TO deserve the title “model” a Materia Medica must be more than an abridgment restricted to a maximum of five pages to a drug. The limitation of a drug must be measured by its own capacity, not arbitrarily.
To meet all the requirements of a “model” each drug should be arranged with due regard to the following points:
1. Its officinal name, its place in natural history and its composition.
2. A concise statement of such characteristic features as are nearly or quite universal in its symptomatology.
3. A clear compact but complete arrangement of its symptoms, subjective and objective.
(a) These symptoms should comprise not only the effects of provings, but also such developments of provings and such merely clinical symptoms as are indisputably characteristics.
(b) As we depend so much upon the parts of the body affected, every attention must be paid to the localization of symptoms.
Let us dilate somewhat upon these several points:
1. That officinal names are needed is self-evident. Equally apparent is that euphony requires the adoption of a fixed pronunciation of drug names; and this can be utilized by proper syllabic marks.
The origin of a remedy is often very suggestive. So soon as it is known that Duboisia belongs to the Solanceae, our familiarity with the mydriatics of this order, enables us at once to interpret the dilated pupil and dry mouth of the new plant. When Bothrops is found to be an Ophidian, the general nature of its effects is almost pre-determinable.
Composition is often more suggestive even than origin. Two or more substances, which contain the same active principles, must, of necessity, possess similar properties.
A knowledge of the source and of the constituents of drugs, is all important, then, as it leads to an intelligent unification of the Materia Medica.
2. Before any schema of symptoms is devised, the drug should be prefaced with a concise statement, not of its vague generalities, as has been the custom, but of peculiarities which are essentials, and which, consequently, must enter the thought as qualifications of what is to follow.
3. But the chief task is that of arranging the symptoms of a drug. To render a work practical, it must be free from all verbosity, unnecessary repetitions and vague, unimportant symptoms. But condensation is so frequently effected at the sacrifice of valuable matter, that if we would avoid such loss, we must proceed cautiously and intelligently. Whenever in the provings we find two or more symptoms differing only in fulness of expression, we may select that on e which is nearest complete in phraseology. But if two symptoms, agree in the main, but offer in addition entirely different modalities, both must be employed.
In selecting symptoms which are local, those are preferable that are most characteristic, But since a drug, when fully proved, acts somewhat on nearly all parts of the body, completeness requires that all parts should be represented in the abridgment.
Clinical experience has taught us that local symptoms are of inestimable value. For instance guided by the splenic pains of Ceanothus, leucorrhoea has been cured by that remedy. Influenced by the sour stomach of Robinia, one physician learned to value that drug in ulcers on the legs. And so on indefinitely But since such indications are frequently derived from practice, we must not neglect clinical symptoms.
Our estimate of these latter symptoms should depend, it seems to us, upon their agreement with the provings, with the genius of the drug to which they are assigned, and also upon the reputation of the physician who reports them. If they disagree with the provings, they can form no part of a precise Materia Medica.
The clinical symptoms are most trustworthy, which are evident developments of imperfectly expressed provings; or, which have been so frequently confirmed as to have become indisputable facts. Xanthoxylum has not caused pains along the anterior crural nerve, and yet it seldom fails to relieve. But as it has caused neuralgic pains in the thighs, and also uterine and ovarian pains, we have a right to conclude that its clinical estimate in crural pains is just. Hepar as a remedy in suppuration has no foundation in provings, other than in certain subjective sensations, which led to its trial; and yet no one to-day, not even an Allopath, will deny its efficacy.
Having made choice of the material to be used, the next step is the adoption of a schema of arrangement.
All plans hitherto employed are open to the serious objection that they violently severe symptoms and so impair or destroy the natural sequence of drug-effects. We do not quite agree with those who assert that a remedy is of no use unless selected according to the order of its symptoms. Nor do we coincide with those who affirm that parts of one series of symptoms cannot be transferred to another series. For instance, if a drug causes headaches on the right side, worse from motion, and, in another prover, headache on the left side, with nausea, it does not follow that the qualifying phrase in the first may not also qualify the second, and vice versa.
It seems to us that the most efficient schema is one which begins, as we have already observed, with a description of the universal qualities of a remedy, which next considers symptoms as to their respective localities and concomitants, and which finally displays such rational combining of subjective and objective, physiological and pathological symptoms as will enable the reader to make practical application of them. It is useful to say that Hepar may be employed in that pathological condition known as pus formation; but it is more practicable to say that Hepar may be employed when, in addition to the presence of forming pus, there are also present throbbing pains, rigors and the extreme sensitiveness to touch, so characteristic of the remedy.
But, further an intelligent arrangement of drug-effects requires a knowledge of Anatomy, Physiology, Pathology and indeed, of many branches of a scientific education. Symptoms are not merely empty words, they mean something, and to determine that meaning one needs all the culture a complete education can afford. A “model” Materia Medica demands more than the vague statement that for instance, “slimy yellow mucus covers the tongue” if that so-called mucus is actually pus hanging from Steno’s duct!.
But, though very useful, the ordinary means of investigation employed by the old school are often too gross to fulfil the requirements of our molecular drugs. A thermometer will tell us whether or not a medicine taken is affecting the temperature; chemical analysis will reveal the nature of the red deposit in the urine, and the microscope will tell when the sputa contain pus-cells, lung-tissue, etc.; but we need psychology to teach us to estimate relations between mental and bodily symptoms; we need such delicate machinery as the volumenometer and the French graphic method of determining the separate and combined effects of cerebral, pulmonary and cardiac motions; and, above all, we need a firm reliance upon a Pathology which teaches not merely the ordinary course of diseases, but also such molecular changes as are set forth in the totality of the symptoms of a given case.
Lastly, to complete the schema, the several symptoms employed must be compared with one another that analogies and differences may be clearly seen; and three great discrimination is required. It does not follow that because a drug acts upon the heel (Natrum Carb. for example), that therefore it can cure the same symptoms when located upon the instep. Still, just as metastases are apt to take place in tissues of similar function, so are analogous parts prone to be affected by a drug. Reasoning from such premises, Arum Triphyllum, which causes rawness of the corners of the mouth, was successfully employed by Dr. B.F. Betts for a similar condition of the os uteri; and upon the same principle, drugs which disease the testicles have been used when the ovaries are affected.
In the hope of making ourselves better understood, and also in compliance with the instructions of the Chairman of Bureau, we essay an application of our several points to the study of Nux Vomica. At the risk of prolixity, we shall explain out steps by numerous annotations, observing here, however, that of course no such addenda should mar the pages of a fully-prepared “model”.
(STRYCHNOS NUX VOMICA)
Natural Order: Loganiaceae. It yields Strychnia, Brucia, Igasuria.
Nux Vomica owes its chief effects to the Strychna which it contains. It causes in small doses an increase in the heart’s action and a general increase of functional activity. In large doses, its action upon sympathetic nerves and also upon the spine, by which it induces an exaltation of reflex functions, leads to a train of symptoms, varying from a very characteristic over-susceptibility to impressions, to tetanus and trismus; also dilatation of the pupils, erection of the hair-follicles, tinnitus, sweat, marked rise in the arterial pressure, and finally death from tonic spasms of the respiratory muscles or from exhaustion. Paralyses are not direct effects, they arise only from exhaustion following the intense excitation. Cerebral and spinal softening have been observed post mortem after the patient had suffered from intense congestions.
Nux Vomica likewise causes changes in secretions and some structural alterations.
In nearly every case in which it is indicated, gastric and enteric disturbances are present. Functions are performed defectively, not so much from atony, as from derangement in the normal order of muscular contractility with over-susceptibility to even normal stimuli. This universal quality arises from the tendency of the drug to increase reflex-action (1).
Many ailments are worse in the morning and are made worse by exertion, by exposure to cold air, by leading a sedentary life (1), and for mental exertion (1 19). Complaints originating in an excess of stimulants, condiments, or in so-called “high- living”. Hence, many ailments are due to abdominal plethora, or to sudden suppression of haemorrhoidal flow.
MIND AND SENSORIUM (3)
Over-impressionable from internal or external sources, hence irritable, and even if sad and tearful, still morose or angry.
Feels faint, nauseated and has flushes of heat with the mental symptoms.
Intellectual labour impossible or effected with difficulty; many ailments result (19).
Anxiety with delirious fancies at night-with orgasm of blood, worse in the morning (18) with suicidal impulse in hypochondriasis.
Delirium Tremens with over-sensitiveness and malicious vehemence; marked trembling of the hands. Can bear no contradiction or even gentle persuasions. Reproaches others; quarrelsome; angry; scornful. Dreads intellectual work, if it requires thinking, worse in the morning; slow flow of ideas; makes mistakes in speaking. Cerebral hyperaemia in vigorous, tense-fibred, irascible persons, or when caused by mental labor, abuse of Alcohol, coffee, highly-seasoned foods, etc.; also from suppressed haemorrhoidal discharges; Apoplexy from similar cause (5). Softening of the brain. Feeling of intoxication, dizziness, with heaviness, worse in the morning or when stooping. Confused feeling and fullness, worse after a carousal in the morning. (18), after dinner: worse when the head is erect, though bending forward causes heaviness in the forehead.
Vertigo (6) as if the brain was turning in a circle, momentary loss of consciousness; feels like falling to the side or backwards. Caused by abdominal plethora, and then worse in the
morning (18) or after meals; the face is red or the cheeks flushed on a swallow ground. Also caused by mental exertion, by drinking wine, etc. Nervous vertigo from strong odors, after loss of sleep, after loss of animal fluids with obscuration of sight, ringing in the ears, and fainting.
Head (3, 7)
Headaches originate in irritation of brain tissue; or more commonly reflexly from hepatic and abdominal plethora, from gastric affection and constipation. They are most frequently situated in the forehead, or in the occiput. Characteristic sensations are: fullness; bursting; bruised soreness; tension; pressure. The pains increase from morning (18) to noon. and then decrease towards evening.
Stunning headache after eating, in the sunshine, in the morning(18). Pains seem to be in the middle of the brain. Internal soreness as from the blows of an axe.
Congestive headaches; burning in the forehead, whole head, with hot and bloated face, body chilly; feels, as if the skull would burst; throbbing. Worse mornings (18), moving the head, walking in the open air, studying (19) and after eating. Better at rest and in a warm place.
Clavus, worse from coffee. Headache in the middle of the brain, worse on awaking in the morning (18). Periodical headaches.
Tension, drawing in the forehead as if pressed in; worse at night and in the morning (18) and from exposing the head to cold air.
Headache pressing in the forehead; stitches in the left temple, left eye, or in the occiput; worse in the morning (18) on awaking, or, begins early and reaches the acme at noon. All worse from late suppers, mixed diet, debauchery, mental labor (19) sedentary habits; accompanied with nausea and sour vomiting.
Head feels full, heavy, worse from stooping, worse from want of sleep.
Brain seems to shake when one walks.
Scalp sensitive to touch; liable to take cold from dry winds or drafts. Fetid sweat of one side of the head and face, with dread of uncovering the head; sweat relieves the pains; parts feel cold to the touch.
SPECIAL SENSES (3)
The senses are rendered over-sensitive, are perverted and finally are destroyed. The sense of taste is not intensified proportionately to the others, though even here natural taste of food despite Perverted taste from disordered stomach, shows the characteristic tendency of the drug.
Retinal hyperaesthesia with pains at the top of the head; sleeplessness. Vision sensitive. Sees objects more distinctly.
Bright, glittering objects in the field of vision.
Photophobia, worse in the morning (18); in Keratitis, Scrofulous Ophthalmia, etc.
Dilated pupils with irritation of the spine.
Amblyopia Potatorum. Blurred vision, worse when overheated. (See also Headaches.) Atrophy of the optic nerve (Nux or Strychnia).
Biting, as from salt (17), worse in the external canthi, with lachrymation.
Conjunctivitis, especially if the cornea is involved; also when ecchymoses are found in the conjunctival tissue, or when blood oozes from between the lids. Eyes swollen, red streaks in the whites, pressive-tensive pains.
Blepharitis, smarting and dryness (17): margins of lids feel, as if rubbed sore. (See Skin.) Worse from touch, and in the morning (18).
Spasms of the muscles. Eyes wild, upturned, or in constant motion. Paralysis of the rectus externus.
EARS Sounds reverberate.
Noises: ringing; hissing; roaring in the morning(18).
Ear-ache; lancinating, pinching pains.
Over-sensitive to odors, even fainting.
Illusory smells; of Sulphur, bad cheese, a smoking candle-wick, etc.
Nose-bleed during sleep or in the morning; preceded by red cheeks, headache; or accompanying abdominal plethora.
Catarrh (18): mucous membranes are irritated and inflamed, with a sensation of smarting (17) conjunctival roughness and rawness (throat). Discharges are scanty, watery and acrid, thick and adherent, or bloody and clotted.
Colds are contracted by exposure to dry, cold air, or by a draft. Gastric symptoms are usually present. The air-passages feel stuffed. Diphtheria has been relieved when the breath was putrid, and an undisturbed nap relieved.
Stuffed nose even with watery or thick mucous secretion. Severe pains in the frontal sinuses. Sneezing. Itching along the Eustachian tubes. Pharynx feels constricted. Throat and larynx, as if scraped and raw.
Small aphthous ulcers in the mouth, stomacace.
Cough dry, painful, caused by irritation about the plate, in the throat or larynx, by constriction, or by adherent mucus in the trachea, or by eating; worse when exerting the mind (19), on ascending, in the evening on lying down, or in the morning (18); with bursting headache, bruised pain in the abdominal walls, tightness of the chest.
GASTRO-ENTERIC SYMPTOMS (3, 9)
Irritation of stomach and bowels leads to irregular and perverted functioning, and to abnormal cravings (10). Hence arise excesses with consequent over-stimulation, with abnormal plethora, resulting in dyspepsia, neuroses, piles and many reflex phenomena. There are many nervous symptoms; such as cardialgia, colic, bearing-down etc. The mucous membrane is affected very much as in other parts, with smarting (17) rawness and scanty secretions or clotted bloody discharge. Most of the ailments are markedly exacerbated in the morning (18).
Face pale, yellow; flushed red, the skin being still sallow; yellow about the mouth.
Toothache, stinging in decayed teeth; tearing in cold air; worse from exerting the minds (19). Gum-boils.
Tongue dry in the morning (18) without thirst; still there may be much saliva in the fauces. Tongue white or yellow coated, worse near the root. Saliva increased.
Taste bitter, putrid, sour; food has natural taste. The mucus hawked is bitter or putrid.
Appetite wanting, though there may be hunger. Hungry 24 hours before a dyspeptic attack. Craves sauces, condiments, beer, fats, meats, lime (11). Aversion to food. Ailments from coffee, milk, beer, brandy, cold foods (11).
Thirst, but water nauseates. Aversion to drinks (11).
Eructations sour, bitter; also with spasmodic constriction of the oesophagus. Heart-burn. Water-brash.
Hiccough; also when worse from hot drinks.
Nausea, qualmishness and faint-like weakness. Vomiting with marked retching (12) and deathly nausea. Vomit is sour, bilious, foetid, slimy, bloody, or excrementitious.
Distended stomach and abdomen (14), worse after eating. Cannot bear the pressure of the clothing about the hypochondria. Flatulency, abdominal plethora, etc.
Pains (13) pinching, clawing, spasmodic; cramping; pressing as from a stone; accompanied with nausea; with pains in the back, pressure between the scapule etc. Gastralgia. Colic, flatulent, haemorrhoidal from cold or from indigestion.
Flatus incarcerated; presses up under the ribs or downwards or to rectum and bladder, with tormenting but ineffectual urging to defecation and maturation. Liver swollen, sensitive painful. Congested liver of drunkards (15).
Throbbing pain, as from an ulcer.
Jaundice, with faint spells; caused by anger, by cold, “high- living,” debauchery, etc.
Dragging in the abdomen as from a load; weak feeling in one of the abdominal rings, as if a hernia would protrude. Piles, bleeding or not; constricting pain in rectum and anus, worse after a meal and after exerting the mind (19): Burning, smarting (17), sticking, pressive pains. Proctitis; evacuation of dark- coloured mucus.
Stools hard, dry; with ineffectual urging, or with incomplete evacuation, and followed by a sense of constriction of the rectum.
Diarrhoea scanty and attended with irregular, unsatisfactory urging and tenesmus, with smarting and burning in the rectum. Mucous and bloody stools.
URINARY ORGANS (3).
From imperfect action of the liver, etc. the urine contains lithic acid;;and so the remedy is useful in renal colic when the characteristic pains obtain. The same irregular, spasmodic action observed in the rectum occurs also in the bladder.
Renal colic, worse on the right, side, with ineffectual urging to urinate.
Ineffectual urging to urinate; strangury. Burning, tearing pain during micturition. Tenacious mucus in the urine. Dirty-yellow sediment. Haematuria.
GENITAL ORGANS (3)- MALE.
Irritable weakness, hence sexual desire is easily excited, but erections are too short or the emission is too speedy. Therefore, useful after excesses. (See spine.)
Chancroid. Gonorrhoea with thin discharge and strangury. Orchitis, when there is spasmodic contraction with retraction of the testicle.
Soreness on the margin of the prepuce; biting, itching of inner surface.
GENITAL ORGANS (3)- FEMALE
The usual bearing-down, cramping pains of the remedy, with exquisite over-susceptibility; hence many reflex symptoms; but irritability, faintness and weakness predominate.
The menses are too early and long-lasting, though not necessarily profuse; flow dark, clotted.
Displacements of the uterus; recent cases after lifting, over- exertion, etc. Bearing-down in abdomen and back, with ineffectual urging to stool and urination. Labor-pains, Metrorrhagia, etc., with the same concomitant.
Internal swelling of the vagina, like a prolapsus, burning pain; touch intolerable.
LUNGS– HEART (3) Chest symptoms are usually reflex. Thus, there are Asthma, tightness, dyspnoea and congestion, caused by spinal irritation, dyspepsia, suppressed haemorrhodial flow. The Asthma is worse after midnight and is felt more in the lower part of the thorax.
Spasmodic palpitation of the heart, fluttering at the pit of the stomach. Palpitation on lying down after dinner.
SPINE (3) By increasing the reflex action, Nux Vomica causes many motor symptoms. These are inharmonious, in-co-ordinate, and finally followed by paresis. Hence, the symptoms are spasmodic, paretic and mixed, giving the so called irritable weakness; tetanus, trismus, renewed by touch, a strong light or a draft of cold air. Tonic spasms. Spine symptoms from loss of fluids with dyspepsia, constipation, etc.
Burning, tearing in the back. Bruised pains; worse 3 A.M.
(18). Pains in lumbar and sacral regions.
Gait tottering, inco-ordinate as in Ataxia. Sense of sudden loss of power. Bruised, tired pains in the legs; irresistible desire to lie down. Numbness, stiffness and tension in the limbs. Cramps in the calves.
MUSCLES AND JOINTS
Are bruised, swollen, tense; over-lying skin, pale with tearing pains; affects generally the large joints and the muscles of the trunk. The tearing pains compel a change of position, but with only momentary relief; the bruised sensation, the swellings, etc., are made worse by motion. Tension, shortening of the tendons, jerks on going to sleep, cramps and numbness, point to co-existing nervous irritation.
As in mucous membranes, so here, there are soreness, as if ulcerated, especially on the margins (17) of skin and mucous membrane, crawling, itching and burning. There is also extreme sensitiveness of the skin to slight touch (see Senses), to drafts of cool air, etc. Painful desquamation, especially of the lips, whenever fatigued or after excess.
Acne on the face, after excessive use of liquor; also after cheese.
Ulcers with raised, pale edges; pain, as if beaten; itching, worse in the evening; feeling of tension; burning and sticking of flat ulcers in the mouth and throat. Boils. Abscesses.