid secreted by the cuttlefish and Murex from the dried secretion of the purple gland of Murcx, the purple fish, so this remedy, also known as .Cal~r~ Ostr~rum, is prepared from the secretion of Ostrea edulis, the oyster. The source of the remedy, the soft, snowy white calcareous substance in the middle layer of the oyster's shell, is excreted by the mantle of the mollusc a n d is in fact a deposit of finely crystalline calcium carbonate. This torpid-appearing mollusc, placed between the snail and the cuttlefish, ~quats on the ocean bed with the two halves of its shell widely gaping in seeming indolent inertia. I t is, however, capable of one form of movement, for if there is t h e slightest disturbance of the water in its vicinity it closes its shell with vicelike firmness, obviously manifesting a capacity for strong muscular spasm. I t is noteworthy that the Calr~r~ subject is unduly sessile, exhibits an air o f toneless inertia, and covers with a mask of clam-like unresponsiveness the turmoil of fears and anxieties that are seething within. The tightly-shut she]] o f the oyster conceals the agitation within which gives rise to the spasmodic closure as a shield for its defencelessness. As well as manifesting lack of tone and muscular weakness the Calcarea subject may also present conditions of muscle spasm affecting both skeletal and plain muscle. PHARMACOLOGY
The predominant mineral form of calcium in nature is the carbonate. As such it is, next to alumininm and iron, the most abundant metalin the earth. Calcium is also the most important inorganic element in the body and occurs in the highest amount. The cyclic fate and behaviour of calcium in the earth and in the body are, on broad lines, analogous. The calcium processes in the body swing either to precipitation, calcium becoming bound in the tissues, or to diffusion, free calcium ions being available for cell-action. Calcium is stored in the skeleton mostly as phosphate and carbonate; the active ions combine as required with bicarbonate, acid phosphates and, to a lesser extent, with chlorides. Sufficient supplies of calcium, for instance in the form of food additives, lime-water, or calcium tablets, do not necessarily guard against disorders of calcium metabolism. Many factors enter into the processes of calcium absorption, assimilation and utilization. I t is essential for the calcium to be present in the right proportion to the other members of the metabolic quartette, namely sodium, potassium and magnesium; these four must be maintained in active equilibrium and, for this, calcium assimilation and excretion must be kept adequately balanced.
106
THE
BRITISH
HOM(EOPATHIC
JOURNAL
Calcium antagonizes sodium and potassium ions which i n d u c e cell colloids to imbibe water, and in this way calcium acts as a bar and decreases the permeability of the cell membranes, thus upholding the tone of the cells and preventing them from becoming waterlogged. Preponderance of calcium, however, makes the exchanges between cells and fluids over-difficult and thus slows down metabolism. The membranes are altered as it were from filter paper to parchment and excretion of water and solutes is cut down. Combustion is reduced and the picture of a person with a tissue-blocked calcium imbalance is produced, namely a sluggish, cold, flabby, pale, pasty, obese, phlegmatic "oyster-like" individual. The retarding depressant action of calcium is evident also in the neuromuscular sphere. Without the brake imposed by calcium the unrestrained influence of sodium and potassium ions would keep the skeletal muscles in a constant state of hypertonus, resulting in tetany and leading finally to paralysis through exhaustion. Too little circulating calcium is, therefore, as productive of disturbed metabolism as too much. Homceostasis, electrolyte balance, is the aim, and when this is out of order Calcarea in potency may be able to restore essential equilibrium. An understanding of the multiple functions of calcium in the body, or rather of the multiplicity of functions (for they are none too well understood) is a help in appreciating the varied symptomatology presented by this remedy. Calcium is, of course, a main constituent of bone, where it is present in the form of apatite, a crystal lattice composed of calcium carbonate and calcium phosphate, which gives to bone its hardness. Calcium is essential for clotting reactions whether in blood or in milk. In optimal concentration calcium accelerates the action of several enzymes b u t if present in excess it inhibits enzyme activity. Calcium is also considered to play a leading rSle in the development of bioelectric potentials, due to the existence of a calcium electrode in the calcium proteinate of the cell cortex. In fact it is likely that the ability of calcium to combine with proteins to form compounds which occur almost everywhere in the body is the most significant biological property of the element. This accounts for its vital participation in so many physiological activities. Obviously a wide range of disorders may stem from imperfect calcium absorption, distribution or utilization; and these include such conditions as inadequate nutrition, inhibited growth and development, imperfect formation of bone, decreased eoagulability of blood, increased excitability of nerves and liability to tetany. The balance of calcium equilibrium in the body may thus swing in either o f two directions, towards calcium repletion or towards calcium depletion. Not only do these disorders help to explain the varied symptoms manifested b y Calcarea patients but experience has shown that the remedy administered a p t l y and in potency can effectively correct the disordered balance and restore health. PHYSIOGNOMY
The Calcarea subject is often an obese blonde with blue eyes, a pale waxy complexion, pale lips, pale ears and pale fingers. Though the face may at times have a red tinge. Sometimes the Calcarea patient may he a thin scrawny brunette with a sallow skin.
CALCAREA CARBONICA, A STUDY
107
Babies appear soft, flabby, pasty-faced and are constantly sweaty about t h e head. The Calcarea child appears lethargic, is sessile, stays put wherever dumped by its parent, picks at its fingers, fiddles with small objects. I t displays delayed dentition, late closure of fontanelles, hot breath, cud-chewing movements o f the lower jaw, possibly signs of rickets. Walking is late and wobbly owing to weakness of muscles. In general there is an appearance of fatness without fitness. Adolescents show obesity. But some children will be emaciated about the neck and limb~ with a protuberant taut belly. Poor circulation is evidenced by a hand like a dead fish, cold, clammy, lifeless, lacking grip, and by damp cold feet. The hand may in some cases b e soft, warm, moist and feel boneless. Wide pupils manifest low parasympathetic tone. Speech may be non-stop, a constant chatter about trivialities of a personal nature, or the subject may relapse into obdurate silence and become almost catatonic. A noticeable feature is a peculiar sour odour of body, of vomit, of stools. PSYCHOLOGY
The emotional attributes mirror in the main the general retardation which derives from disordered calcium metabolism. The Calcarea subject is slow, dull, uninterested, timid, and shuns any form of mental effort. This is not due to inherent laziness but to the inability for effort which is the affliction rather than the fault of the sufferer. Children don't like to be laughed at and, if frustrated, just give up. They are slow at school, slow at games, get scared in the dark, may see faces in the dark, and are given to night terrors. They may become low-spirited and weepy. The Calcarea subject is apt to be fretful, obstinate, unable to think consecutively or remember things, and becomes quite incapable of arriving at a decision. Mental or any kind of effort causes distress, and this may reach the point where he feels he can't continue and quits. Fear is a marked feature. The Calcarea subject is full of fear fear of people, fear of the dark, fear of being looked at, fear of solitude, a vague fear of "scarcely knows what", a growing fear of impending insanity. In this latter condition the sufferer can't stop thinking about his apprehension, can't stop talking about it and thinks everybody is looking at him with suspicion. Another feature is an unresponsiveness, the individual shutting up like a clam and assuming an air of indifference, which is in actuality an attempt to camouflage the anxiety and agitation within. He may become discouraged, despairing and disgusted with life. A state of over-sensitivity may supervene, jumpiness, easily startled at the least noise, exceedingly distressed on hearing of cruelty, scared at the sight of wounds, impulse to scream or indulge in causeless tears. There may be a tendency to grouse and complain over ancient wrongs, to become peevish, take everything amiss, and develop an unreasoning antipathy towards certain individuals. PHYSIOLOGY
Calcium stagnation impairs heat production in the body. I t is not surprising, therefore, that the Calcarea subject is excessively chilly and quite miserable.
I08
THE BRITISH
HOM(EOPATHIC
JOURI~AL
when cold. There is a desire to be well and warmly wrapped up, and an aversion f r o m open air and the least draught. Direct sunlight also is disliked. Irregular distribution of blood-flow m a y produce internal heat combined with ~external chilliness; cold is often felt in patches; feet, normally cold, may, however, burn at night and be pushed around in search of a cool spot or shoved ,out from under the bed covers--a symptom shared with Chamomilla, Medorrhinum, Pulsatilla and Sulphur. The hands m a y " b u r n " on the dorsal aspect. T h e Calcarea individual easily becomes over-heated and distressed, and then, ~on ceasing from activity, quickly feels over-cold. Hunger is the norm with a tendency to experience a faint, e m p t y sensation a t any hour, perhaps immediately after a meal. There is a fondness for sweet things and often a real craving for eggs, even with children. There is often an aversion from hot food, meat, coffee and tobacco, and from milk which m a y disagree. A peculiar feature in the sphere of appetite is a tendency to odd perversions-t h e child m a y eat dirt, coal, chalk, possibly manifesting in this way an impaired calcium assimilation. Thirst m a y be marked, but drinking water can cause nausea. Iced water is, however, tolerated better, and preferred. Sleep is liable to be disturbed b y terrifying dreams; children wake from sleep screaming, and can scarcely be pacified. The child m a y sleep-walk, grunt or :grind the teeth in his sleep, and m a y lie with his hands under his head. There is often difficulty in getting off to sleep; a flow of anxious thoughts prevent sleep until 2, 3 or 4 a.m.; or sleep m a y be broken about 3 a.m. and give place to restless tossing. Sweating is a prominent feature, often excessive and especially marked on the head and feet. This is most evident at night, when the child's pillow will be found quite soaked with perspiration during sleep. Sudden sweats also are liable to occur from exertion or from excitement or fright. The General Modalities are such as would be expected. Aggravation is caused b y a n y contact with cold air, b y draughts, by a change from warm to cold weather, in wet weather and b y contact with cold water. There is aggravation also both before and during the menstrual period, from the standing posture a n d when a limb is allowed to hang down, all of which cause embarrassment of the circulation. Chronologically symptoms tend to be worse after midnight, a n d also at full moon. There is amelioration in warm, dry weather, when lying on the same side as the lesion and, curiously enough, when constipated. PATHOLOGY
The symptoms associated with this remedy exhibit one or other aspect of disturbed calcium metabolism, the effects of slowed-down functional activity and deficient oxidation of tissues on the one hand or of hypertonus and hypersensitivity on the other. The picture, therefore, is one of lack of stamina, very easy fatigue, fatigue moreover associated with actual muscular weakness and poor development. As the result of this inherent weakness any exertion tends to produce distress in the form of d y s p n e a , flushing, headache, and general malaise. Noticeable also is a great liability to catch "cold" and develop catarrhal troubles. Involvement of mucosal surfaces leads to the formation of polypoid or papillomatous growths, which are liable to bleed.
CALCAREA CARBO~ICA~
A STUDY
109
Head Region. While it is usual for the scalp to feel cold with a desire to have the head warmly wrapped, there m a y be at times a swirl of blood to the head accompanied b y a sensation of burning heat, especially on the vertex. Vertigo is readily induced b y extra physical effort or even b y mental exertion, owing to the inability of the circulation to cope with increased demand. Headache is common, a tearing or splitting headache above the right eye extending downwards in a wedge towards the nose, or a periodic headache, recurring every seven or fourteen days and accompanied b y biliousness. The headache is aggravated b y daylight and is relieved by warmth or hot applications and b y lying down in a darkened room. A unilateral headache is also described, aggravated by noise and b y the effort of talking, and tending to be better b y evening. Alopecia occurs, the hair coming out in patches rather than all over the scalp. Eyes. Eye symptoms m a y be severe with involvement of the cornea, possibly going on to ulceration, and extreme photophobia. Dimness of vision m a y precede these severe changes, a sensation as if there was a veil or a film before the eyes. The symptoms are much aggravated b y a n y exertion or prolonged use of the eyes for reading or other occupation. Ears. Catarrhal involvement of the middle ear m a y lead to perforation of the drum with chronic discharge, thick, yellow and mucopurulent in type and liable to exacerbation from every exposure to cold. Regional lymphnodes are often involved and eruptions m a y break out on the pinna or behind the ear. Respiratory System. As already mentioned there is an undue liability to "colds". These tend to be accompanied b y sore throat of an obstinate type with enlarged tonsils and involvement of cervical lymph nodes. Colds tend also to extend downwards and cause hoarseness of voice, which is painless and worse in in the morning. There m a y be complaint of a feeling as if a lump was lodged in the left side of the throat. Nasal catarrh m a y become very chronic with soreness of the nose, swollen ulcerated mucosa and thick yellow discharge with presence of crusts. Nasal polyps m a y develop. A persistent tickling cough is likely to be especially tiresome at night, or cough m a y be productive with copious, thick, yellow, sweetish-tasting sputum, possibly stained with blood. Respiration m a y be rattling from excess of mucus, and the chest is apt to feel as if it were too full of blood. Alimentary System. An unpleasant sour taste in the mouth is accompanied b y foetor oris. Burning pain m a y be felt at the tip of the tongue. The digestion seems sluggish with a tendency to frequent sour eructations or even sour vomiting. There is a curious repugnance to hot foot, and a good deal of heartburn, and possibly a cutting pain deep to the right scapula with spread to the right hypochondrium and epigastrium. The latter area is often quite tender to touch. Stubborn constipation m a y be present with pasty, clay-coloured stools, and associated sensations of crawling, burning and weight in the rectum. Recurrent diarrhoea is common, worse in the afternoon with whitish, watery, frequent stools, having a sour pungent odour and liable to cause excoriation of the perianal skin. The stool often contains curds and undigested food particles.
110
THE
BRITISH
HOM(EOPATHIC
JOURI~AL
The remedy has value in relation to tabes mesenterica; and also in helminthiasis.
Lymphatic and Glandular Systems. Lymph nodes in various sites become enlarged, indurated, with burning and stinging pains. Masses of matted nodes can be palpated, especially in the cervical regions and also in the mesentery. The lymphadenitis is often tuberculous in nature. Cardiovascular System. In association with the general state of asthenia cardiac response to effort is poor and exertion such as going upstairs is accompanied by dyspncea and palpitations. There is a liability to attacks of faintness while walking out of doors. Veins show varicosity and varicose lesions are associated with much burning discomfort. Urinary System. Cystitis is associated with dark, brownish coloured urine which has a peculiarly unpleasant sour pungent odour. Genital System. Menstrual periods tend to be previous, profuse, prolonged-too long and too strong. A period may be precipitated prematurely by either emotional stress or physical exertion. The breasts are apt to swell and be painful before the period and while it is continuing; dysmenorrhcea is characterized by cramping uterine pains and also general stomach pains. Pain in the region of the right ovary is apt to extend into the thigh, and is worse when reading or writing. Leucorrhoea is profuse, the thick discharge being accompanied by itching, burning and smarting. There is a tendency to develop uterine or vaginal polyps which bleed easily. Nervous System. Calcarea is mentioned in connection with convulsions which occur during the night, also with attacks of epilepsy preceded by a peculiar aura as if a mouse was running up the arm or leg. Par~esthesia may be complained of--pricking, darting sensations, quivering of muscles, a feeling of "cold, damp stockings on the feet", feeling as if "the part would burst". Locomotor System. The muscular weakness militates against any prolonged effort. Lifting has to be avoided for fear of spraining a muscle. The ankles are weak and readily turn over. Spinal muscles arc weak leading to faulty position when sitting and encouraging spinal curvature. Cramp is liable to occur at night, especially in the calf muscles. Rheumatic pains in the limbs are associated with much stiffness. Joints may become hot and swollen. Gouty affections of small joints with nodule formation are met with. Post-rachitic deformities may be present. Disorders of bone metabolism may occur, especially formation of exostoses. Skin. Chronic urticaria is mentioned in connection with Calcarea, also warts and papillomatous growths. The skin cracks easily, forming "chaps". Warning is given against the use of ointments and bandaging in skin complaints of Calcarea
CALCAREA
CARBONICA~
A STUDY
1|I
children. "The excess calcium is seeking a way out of the body per the skin and must not be dammed back." POSOLOGY
This remedy affords a good example of the importance of treating the patient and not prescribing by disease label. It is the patient-picture of Calcarea, especially the constitutional and mental manifestations, that is the chief guide to its use. Bryonia should not directly precede or follow Calcarea, but Belladonna is its complementary remedy in acute exacerbations. Rhus toxicodendron or PulsatiUa may be indicated in sequence to the remedy, but it should not be followed by Nitricum acidum or by Sulphur. A satisfactory sequence is Calcarea carbonica --> Lycopodium -->Sulphur. In association with py~emie abscesses in the deep tissues it is said to be able to induce resorption of pus. Too frequent repetition in old people is unwise, but the remedy can be repeated quite frequently in children if called for.
GIBSON,
M.B., B.S.LOND., F.R.C.S.EDIN., F.F.HOM.
PHARMACOGNOSY
This extremely important remedy can be classified as of animal source in association with Sepia and Murex, its aquatic confreres. Just as Sepia is prepared from the dark fluid secreted by the cuttlefish and Murex from the dried secretion of the purple gland of Murcx, the purple fish, so this remedy, also known as .Cal~r~ Ostr~rum, is prepared from the secretion of Ostrea edulis, the oyster. The source of the remedy, the soft, snowy white calcareous substance in the middle layer of the oyster's shell, is excreted by the mantle of the mollusc a n d is in fact a deposit of finely crystalline calcium carbonate. This torpid-appearing mollusc, placed between the snail and the cuttlefish, ~quats on the ocean bed with the two halves of its shell widely gaping in seeming indolent inertia. I t is, however, capable of one form of movement, for if there is t h e slightest disturbance of the water in its vicinity it closes its shell with vicelike firmness, obviously manifesting a capacity for strong muscular spasm. I t is noteworthy that the Calr~r~ subject is unduly sessile, exhibits an air o f toneless inertia, and covers with a mask of clam-like unresponsiveness the turmoil of fears and anxieties that are seething within. The tightly-shut she]] o f the oyster conceals the agitation within which gives rise to the spasmodic closure as a shield for its defencelessness. As well as manifesting lack of tone and muscular weakness the Calcarea subject may also present conditions of muscle spasm affecting both skeletal and plain muscle. PHARMACOLOGY
The predominant mineral form of calcium in nature is the carbonate. As such it is, next to alumininm and iron, the most abundant metalin the earth. Calcium is also the most important inorganic element in the body and occurs in the highest amount. The cyclic fate and behaviour of calcium in the earth and in the body are, on broad lines, analogous. The calcium processes in the body swing either to precipitation, calcium becoming bound in the tissues, or to diffusion, free calcium ions being available for cell-action. Calcium is stored in the skeleton mostly as phosphate and carbonate; the active ions combine as required with bicarbonate, acid phosphates and, to a lesser extent, with chlorides. Sufficient supplies of calcium, for instance in the form of food additives, lime-water, or calcium tablets, do not necessarily guard against disorders of calcium metabolism. Many factors enter into the processes of calcium absorption, assimilation and utilization. I t is essential for the calcium to be present in the right proportion to the other members of the metabolic quartette, namely sodium, potassium and magnesium; these four must be maintained in active equilibrium and, for this, calcium assimilation and excretion must be kept adequately balanced.
106
THE
BRITISH
HOM(EOPATHIC
JOURNAL
Calcium antagonizes sodium and potassium ions which i n d u c e cell colloids to imbibe water, and in this way calcium acts as a bar and decreases the permeability of the cell membranes, thus upholding the tone of the cells and preventing them from becoming waterlogged. Preponderance of calcium, however, makes the exchanges between cells and fluids over-difficult and thus slows down metabolism. The membranes are altered as it were from filter paper to parchment and excretion of water and solutes is cut down. Combustion is reduced and the picture of a person with a tissue-blocked calcium imbalance is produced, namely a sluggish, cold, flabby, pale, pasty, obese, phlegmatic "oyster-like" individual. The retarding depressant action of calcium is evident also in the neuromuscular sphere. Without the brake imposed by calcium the unrestrained influence of sodium and potassium ions would keep the skeletal muscles in a constant state of hypertonus, resulting in tetany and leading finally to paralysis through exhaustion. Too little circulating calcium is, therefore, as productive of disturbed metabolism as too much. Homceostasis, electrolyte balance, is the aim, and when this is out of order Calcarea in potency may be able to restore essential equilibrium. An understanding of the multiple functions of calcium in the body, or rather of the multiplicity of functions (for they are none too well understood) is a help in appreciating the varied symptomatology presented by this remedy. Calcium is, of course, a main constituent of bone, where it is present in the form of apatite, a crystal lattice composed of calcium carbonate and calcium phosphate, which gives to bone its hardness. Calcium is essential for clotting reactions whether in blood or in milk. In optimal concentration calcium accelerates the action of several enzymes b u t if present in excess it inhibits enzyme activity. Calcium is also considered to play a leading rSle in the development of bioelectric potentials, due to the existence of a calcium electrode in the calcium proteinate of the cell cortex. In fact it is likely that the ability of calcium to combine with proteins to form compounds which occur almost everywhere in the body is the most significant biological property of the element. This accounts for its vital participation in so many physiological activities. Obviously a wide range of disorders may stem from imperfect calcium absorption, distribution or utilization; and these include such conditions as inadequate nutrition, inhibited growth and development, imperfect formation of bone, decreased eoagulability of blood, increased excitability of nerves and liability to tetany. The balance of calcium equilibrium in the body may thus swing in either o f two directions, towards calcium repletion or towards calcium depletion. Not only do these disorders help to explain the varied symptoms manifested b y Calcarea patients but experience has shown that the remedy administered a p t l y and in potency can effectively correct the disordered balance and restore health. PHYSIOGNOMY
The Calcarea subject is often an obese blonde with blue eyes, a pale waxy complexion, pale lips, pale ears and pale fingers. Though the face may at times have a red tinge. Sometimes the Calcarea patient may he a thin scrawny brunette with a sallow skin.
CALCAREA CARBONICA, A STUDY
107
Babies appear soft, flabby, pasty-faced and are constantly sweaty about t h e head. The Calcarea child appears lethargic, is sessile, stays put wherever dumped by its parent, picks at its fingers, fiddles with small objects. I t displays delayed dentition, late closure of fontanelles, hot breath, cud-chewing movements o f the lower jaw, possibly signs of rickets. Walking is late and wobbly owing to weakness of muscles. In general there is an appearance of fatness without fitness. Adolescents show obesity. But some children will be emaciated about the neck and limb~ with a protuberant taut belly. Poor circulation is evidenced by a hand like a dead fish, cold, clammy, lifeless, lacking grip, and by damp cold feet. The hand may in some cases b e soft, warm, moist and feel boneless. Wide pupils manifest low parasympathetic tone. Speech may be non-stop, a constant chatter about trivialities of a personal nature, or the subject may relapse into obdurate silence and become almost catatonic. A noticeable feature is a peculiar sour odour of body, of vomit, of stools. PSYCHOLOGY
The emotional attributes mirror in the main the general retardation which derives from disordered calcium metabolism. The Calcarea subject is slow, dull, uninterested, timid, and shuns any form of mental effort. This is not due to inherent laziness but to the inability for effort which is the affliction rather than the fault of the sufferer. Children don't like to be laughed at and, if frustrated, just give up. They are slow at school, slow at games, get scared in the dark, may see faces in the dark, and are given to night terrors. They may become low-spirited and weepy. The Calcarea subject is apt to be fretful, obstinate, unable to think consecutively or remember things, and becomes quite incapable of arriving at a decision. Mental or any kind of effort causes distress, and this may reach the point where he feels he can't continue and quits. Fear is a marked feature. The Calcarea subject is full of fear fear of people, fear of the dark, fear of being looked at, fear of solitude, a vague fear of "scarcely knows what", a growing fear of impending insanity. In this latter condition the sufferer can't stop thinking about his apprehension, can't stop talking about it and thinks everybody is looking at him with suspicion. Another feature is an unresponsiveness, the individual shutting up like a clam and assuming an air of indifference, which is in actuality an attempt to camouflage the anxiety and agitation within. He may become discouraged, despairing and disgusted with life. A state of over-sensitivity may supervene, jumpiness, easily startled at the least noise, exceedingly distressed on hearing of cruelty, scared at the sight of wounds, impulse to scream or indulge in causeless tears. There may be a tendency to grouse and complain over ancient wrongs, to become peevish, take everything amiss, and develop an unreasoning antipathy towards certain individuals. PHYSIOLOGY
Calcium stagnation impairs heat production in the body. I t is not surprising, therefore, that the Calcarea subject is excessively chilly and quite miserable.
I08
THE BRITISH
HOM(EOPATHIC
JOURI~AL
when cold. There is a desire to be well and warmly wrapped up, and an aversion f r o m open air and the least draught. Direct sunlight also is disliked. Irregular distribution of blood-flow m a y produce internal heat combined with ~external chilliness; cold is often felt in patches; feet, normally cold, may, however, burn at night and be pushed around in search of a cool spot or shoved ,out from under the bed covers--a symptom shared with Chamomilla, Medorrhinum, Pulsatilla and Sulphur. The hands m a y " b u r n " on the dorsal aspect. T h e Calcarea individual easily becomes over-heated and distressed, and then, ~on ceasing from activity, quickly feels over-cold. Hunger is the norm with a tendency to experience a faint, e m p t y sensation a t any hour, perhaps immediately after a meal. There is a fondness for sweet things and often a real craving for eggs, even with children. There is often an aversion from hot food, meat, coffee and tobacco, and from milk which m a y disagree. A peculiar feature in the sphere of appetite is a tendency to odd perversions-t h e child m a y eat dirt, coal, chalk, possibly manifesting in this way an impaired calcium assimilation. Thirst m a y be marked, but drinking water can cause nausea. Iced water is, however, tolerated better, and preferred. Sleep is liable to be disturbed b y terrifying dreams; children wake from sleep screaming, and can scarcely be pacified. The child m a y sleep-walk, grunt or :grind the teeth in his sleep, and m a y lie with his hands under his head. There is often difficulty in getting off to sleep; a flow of anxious thoughts prevent sleep until 2, 3 or 4 a.m.; or sleep m a y be broken about 3 a.m. and give place to restless tossing. Sweating is a prominent feature, often excessive and especially marked on the head and feet. This is most evident at night, when the child's pillow will be found quite soaked with perspiration during sleep. Sudden sweats also are liable to occur from exertion or from excitement or fright. The General Modalities are such as would be expected. Aggravation is caused b y a n y contact with cold air, b y draughts, by a change from warm to cold weather, in wet weather and b y contact with cold water. There is aggravation also both before and during the menstrual period, from the standing posture a n d when a limb is allowed to hang down, all of which cause embarrassment of the circulation. Chronologically symptoms tend to be worse after midnight, a n d also at full moon. There is amelioration in warm, dry weather, when lying on the same side as the lesion and, curiously enough, when constipated. PATHOLOGY
The symptoms associated with this remedy exhibit one or other aspect of disturbed calcium metabolism, the effects of slowed-down functional activity and deficient oxidation of tissues on the one hand or of hypertonus and hypersensitivity on the other. The picture, therefore, is one of lack of stamina, very easy fatigue, fatigue moreover associated with actual muscular weakness and poor development. As the result of this inherent weakness any exertion tends to produce distress in the form of d y s p n e a , flushing, headache, and general malaise. Noticeable also is a great liability to catch "cold" and develop catarrhal troubles. Involvement of mucosal surfaces leads to the formation of polypoid or papillomatous growths, which are liable to bleed.
CALCAREA CARBO~ICA~
A STUDY
109
Head Region. While it is usual for the scalp to feel cold with a desire to have the head warmly wrapped, there m a y be at times a swirl of blood to the head accompanied b y a sensation of burning heat, especially on the vertex. Vertigo is readily induced b y extra physical effort or even b y mental exertion, owing to the inability of the circulation to cope with increased demand. Headache is common, a tearing or splitting headache above the right eye extending downwards in a wedge towards the nose, or a periodic headache, recurring every seven or fourteen days and accompanied b y biliousness. The headache is aggravated b y daylight and is relieved by warmth or hot applications and b y lying down in a darkened room. A unilateral headache is also described, aggravated by noise and b y the effort of talking, and tending to be better b y evening. Alopecia occurs, the hair coming out in patches rather than all over the scalp. Eyes. Eye symptoms m a y be severe with involvement of the cornea, possibly going on to ulceration, and extreme photophobia. Dimness of vision m a y precede these severe changes, a sensation as if there was a veil or a film before the eyes. The symptoms are much aggravated b y a n y exertion or prolonged use of the eyes for reading or other occupation. Ears. Catarrhal involvement of the middle ear m a y lead to perforation of the drum with chronic discharge, thick, yellow and mucopurulent in type and liable to exacerbation from every exposure to cold. Regional lymphnodes are often involved and eruptions m a y break out on the pinna or behind the ear. Respiratory System. As already mentioned there is an undue liability to "colds". These tend to be accompanied b y sore throat of an obstinate type with enlarged tonsils and involvement of cervical lymph nodes. Colds tend also to extend downwards and cause hoarseness of voice, which is painless and worse in in the morning. There m a y be complaint of a feeling as if a lump was lodged in the left side of the throat. Nasal catarrh m a y become very chronic with soreness of the nose, swollen ulcerated mucosa and thick yellow discharge with presence of crusts. Nasal polyps m a y develop. A persistent tickling cough is likely to be especially tiresome at night, or cough m a y be productive with copious, thick, yellow, sweetish-tasting sputum, possibly stained with blood. Respiration m a y be rattling from excess of mucus, and the chest is apt to feel as if it were too full of blood. Alimentary System. An unpleasant sour taste in the mouth is accompanied b y foetor oris. Burning pain m a y be felt at the tip of the tongue. The digestion seems sluggish with a tendency to frequent sour eructations or even sour vomiting. There is a curious repugnance to hot foot, and a good deal of heartburn, and possibly a cutting pain deep to the right scapula with spread to the right hypochondrium and epigastrium. The latter area is often quite tender to touch. Stubborn constipation m a y be present with pasty, clay-coloured stools, and associated sensations of crawling, burning and weight in the rectum. Recurrent diarrhoea is common, worse in the afternoon with whitish, watery, frequent stools, having a sour pungent odour and liable to cause excoriation of the perianal skin. The stool often contains curds and undigested food particles.
110
THE
BRITISH
HOM(EOPATHIC
JOURI~AL
The remedy has value in relation to tabes mesenterica; and also in helminthiasis.
Lymphatic and Glandular Systems. Lymph nodes in various sites become enlarged, indurated, with burning and stinging pains. Masses of matted nodes can be palpated, especially in the cervical regions and also in the mesentery. The lymphadenitis is often tuberculous in nature. Cardiovascular System. In association with the general state of asthenia cardiac response to effort is poor and exertion such as going upstairs is accompanied by dyspncea and palpitations. There is a liability to attacks of faintness while walking out of doors. Veins show varicosity and varicose lesions are associated with much burning discomfort. Urinary System. Cystitis is associated with dark, brownish coloured urine which has a peculiarly unpleasant sour pungent odour. Genital System. Menstrual periods tend to be previous, profuse, prolonged-too long and too strong. A period may be precipitated prematurely by either emotional stress or physical exertion. The breasts are apt to swell and be painful before the period and while it is continuing; dysmenorrhcea is characterized by cramping uterine pains and also general stomach pains. Pain in the region of the right ovary is apt to extend into the thigh, and is worse when reading or writing. Leucorrhoea is profuse, the thick discharge being accompanied by itching, burning and smarting. There is a tendency to develop uterine or vaginal polyps which bleed easily. Nervous System. Calcarea is mentioned in connection with convulsions which occur during the night, also with attacks of epilepsy preceded by a peculiar aura as if a mouse was running up the arm or leg. Par~esthesia may be complained of--pricking, darting sensations, quivering of muscles, a feeling of "cold, damp stockings on the feet", feeling as if "the part would burst". Locomotor System. The muscular weakness militates against any prolonged effort. Lifting has to be avoided for fear of spraining a muscle. The ankles are weak and readily turn over. Spinal muscles arc weak leading to faulty position when sitting and encouraging spinal curvature. Cramp is liable to occur at night, especially in the calf muscles. Rheumatic pains in the limbs are associated with much stiffness. Joints may become hot and swollen. Gouty affections of small joints with nodule formation are met with. Post-rachitic deformities may be present. Disorders of bone metabolism may occur, especially formation of exostoses. Skin. Chronic urticaria is mentioned in connection with Calcarea, also warts and papillomatous growths. The skin cracks easily, forming "chaps". Warning is given against the use of ointments and bandaging in skin complaints of Calcarea
CALCAREA
CARBONICA~
A STUDY
1|I
children. "The excess calcium is seeking a way out of the body per the skin and must not be dammed back." POSOLOGY
This remedy affords a good example of the importance of treating the patient and not prescribing by disease label. It is the patient-picture of Calcarea, especially the constitutional and mental manifestations, that is the chief guide to its use. Bryonia should not directly precede or follow Calcarea, but Belladonna is its complementary remedy in acute exacerbations. Rhus toxicodendron or PulsatiUa may be indicated in sequence to the remedy, but it should not be followed by Nitricum acidum or by Sulphur. A satisfactory sequence is Calcarea carbonica --> Lycopodium -->Sulphur. In association with py~emie abscesses in the deep tissues it is said to be able to induce resorption of pus. Too frequent repetition in old people is unwise, but the remedy can be repeated quite frequently in children if called for.