GRAPHITES is one of the routine medicines prescribed in cases of duodenal ulcer but, unless the definite Graphites indications are present, one does not obtain a satisfactory result and, as there are quite a number of other drugs which also have a bearing on duodenal ulcers, it is important to have the Graphites picture quite clear.
The majority of Graphites patients are rather overweight; they tend to be fat. They are usually pale in colour, although sometimes they have a fair amount of colour. One woman with a duodenal ulcer responded very well to Graphites and she had quite a high colour.
Mentally, they tend to be rather despondent, depressed and lacking in energy. It is not so much mental stamina they lack, but actual drive. They cannot make up their minds, are hesitant in all they do, and worry about their affairs. Quite frequently you are told that the actual acute attack for which they consult you was precipitated by a period of unusual mental stress.
As a rule, these patients are chilly and feel the cold a good deal. But they are very sensitive to any stuffy atmosphere or lack of air. If you enquire into their history carefully, you often find that they have suffered at some time from some degree of skin disturbance, usually an eczematous type of eruption-very often eczematous patches at the back of the ears. Or, they may have had digestive upsets with attacks of piles, very troublesome peri-anal fissures, and eczema.
As regards their actual complaints, they have a beastly, spoiled stomach which feels just out of order; they feel rather sick and get a good deal of eructation. That goes on to more acute attacks in which they have heartburn or actual acute pain, which is usually of a griping character and, when this is extreme, there may be attacks of vomiting.
Not infrequently these patients say that with the attack of pain and feeling of sickness there is a horrible, sudden sensation of extreme weakness-a feeling as if they were going to faint. Following this sensation of faintness, in quite a number of cases, there has been vomiting of blood or, short of that, definite melaen for the next day or two. So this feeling of collapse is apparently associated with a sudden gastric haemorrhage.
In addition to the more or less chronic state, Graphites patients suffer from definite hunger pains which gradually develop about two hours after food, and are relieved by eating.
Considering actual likes and dislikes, one of the outstanding differentiating Graphites symptoms is the marked aversion to sweets. There is very often an aversion to salt also, but this is not so marked.
Frequently one comes across a patient who has a very definite aversion to animal food. This seems to be more mental than physical, for the patient will often say that the food tastes quite good if they can overcome the aversion, but they shy from taking animal food in any form.
With their acute attacks of heartburn, there is a feeling of intense heat in the stomach and throat and a desire for cold drinks, in order to cool down the stomach; but, as a rule, Graphites patients are aggravated by cold food. When they have pain they are relieved by warm drinks, very often especially relieved by warm milk.
These patients always complain of a good deal of abdominal flatulence, a feeling of general abdominal distension with indefinite griping pains. With these attacks of flatulence they feel a sudden rush of blood, a sudden flush of heat, to the face and head. With the general abdominal distension they are very intolerant of any tight clothing, it makes them more uncomfortable. And I have been told that, after one of the acute attacks, the patient developed a definite herpetic eruption round the abdomen.
Most Graphites patients are constipated, and their constipation is rather suggestive. They have periods when there is no inclination for the bowels to act; followed by a griping, colicky disturbance and then an action of the bowel in which they pass a very large stool accompanied by a quantity of white mucus. Normally, the stool tends to be palish but, after one of the acute attacks in which there is leakage from a gastric or duodenal ulcer, they have black, melaen stools.
Often Graphites patients complain of a very unpleasant taste in the mouth: either just a spoiled taste like the spoiled sensation they get in the stomach, or a bitter, salt taste. With this saltish, bitter taste they frequently develop little burning blisters on the side of the tongue.
There is one other point that sometimes helps in diagnosis : many of these Graphites patients develop a marked hyperaesthesia of the sense of smell, particularly to the odour of flowers. This is not constant, however, and others suffer from a chronic nasal catarrh in which the sense of smell is entirely lost; they have a yellowish, excoriating discharge, a tendency to develop cracks at the side of the nose, and small, slightly spreading eczematous patches.
As regards the actual pathological condition, most cases tend to develop a duodenal ulcer. In most of the satisfactory Graphites cases I have seen, actual ulceration has been demonstrated by a barium meal.
There is astonishingly little scarring after Graphites. I have found that the ulcer has disappeared and the duodenal cap returned practically to normal-as shown by X-ray examination-and it is quite insensitive to pressure. In any case, with persistent scarring I would give Graphites in low potency, say 6, for a week or two to see if it could be diminished.