Natrum sulphuricum, a study

Natrum sulphuricum, a study D. M. G I B S O N ,

M.m, B.S.LOrCD., F . R . C . S . E V I N . , r . F . H O M .

PHARMACOGNOSY

This remedy is a preparation of sodium sulphate--Glauber's salts---which occurs in large, colourless, transparent, prismatic crystals. The crystals are deliquescent, melting in warm air in their own water of crystallization. The salt constitutes the chief ingredient of m a n y mineral spa waters. PHARMACOLOGY

Sodium is one of the big four, potassium, sodium, magnesium and calcium, on the relations of which depends the maintenance of optimal electrolyte balance in the body fluids. The sulphate is not so readily absorbed as the chloride, but its involvement in electrolytic imbalance m a y lead to waterlogging of the tissues and catarrhal states. The claim t h a t this salt stimulates intestinal and biliary secretions has not been substantiated. I t s action on the bowel in inducing purgation is due to retention of the water content of the ingesta as the result of retarded absorption. There m a y be a superadded increase of fluid content in the bowel as the result of withdrawal of water from the blood owing to increase in osmotic pressure. The net effect is to cause distension of the bowel with fluid and consequent increased rate of downward propulsion with hyperactive peristalsis. The ensuing dehydration and associated malnutrition tend to produce physical debility and mental depression. PHYSIOGNOMY

A sallow, pimply complexion of earthy hue is described. There is an air of depression, accompanied by definite disinclination to indulge in conversation. There is obvious weakness, perhaps associated with trembling or twitching in the limbs. The tongue shows a dirty yellow coating towards the root. Discharges are green or yellow in colour. Despite the debility there is a restless urge to keep constantly changing position or moving about. Audible rumbling in the belly m a y be noticed. PSYCHOLOGY

The subject is restless, discontented, tired of life; m a y have to use restraint to keep from committing suicide. There is aversion from meeting people and from talk. The individual is sensitive, suspicious, and apt to harbour feelings of hate and vengefulness. There is fear of people, of crowds, of evil. There is great sensitivity to noise; music m a y be intolerable, even inducing

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tears. Depression is worst in the morning; it may take the shape of despair of recovery. Is ~lways worse when the weather turns wet; change of scene or circumstances gives some relief. PHYSIOLOGY

The characteristic feature about Natru~n sulph, subjects is a marked susceptibility to every change from dry to wet weather. They cannot tolerate sea-air, and are unable to digest plants which grow near water. They feel best on dry days. Appetite is usually poor, perhaps with a repugnance to food. There may be an acquired aversion from bread. Food intolerances include vegetables, fruit, pastry, cold dishes, cold drinks, anything grown near water. Thirst varies; there may be a considerable thirst for cold, iced water, despite the fact that it disagrees. A dry mouth may be associated with lack of thirst. Drowsiness is usual during the daytime. At night there is a liability to start awake in fear shortly after dropping off to sleep. Sweating is unaccompanied by thirst.

Moclalities. The outstanding modality is aggravation from damp in any form, cold wet weather, even warm weather if humidity is high, seaside, damp dwellings, proximity to water. Is worse when lying on the left side and often has to turn on to back; worse contact, tight clothing, when at rest, in early morning, in the spring. There is relief in warm dry weather, from firm pressure, from change of posture (for a short while), in open air. PATHOLOGY

General. Pains are tearing, shooting, boring or jerking in character; they are often accompanied by a sense of oppression in the chest, which is worse in the evening or at night. Oedematous states occur, possibly associated with. yellow, watery or mucoid discharges. Marked weariness of the body forces the subject to lie down. Symptoms of ague are accompanied by bilious vomiting, induced and aggravated by damp. Periodicity of symptoms is common, e.g. violent colic recurring at 2 a.m., asthma attacks coming on at 4 to 5 a.m., onset of diarrhoea at 9 a.m. Recovery after an illness tends to be slow. Symptoms are predominantly left-sided. Head. An attack of giddiness at 6 p.m. may be accompanied by acid vomiting. A sensation of heat may be noticed on the top of the head. Another sensation described is as if the brain were loose inside the skull. Severe headache of the bursting or splitting variety is aggravated by mental effort, by use of the arms, when walking, by coughing, by vomiting, and during the menstrual period. Some relief is obtained by lying down in the quiet and by firm pressure of the hand. The scalp is unduly sensitive and a creeping sensation may be felt in it. A boring sensation occurs in the facial bones. Violent pains in the head and in the nape may follow a head injury, or may be related to injury incurred at a remote date in the past.

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Periodic headaches occur in association with stomach or liver complaints, and are accompanied b y bilious vomiting. : The remedy m a y be called for in relation to cerebrospinal meningitis associated with lateral decubitus.

Eyes. Pain m a y be experienced in the eyes when reading by artificial light. Eye complaints m a y be accompanied b y thick, green discharges, agglutination of lids in the morning, and an extreme degree of photophobia. E y e s burn and eyeballs seem to radiate heat; there m a y be a crawling sensation in the eyes; the lids feel as h e a v y as lead. All eye symptoms are worse near the fire, but rubbing affords some relief. Scintillations m a y be noticed before the eyes on blowing the nose. Ears. A sensation of forceful outward pressure m a y be felt in the ears. Sudden violent stitches occur in the ears. A sensation of boring m a y be felt behind the ears.

Chirping sounds in the ears occur in the evening. There m a y be noises as of bells tinkling in the distance. The remedy m a y be called for in purulent otitis media.

Respiratory system. Nasal catarrh is associated with profuse, thick, green, tenacious, offensive, blood-streaked discharge. The nostrils become obstructed with thick mucus at night. There m a y be much itching of the alae nasi. Boring pain is felt at the root of the nose. This is likely to be associated with sinus involvement. Post-nasal discharge is associated with much hawking of salty mucus in the morning. A choking feeling m a y be noticed in the throat when walking, perhaps in association with thyroid enlargement. A loose cough is accompanied by soreness and pain in the left side of the chest, much greenish, mucopurulent sputum and noisy rs The cough is painful and m a y cause the sufferer, to spring up in bed and hold on to the chest with both hands, a s y m p t o m shared with Drosera. The cough is worse in damp weather, when lying down, and at 3 to 4 a.m. I t is somewhat better when sitting up, and m a y be paroxysmal. There is often an all-gone feeling in the chest associated with a frequent desire to take a deep breath; this is especially so in d a m p evening air. Asthmatic attacks occur with every change to wet weather or at the seaside, and are apt to be associated with bronchial catarrh. Alimentary system. Tongue feels burning, and m a y be thickly coated with greenish brown fur. Extremely sensitive blisters occur on tongue or palate; the soreness is relieved by taking cold food or fluids. Much slimy or sticky salty mucus is present in the mouth. Gums become ulcerated and burn. Toothache is aggravated by w a r m t h or by taking hot drinks; it is relieved b y inhaling cold air, b y holding cold water in the mouth, and by smoking tobacco. Nausea occurs in the morning associated with hiccough; it is not relieved by vomiting. Stomach upsets are associated with a tendency to regurgitation of food ingested;quantities of thick, viscid, slimy mucus are hawked up. There is persistent nausea with vomiting of g r e e n b i l e .

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Much bloating of the belly occurs with great aversion from anything tight around the waist; both belching and passage of flatus per anum afford relief, Borborygmus is marked. A dragging sensation is felt iu the right hypochondrium when lying on the left side. Pain and soreness is located in the right iliac fossa, associated with colic. The liver may be enlarged, painful, with stabbing pains, and hurts if touched or jarred, as when walking. The remedy may be called for in relation to the presence of gall stones. Acute diarrhoea occurs after the early cup of tea with stools like a jet from a hose, watery, spluttery, yellow and burning. Chronic diarrhoea also occurs, with a stool at the same time each day, usually soon after rising in the morning (compare the early morning diarrhoea of Sulphur which drives from bed). The stools arc thin, watery, gushing and spluttery accompanied by the passage of enormous quantities of flatus, and may be associated with pain in the region of the descending colon. The stools may on occasion be passed involuntarily.

Lymphatic and glandular system. Lymphadenitis shows a tendency to suppurative lesions.

Urinary system. Chronic urethritis is associated with thick, greenish-yellow painless discharge. The remedy may be called for in relation to post-exanthematous nephritis, glycosuria, polyuria, phosphaturia, nocturnal frequency, burning and cutting sensation both during and after urination. It is of value in relation to enlargement of the prostate. The urine may show a white sandy deposit, a copious jelly-like sediment, or a brick red or yellowish deposit. There m a y be excess of uric acid in the urine; much urging to urinate with cutting pain at the meatus and a sticking pain in the groin. Genital system. Menses tend to be scanty, late and associated with colic and constipation. The flow is only in the morning, is acrid, contains clots and excoriates the thighs. Nervous system. The remedy is indicated in Jacksonian epilepsy following a head injury. Tremors of hands may occur on waking or when writing. Locomotor system. Limbs tend to feel bruised and weary. There are sudden onsets of heaviness of the arms, tearings or shootings in hands and fingers, trembling and weakness of hands with inability to hold anything at all weighty, tinglings in finger tips. Sharp pains occur in the hips on stooping or when rising from sitting, and at nigh%. Tearing pains, heat and pulling sensations are felt in the legs, especially in the calf muscles and the Achilles tendon. Lancinating pains occur in the heels. There is much unease or actual pain in the feet; possibly violent itching of and between the toes, especially on removing shoes and stockings at night. Is apt to constantly move the feet in search of relief. The limbs are often extremely restless in bed. Pain and stiffness may affect the temporo-mandibular joint, also the muscles of the neck. Pains spreading from nape to occiput may be so violent as to extort cries; these are made worse by movement, but relieved by massage.

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Stabbing pains occur between the shoulder-blades. Fingers may become swollen and stiff. Sharp pains, burning or numbness may affect the toes; these are relieved by rubbing. The soles of the feet are apt to burn at night.

Skin. Vesicles or pimples occur on face or chin, and burn when touched. An itching eczematous eruption may occur on the face, with watery oozing. A generalized pruritus is aggravated on taking off the clothes. The remedy is indicated in paronychia, which may tend to be recurrent. Other conditions calling for its use are chronic sinuses, with undermined edges; psoriasis of palms; raw, sore palms which exude a watery discharge; gonorrhoeal warts; intertrigo; red wart-like excrescences all over the body. A sensation is described as of "blood trickling down the legs". POSOLOGY

Causal factors which may point to the possible use of the remedy are emotional strain from nursing relations for a prolonged period; the onset of humid weather; a head injury with or without loss of consciousness, which m a y have occurred some years before the present illness. Complementary remedies are Arsenicum album and Thuja.

Dulcamara, a study D. M. G I B S O N ,

M.B., B . S . L O ~ D . , F . R . C . S . ( E D I N . ) , F.F.HOM.

PHARMACOGNOSY

Solanum dulcamara, the woody nightshade, belongs to the same family as Belladonna (deadly nightshade), Solanum nigrum (garden nightshade), Capsicum, Hyoseyamus, Mandragora, and Stramonium (thornapple). The plant grows in damp and shady places, its woody stem giving place to slender branches which climb and trail restlessly over shrubs and hedgerows by twining around any available support. This urge to keep moving is characteristic also of the Dulcamara patient. The star-shaped flowers are very striking with their five pointed purple petals surrounding a central cone of golden stamens. The flowers continue to bloom throughout the summer months; they are borne on branching stalks which always point in the opposite direction to the corresponding leaves. The leaves are dark green with short stalks and the upper ones have three lobes, the central lobe being large with two much smaller lobes at the base. Clusters of ovoid berries form the fruit, dangling from slender stalks which show a distinct kink, and turning from green to bright scarlet. The berries are