THERE are one or two conditions in which Nitricum acidum is particularly useful from the digestive point of view, far and away the commonest of which is ulceration of the lower bowel.
You seldom get indications for this remedy in an ordinary acute gastritis, except in a typical Nitricum acidum patient. But the kind of case in which you get indications for it is the very old broken-down, chronic ill-health patient, very often with an old digestive history dating back over years, with indefinite bouts of diarrhoea.
Often there is a history of an old dysentery or something similar; and the patient complaints of indefinite abdominal discomfort, very often with pains centred round the right iliac fossa. It is not clear whether the patient has a chronic appendix or whether it is a legacy from an old dysentery with a chronically inflamed caecum and a history of recurring diarrhoea which is always very painful.
The other type is the patient with a history of tuberculosis. He is liable to get feverish with an irregular, swinging temperature, and sweating; associated with that, he has digestive disturbances, again with recurring attacks of diarrhoea.
In addition to this pathological background the Nitricum acidum picture is important. As a rule, the patient is somewhat emaciated, easily tired, and always in a very nervy, excitable, irritable, peevish condition. The irritability may be very acute and go on to violent attacks of rage, or it may be a general peevishness tending towards despondency and hopelessness, with some degree of anxiety.
Nitricum acidum patients are usually dark-complexioned and rather swarthy; usually they have brown hair and brown eyes. They are very easily startled; they jump at noises or at any sudden approach, and they are particularly liable to be scared if anyone suddenly touches them. Another common feature in the Nitricum acidum patient is a red nose.
The Nitricum acidum picture is of someone looking rather thin, dark and sallow, with a very red nose. Most of these patients complain that their noses often get blocked, and they commonly suffer from a persistent post-nasal discharge.
These patients usually suffer from severe headaches, whose type is most suggestive. There is always a sensation of increased tension in the head : the patients describe it either as feeling like something clamping down on the head, or else as a constricting, tight band round the head.
They are always very sensitive to cold; they are chilly patients, and cold aggravates all complaints.
They commonly have an unhealthy mouth. There are small exceedingly sensitive blisters on the tongue and on the inside of the cheeks; and the gums become inflamed with a good deal of bleeding and a very offensive smell. There is always considerable salivation and, nearly always, a tendency to develop cracks at the angles of the lips.
As regards the actual digestive condition, the Nitricum acidum patient is very much upset by milk, which produces a sour eructation and a feeling of intense bitterness. The patient very often gets this better taste after any food, and quite often he gets eructations tasting of what he has eaten many hours before.
In spite of these digestive upsets, Nitricum acidum patients often have a ravenous hunger, but are particularly uncomfortable after a meal. They develop an acute craving for highly-tasting food-salt, pickled herring, etc. Often they have strange desire for fat; and yet any fatty food is very liable to produce a sensation of nausea.
In all their condition, these patients have a definite aversion to meat and to bread. They say the bread turns sour and is liable to produce sickness and vomiting.
These patients very often feel more comfortable while they are actually eating; afterwards, they get the burning sensation in the stomach which goes on to definite abdominal colic. During the period of discomfort, the Nitricum acidum patients feel very hot and sweaty.
There are two characteristic conditions in connection with the stomach. One is on swallowing when there is a feeling of obstruction at the cardiac end of the stomach. There may actually be acute stitching pain in that region on swallowing, and occasionally X-ray reveals a definite lesion. More commonly it is merely a spasm, but there may be actual ulceration.
The other condition is a similar spasm in the pyloric region; on palpation in the epigastrium there is very often a tender spot over the pylorus. Where this is present in addition to sour eructations after food, the patients are liable to develop nausea and vomiting; they frequently vomit a quantity of tenacious, bloody mucus, which is very offensive.
In the abdomen, there are attacks of colic with severe pinching, stitching pains, and a complaint of constant abdominal disturbances, a feeling of rumbling in the abdomen which the patients very often describe as if their inside were boiling. These attacks of abdominal pain may come on some little time after a meal, or they may be induced by the patient’s being exposed to cold.
With the more chronic abdominal disturbance, Nitricum acidum patients get a certain amount of enlargement-congestion-of the liver, and there may be a degree of jaundice.
The most common characteristic is the liability to attacks of diarrhoea. The actual character of the stool varies very much with the pathological condition, but it is always very offensive. It may contain mucus or blood. On examination, there is very likely to be definite-possible very extensive-ulceration in the rectum.
From experience, I have not found Nitricum acidum helpful in carcinoma of the rectum. One would think it should help because it has the symptoms-the pain, the urging, the offensive stools and the blood and mucus, but I have never seen it do much good. It seems to have more affinity for an ulcerative colitis.
The constant characteristic of Nitricum acidum diarrhoea is its extreme painfulness. The patients get colicky attacks before stool, and they get an extremely severe tenesmus during stool and after : in fact, it is even worse after the passage of the motion than during it. They describe it as if the rectum were being torn, or as if knives were sticking into it. You will see them simply writhing in agony.
In addition to the offensiveness, the Nitricum acidum stool is very excoriating. I have seen cases with extensive excoriation spreading right back between the buttock, the whole area being extremely painful.
There is tendency, as would be expected with this enlarged liver and the bowel irritation, for Nitricum acidum patients to suffer from piles. These indications for Nitricum acidum appear mostly in a patient who for some time, has had piles which have had a tendency to bleed but have never been very troublesome; then, for some reason, the bleeding has suddenly stopped and the piles have become inflamed and intensely painful, especially after the bowels have acted.
This, in the typical, broken-down kind of patient in which Nitricum acidum is indicated, is the case that responds very well.
In addition to piles, with the chronic diarrhoea these patient are very liable to develop fissures about the anus. These are extremely tender, very sensitive to touch and often burn like fire. patients say when the bowels act, it feels as if the fissure were being split open, or as if it were being cut by a knife.
There is one other point abut Nitricum acidum patients which is almost constant : they tend to have a very strong-smelling urine. It is almost as penetrating as the BENZOICUM ACIDUM urine, and has very much the same character, often described as “horse’s urine.”
There is one weird thing about Nitricum acidum patients. Certain of their symptoms are produced, or aggravated, by railway travel. There are liable to get a headache from it, and to get sick; and yet, certain of their other disturbances are definitely helped by travelling -even their headache is sometimes relieved by it.
Occasionally you find a patient who says that the only time he is comfortable is when travelling. You may get it either way : travelling may relieve them or it may aggravate them. So if you get a patient who says travelling always does him good, do not rule our Nitricum acidum patient to be aggravated by travelling of any any kind, but you will occasionally come across patients on whom it has the opposite effect.