Plumbago. Black lead. An allotropic modification of carbon. Trituration of prepared black lead from finest English drawing pencils.
PATHOGENESIS.
GRAPHITES is not quite a pure substance as it contains from 0.4 to 0.6 per cent. of iron. Whether from the fact that it contains this amount of iron. or whether carbon in this different form gives origin to dissimilar pathological symptoms, or from both these causes, graphites has a place of its own on our pharmacopoeia quite independent of carbo vegetabilis, although there are points of similarity between them.
Graphites in its crude state is insoluble and inert, but when triturated and raised to the higher potencies becomes an important antipsoric and a valuable remedy in many chronic diseases. It acts chiefly on the skin and mucous membranes, but also has a deep-seated influence on the system. manifested by certain nervous phenomena. The large secreting and exerting organs seem not to be directly affected by it.
Skin-The predominating skin affections caused by graphites are herpetic and eczematous, and have the characteristic that their discharges are of a glutinous, honey-like nature, sticky and corroding, but dry eruptions, pimples and nodules also occur, and these may break down and ulcerate. Ulcers when present are indolent, callous and have an indurated base, they are inclined to show “proud flesh” and to be covered with foetid pus. The graphites eruptions may appear on any part of the body, but the seats of predilection are around the muco-cutaneous orifices and in the flexures, especially the parts about the genitals, such as the scrotum, the folds of the nates and the groin, the upper part of the thighs adjacent to the scrotum, the female pudenda, the prepuce and the glands penis. The backs of the ears, the scalp, the face and chin are also s4eats of election of graphites. The glutinous character of the discharge is conspicuous in all these positions. There is much irritation of the vulva, which is sore and moist with sticky secretion. Round about the anus are cracks and fissures, which itch and bleed and exude the characteristic viscid fluid. There are itching in the anus and stitching, smarting nd sore pain there after wiping the part. Other orifices are similarly affected; the meatus auditorius is sore and exudes the sticky discharge which smells like herring brine; sores and scabs from about the nostrils, the commissures of the mouth are seen on the face, which become moist after scratching, or there may be a moist eczema of the face, especially about the chin and round the mouth. The whole scalp may be eczematous and covered with dirty crusts which mat the hair, are painful, sore and itch. The hair falls off in patches. One prover experienced an attack of pure herpes zoster which extended from the spine round the left side of the abdomen to the umbilicus. On other parts of the skin the eruptions are usually herpetic or papular and the skin is rough, hard and dry, but there is offensive perspiration with excoriation between the toes and copious sweat of the feet. The skin on the backs of the hands is hard, hot, fissured and bleeding; horny callosities are present on the palms, the finger-nails are thick, brittle, black and fall off, and the toe- nails are thickened and crippled. Graphites influences scar tissue, it inflames and softens it and often causes a burning pain in it. The skin eruptions are all very irritating, and are worse from heat and the warmth of the bed, while the patient himself is chilly, feels he cannot get warm and is very sensitive to cold air.
Digestive Tract.-Turning to the mucous membrane of the alimentary tract we find that the gums burn and string and recede from the teeth, there is a lancinating or tearing toothache, which is worse after drinking anything cold and in a cold wind, but is also worse at night, with heat in the face. Burning blisters appear on the lower lip and on the tip of the tongue, and painful ulcers on the under surface of the tongue. The gums and mouth emit a putrid odour that smells like urine. Saliva escapes on to the pillow during sleep but the mouth is dry on waking. There is a sensation when swallowing, as of a lump in the throat, and a constant spasm compelling swallowing. On empty swallowing a sensation of constriction is felt which induces retching. The patient is averse from all animal food, fish, salt and sweets; the aversion from both salt and sweets is peculiar to graphites. He craves beer, acids and cold drinks. Frequent eructations occur tasting of food eaten (puls.), or they are of bitter, sour, putrid, greenish water. Nausea is worse in the morning and during menstruation, it is accompanied by weakness and trembling. Vomiting is frequent. Constrictive, griping pains are felt in the stomach, and fulness, distension and pressure from the presence of much flatus which belching relieves (carbo veg.). Periodical gastralgia, with vomiting of food soon after eating it, may take place. Gastric pain is aggravated by cold drinks but relieved by warm milk. The pain gives him a false hunger, he feels he must eat to relieve the gnawing and burning in the stomach, and food does, as a fact, relieve for a time.
The abdomen is greatly distended from incarcerated flatus, the emission of which is preceded by griping. The patient cannot endure anything tight round the distended abdomen (carb. veg., calc., lach.). Herpetic eruptions appear on the groins, and the inguinal glands are swollen and hard.
From the rectum there is excessive discharge of offensive flatus. Diarrhoea is painless, with much flatus, the stool is watery, brown, putrid, lienteric, and excoriates the anus. The more usual condition is constipation, there may be no desire for stool for several days, the stools are large, hard and knotty, and are accompanied with or followed by copious, white or yellow jelly-like mucus, they take a long time and hard straining to pass. The presence of fissures and piles causes sharp, cutting pain, followed by constriction and aching for several hours after stool. There may also be burning pain and bleeding from the anus and a tendency to prolapse of the rectum.
Urine.-The stream of urine is a feeble one and dribbling may occur after urination. The urine soon becomes putrid on standing and deposits much red or white sediment; an iridescent pellicle forms on it after standing awhile. A peculiar symptom is “pain in the sacrum and coccyx when urinating.” A gluey discharge occludes the meatus urinarius.
Sexual System.-In the male generative system graphites produces, primarily, violent erections, and secondarily, a condition of weakness or impotency in the sexual act. Itching, vesicular eruptions occur on the scrotum, herpetic eruptions on the scrotum, herpetic eruptions on the prepuce and excoriation and fissure on the glans penis.
In women the ovaries become enlarged and tender, the vagina is hot and painful, and copious thin, white, viscid, offensive leucorrhoea comes in gushes day and night. Leucorrhoea may replace the menses, which are usually delayed, pale and scanty. There is great itching of the vulva before the period sets in, excoriation of the genitals and between the things during the flow and a corrosive leucorrhoea after. Concomitants of the menses are a dry, fatiguing cough, headache, morning nausea or sickness, pain in the epigastrium, swelling of the face and feet and pain in varices.
Head.-Graphites causes numerous head symptoms. There is vertigo, as if intoxicated, occurring mostly in the morning on rising and in the evening, it causes an inclination to fall forwards and is felt on rising from stooping and on looking upwards. There is apt to be hyperaemia of “the brain” in the evening in a warm room and frequent determination of blood to the head and face with faint feelings. The head feels numb, as if made of wood, there is a feeling in the forehead as if the skin is drawn in folds and a sensation as though a cobweb were spread over the face. a constricting pain occurs in the occiput which extends to the nape, and on looking up the neck is painful, as if broken. Or there may be an intense, heavy weight in the occiput, as if the head were drawn back by it. Another variety of pain is a one-sided headache in the morning on waking, a tearing pain that extends to the teeth and side of the neck. The headaches are worse in a warm room and better in the open air.
Eyes.-The coverings of the eye share in the affections of the skin caused by graphites. The lids are swollen, injected, thickened, and may be inverted, they are raw and bleed, itching, bleeding fissures are seen in the canthi, the lashes are covered with dry crusts, or are glued together by sticky discharge, or they fall out. Styes and cystic tumours occur in the lids, pustules and ulcers invade the cornea. There is extreme photophobia, which is worse in sunlight than in artificial light and is accompanied by copious lachrymation. Letters appear double or run together, flickering, fiery zigzags appear just outside the field of vision. Sight vanishes during menstruation.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,