PHOSPHORIC ACID provides the classical picture of the painless, almost incontinent, watery, non-odorous diarrhoea. But the drug has a field of usefulness far greater than that, and it is one of the most useful drugs we have for the acid dyspepsia of the late adolescent. The kind of case is that of the child who is working for scholarship examination and getting over-tired and whose digestion is beginning to give out. This idea of the overstressed adolescent gives you the key to the whole picture; you get the same kind of condition at any age in anyone who has under stress-particularly mental stress over a length of time-and who is beginning to break down. There may be indications for Phosphorus acid in more acute cases, such as bad shock, but it is much more commonly indicated after a period of prolonged stress.
The mental picture is that of those who are just dead tired. They feel generally indefinite, do not want to talk, cannot concentrate, their thoughts wander away from the subject. Any mental effort it liable to produce an acute headache with a sensation of extreme pressure on the top of the head. On any effort at all these patients are liable to feel giddy.
It is not an acute giddiness but a feeling of general instability, and patients quite frequently describe it as a feeling as if their feet were coming up off the ground and they would fall. Where you get indications for Phosphoric acid in acute illness-for example, in typhoid fever-this sensation is described as a feeling as if they were floating off the bed; but you get a minor degree of the same kind of thing even when the patients are going about.
One outstanding characteristic about Phosphoric acid patients is the astonishing relief they get from even quite a short sleep. You often see them just dead beat-you can hardly get a word out of them-then they have a short sleep (fifteen or twenty minutes) and wake up entirely different beings, their headache has gone and they are quite bright and cheery.
However, any little exertion, mental or physical, seems to use them up again and they slip back to the same state: their headache returns and they are just useless. With such picture, the digestive disturbance most commonly met with is the complete failure of digestion. The digestion is slow, and the patients feel distended and uncomfortable after a meal. They may feel sick, and may vomit a quantity of sour, undigested food some hours after a meal.
Notably associated with the distension-often described as pressure-there is a general sensation of tightness or pressure. They may get it in the head or in the eyes, if they are using them much. They get exactly the same feeling of tightness in the chest on exertion and have generalised rheumatic pains with the same kind of feeling of pressure in the joints and they often complain of pressing pains in the soles on the feet.
Gastric discomfort is very much relieved by warm food or warm drinks. This is the outstanding differentiating point between Phosphoric acid and Phosphorus.
Another symptom in Phosphoric acid digestive disturbances is an excessive amount of flatulence. These tired-out patients very often complain of constant rumbling or gurgling in the abdomen.
There is strange hyperaesthesia in these apparently sluggish patients : they are very sensitive to music, very easily startled and often peculiarly sensitive to odours.
Temperature reactions are a little contradictory. The patients are chilly, sensitive to cold, particularly sensitive to wind, very sensitive to snow atmosphere; and yet, in a hot room they are upset, their headaches are made worse and their mental sluggishness is increased. They are fresher and their headaches are better in the open air, provided it is still.
It is characteristic that they appear to get the most acute gastric discomfort about half an hour after a meal. At that time there is a tendency for the food simply to regurgitate into the throat, and this regurgitation may be accompanied by cramping pains in the stomach.
They are upset by any acid foods, by fresh fruit, cold drinks, or by any over-rich food. Frequently, Phosphoric acid patients are rather thirsty. They tend to have a definite polyuria with a very pale, milky kind of urine and, when that is present, they complain of a very dry mouth and intense thirst.
Another odd characteristic of Phosphoric acid patients is their liability to develop styes. The styes particularly affect the upper lids.
In adolescents with students’ headaches, there may be a tendency for the right pupil to be rather larger than the left. This may be slight or it may be marked, and it is particularly noticeable during a headache.
There is sometimes a complaint of a tendency to bite the tongue during sleep. This is commonly associated with acute gastric disturbances.
In adolescents the picture is not unlike that of Pulsatilla, but it has its own characteristics which should make it clear. In adults the picture is much more clear and individual, and the selection is correspondingly easier.