In the upper extremities the pains are more prevalent on the left side, but in the lower they are equally distributed.
Stiffness and numbness or “paralytic sensations” are described, cracking in joints, especially in right ankle, when walking.
The soles of the feet burn at night (like sulphur cases) and are sore and tender when walking on uneven ground. Cramps attack thighs and calves of legs, worse in morning and when walking. Uneasy restlessness in legs at night compels patient to keep them stretched out, jerking pains. There is usually aggravation at night from cold, after midnight, from touch and on walking, but pain in nates and hamstrings is worse when sitting.
The hands tremble when writing and the knees when walking.
These are a selection from a variety of symptoms they are not very characteristic and taken alone would hardly be safe guides to the remedy.
Sexual Organs.-Ulcerations of the genital organs, with offensive discharge and pain and soreness, like a splinter sticking into the tissues, may require hepar; also free, very offensive leucorrhoea, irrespective of its source if the “general” characteristics of the remedy are present.
Respiratory System.-Though hepar does not, like some other drugs, produce definite pneumonia or pleurisy, it is a very reliable remedy for catarrhal conditions of some parts of the respiratory mucous membrane. The coughs for which it should be prescribed vary with the source and stage of irritation. It may be hoarse and paroxysmal in laryngitis, being suitable when the dry stage is over and secretion has commenced. It is a noisy cough, but not the harsh barking or sawing cough of the early stage of laryngitis or so-called croup. It may have a somewhat spasmodic element, producing “crowing” inspiration when the cough is becoming loose; free secretion is setting in. The paroxysms are excited by the slightest breath of cold air, by tickling, especially on the left side of the throat or larynx. It is worse after drinking, and a child with such a cough will-cry before the attack-herein resembling cases requiring bellad., bryonia and phos., which are all indicated when the fear of an impending cough causes crying, or alternatively interpreted, the irritation of crying brings on a paroxysm of coughing. The voice is hoarse or nearly aphonic.
Hepar is indicated in bronchitis with a loose rattling cough, worse towards morning and aggravated by cold air.
During a late stage of pneumonia when resolution is slow in completion, when a septic element seems to co-exist, indicated by a persistence of fever, by free, offensive, purulent expectoration, loss of flesh and appetite, with some degree of perspiration at night, hepar may rapidly clear up the condition, if the tubercle bacillus be not present. Even if it be present hepar may be the most indicated remedy. Paroxysms of cough in the evening on first lying down would be an extra indication. Similarly if a pleural effusion is threatening to become purulent hepar will stimulate absorption. After the opening of an empyema it will help to check suppuration and restore a healthy condition of the serous surfaces.
Skin.- The skin of a hepar patient is very sensitive to touch and to cold; it is unhealthy, perspiring unduly, especially in the folds, where it readily becomes raw and sore. Cracks appear on the hands and feet.
The perspiration and discharge are sour or foetid.
Ulceration requiring hepar has the usual features- sensitiveness to touch and to cold, and pain, as of a splinter or of a burning and itching kind Itching is usually worse in the flexures and is aggravated at night. Superficial injuries readily suppurate.
Suppuration in any part of the body-skin, cellular tissue, glands, &c., may require treatment by this remedy.
In the early stage of a cellulitis, due to a staphylococcal infection, hepar given frequently in the sixth centesimal potency or upwards may abort the condition. At a later stage it helps the process, relieves pain, and promotes healing. For a streptococcal infection some more toxic drug may be indicated by the patient’s general condition, which should guide to a drug causing a similar state.
Hepar is useful for individual boils and has been recommended for carbuncles, but in our experience sulphur is more effectual in checking a recurrence of boils, and rhus, lachesis and silica for carbuncles. In paronychia and with low with extreme sensitiveness it gives rapid relief and may save destruction of tissue.
The febrile state in hepar cases has a conspicuous early chilly stage. A slight draught or exposure of skin surface to the air causes shivering, especially marked at night, when also any accompanying pain is worse. After the hot stage sweating comes on from the least exertion; it is sticky, sour or offensive, especially in the axillae, between the toes, or in other folds of skin.
LEADING INDICATIONS.
(1) the twelve general indications already given categorically need not be repeated (see pp.496,497).
(2) Headaches : (a) unilateral, as if a nail were pressing in, (b) bursting, relieved by even support as by a bandage, worse from weight of hat.
(3) Acuteness of sense of smell.
(4) Indigestion; flatulence; aversion from fats and longing for acid things; jaundice, dark, scanty urine, with sediment.
(5) Urine flows tardily, slowly and without force; residual urine.
(6) laryngitis, bronchitis, pneumonia, pleural effusions, empyema (after evacuation)-not in the early stages of any of these; cough excited by cold air, by exposure of surface of body outside bed-clothes; by tickling in throat or by drinking on first lying down. Crying before and after cough.
(7) Unhealthy skin-sour odour of body and of perspiration; boils, ulcerations.
(8) Tendency to suppurations, especially staphylococcal.
(9) Torpid, sluggish persons, with fair complexion and flabby muscles.
AGGRAVATION
(see generalities): From uncovering the head; when swallowing (dysphagia); in dry, cold and windy weather; from lying on the painful side.
AMELIORATION :
From wrapping up head and body; warmth in general; even damp weather, if warm; from eating.
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,