IT is not easy to ascertain from the textbooks the Natrum mur. type of digestive upset. In acute cases most of them have either an acute gastritis or a gastric ulcer. Some Natrum mur. patients have a chronic colitis, with a somewhat enlarged liver and general abdominal discomfort and diarrhoea; but that is a much more chronic condition.
I have not found any record in textbooks that Natrum mur. subject had anything suggestive of a gastric ulcer, and yet in practice I have met it quite frequently, with definite ulceration shown by X-ray, and vomiting of blood, either bright red or coffee ground vomit; but there is no record of this in the materia medica. In these cases, one prescribes neither on the local condition, nor on the digestive symptoms, but on the fact that the patient is a Natrum mur. subject.
The only way to tackle the problem is to consider the characteristics of the Natrum mur. patient and the pathological conditions which have responded to it.
It is easy to be misled by the textbook statement that Natrum mur. patients tend to be emaciated. Experience shows that they my be rather thin about the face and neck, but are surprisingly well nourished from the waist downwards: they very often have quite fat thighs and hips, and quite solid legs and feet. They tend to have a rather greasy skin and this is much aggravated during meal times; they break out in a greasy sweat when eating.
Most of them have a relative anaemia. It may not be very obvious because they tend to flush easily, but when the flush settles you find there is a definite pallor; they usually have a lowish red cell count. Most of them have rather pale mucous membranes.
The most important thing about the typical Natrum mur. mentality is its instability. The patients are either very depressed, terrified and miserable, or else they are over- excited, very bright, very often laughing; and they tend to swing from one mood to the other. They are always rather emotional, intense types, and are aggravated by any excitement.
All their senses tend to be over acute. They are oversensitive to noise. Though they are not quite so sensitive to thunder as the Natrum carb. patients, they are very definitely sensitive to it, and liable to get thunder headaches. They are emotionally acutely sensitive to music. They cannot stand being ignored. They very definitely like attention, and yet dislike expressed sympathy; it annoys them and may make them cry.
Mentally, they are somewhat tired; rather absent-minded; tend to be forgetful and any extreme mental effort is liable to produce a headache.
When a Natrum mur. patient complains of headaches from mental effort, it is always worthwhile having his eyes tested, because many Natrum mur. patients suffer from eye strain. Morning headaches in Natrum mur. are much more likely to be due to an ocular defect than anything else, and very often clear up with the aid of a pair of glasses even without the administration of Natrum mur.
Occasionally after a dose of Natrum mur. there is a definite improvement in vision without glasses-the headache disappear, also the sensation of eye strain, but the majority will require glasses before their headaches can be cured.
It is not usual to find a real Natrum mur. patient who has not been subject to headache; and their headaches are particularly bad, and extremely severe in character. It is usually a throbbing headache, and the patient wakes up with it in the morning; it tends to get worse all day, and does not disappear until after a night’s sleep.
There is another type of Natrum mur. headache which develops a little after getting up, or during the earlier part of the forenoon, and tends to clear again about sunset. These headaches are brought on by any excitement or over-work, and occur very often about the menstrual period. They are, in fact, often periodic in nature quite apart from menstruations.
They are often brought on by railway journeys. They may go on to definite attacks of sickness and vomiting. Another thing that will always produce the Natrum mur. headache is irregularity in meals. If the Natrum mur. patient is accustomed to lunch at 1 o’clock and has to go on to 2 o’clock or half-past, he is very apt to develop a headache, which will then not subside until he has had a night’s rest. This is a question of tiredness more than anything else.
All these patients are sensitive to heat, particularly to hot, stuffy atmospheres. They are worse in a warm room and better in the open air. They are very uncomfortable if they get overheated in any way-from over-exertion, stuffy atmosphere, too much excitement; and yet, many of their complaints are better for gentle, reasonable exercise which does not make them hot.
Practically all Natrum mur. patients suffer from headache, constipation, or both, on going to the seaside. Very often this corrects itself in a week or so. Although the headaches may correct themselves, you will find quite a number of these patients who say that, while they enjoy the seaside, they have a headache all the time they are there : it is never severe, but it is constant, and you will find that all these cases suffer from either acute or relative constipation throughout their stay.
As far as the actual digestive symptoms are concerned, there are one or two suggestive points. First of all, the Natrum mur. patients suffer from two types of tongue. They all tend to get herpetic eruptions about the mouth, particularly if they catch a cold, and they may get small ulcers on the lips and tongue. But the typical Natrum mur. tongue is rather coated, with clear areas as if the coating had been stripped off in patches producing a mapped appearance. This is the most typical Natrum mur. tongue. The other is a very shiny, red tongue which tends to have small frothy patches of saliva down the sides.
As regards the appetite, Natrum mur. patients tend to get very hungry in the middle of the morning-there is a typically Natrum mur. empty, sinking sensation between 10 and 11 a.m. Quite distinct from this, they very often have an exceedingly good appetite. They usually have a liking for definitely bitter food, sour things and salt food. Often they have a definite craving for starchy food, and a strong liking for milk and fish. Occasionally, you come across a Natrum mur. patient who has a passion for oysters.
In their gastric upsets, they develop an acute aversion to bread, to fat of any kind, rich foods in general and to meat. They sometimes have an aversion to coffee, and there is the statement that the Natrum mur. patient has an aversion to tobacco. I am not convinced of this since you find the Natrum mur. patient who has an acute aversion to tobacco when it is smoked by one person and no aversion at all when it is smoked by another. But, it is laid down in the text books that Natrum mur. patients have an aversion to tobacco.
One of the common complaints made in connection with their digestion is a feeling of a lump in the throat. It may be just a feeling of discomfort, in which case, after a little eructation, the whole thing disappears. There may, however, be actual difficulty in swallowing, and you will sometimes meet a Natrum mur. patient who, on swallowing, has definite pain at the cardiac entrance of the stomach.
They make the complaint that they have a feeling of a lump in the stomach after food, a feeling of general fullness and discomfort. Quite frequently they complain of what they describe as acute “ulcerative pain” – it is an acute burning pain really, but one quite frequently gets the description that they have the feeling that they have an ulcer in the stomach.
With their more acute gastric upsets, they are liable to get attacks of vomiting, the vomiting usually being rather difficult; and the vomit itself consisting of white, slimy mucus which may be blood-stained. The vomiting always gives a marked sensation of relief. In acute gastric upsets, these patients always tend to be thirsty.
X-ray frequently shows these patients suffering from definite gastric ulcer at the cardiac end or on the lesser curvature, and I do not remember a Natrum mur. patient with a duodenal or pyloric ulcer.
Most Natrum mur. patients suffer from constipation, but you sometimes get patients with a chronic diarrhoea. In these, there is a constant complaint of a horrid, dragging sensation in the abdomen; it feels as if everything was sagging down, and they do get a certain amount of comfort from external abdominal support. With these chronic diarrhoeas, there is usually some degree of hepatic enlargement : in dealing with an old malarial patient, there may be some degree of splenic enlargement, too.
After the 1914-18 War, I saw quite a number of men who had been out East and had chronic malaria. They came back suffering from what was really a malarial diarrhoea-at least, a chronic diarrhoea dating from recurring attacks of malaria. The diarrhoea was very nondescript in character. It cleared up very well on Natrum mur. All of them had a degree of enlargement of the liver, and some splenic enlargement too : the spleens subsided materially after Natrum mur.