A study of Causticum will soon show you that it is a very weakening drug. It causes such severe prostration and weakness to come on that there is a constant desire to lie down and rest. The mind and body are affected in much the same way; thoughts come slowly or vanish; there are marked evidences of incoordination, and the mental functions are carried on in an uncertain and irregular way, so that volitional acts are imperfectly performed and involuntary ones begin to appear. Children are slow in learning to walk.
It is characteristic that its symptoms come on singly or in more or less isolated groups; to these belong the involuntary urination when coughing, sneezing, etc., the aphonia, the inability to get under the mucus when coughing, or the necessity to swallow it when once loosened, and many other evidences of loss of power or paralysis.
The whole trend of the proving inclines toward paralytic weakness of one kind or another, although there are also some evidences of a preceding irritative action, as seen by an inclination to bite the teeth together, involuntary biting of the inside of the cheek and twitchings and spasms, some times returning at stated periods during sleep. Later on starting or jumping of single muscles while awake occurs, and then spells of momentary unconsciousness, with sudden giving away of the knees and sinking down, but with just as quick recovery (Petit mal.), supervene, all going to show that we have to deal with a drug capable of causing irregular action, depression and a progressive slowing down of function, gradually merging into complete loss of control and paralysis.
Pains and sensations which cause powerlessness. It acts more on the right side. While perhaps not as prominently a right-sided remedy as some others, it is still enough so to furnish a very good point of differentiation in making comparisons. There is a right sided hemiplegia which comes gradually; here it competes sharply with Lycopodium and Arnica. In left-sided palsies Lachesis and Rhus tox. come most prominently to mind. The antecedents, concomitants and modalities must decide.
Its pace is slow. Only occasionally do we see an absolutely acute Causticum case; but then we find it deeply rooted in one of the great miasms. There is a type of acute articular rheumatism belonging to this class in which there are bursting (Bryonia, Calc, c.), splitting and burning, pains coming first on the right and then on the left side. “Bursting in the finger- tips” I have verified several times. If we fail to select the simillimum for such a case the patient will soon have an increasing sense of shortening in the affected part, which gradually terminates in actual contraction of the flexors and distortion of the limb-syphilitic-gouty cases.
As a medicine it is hardly suited to high-grade inflammations with intense febrile movements, but, because of the penetrating character of its action, it is admirably adapted to cope with the gravest nonfebrile disorders. There is little of toxicity in it, but much that hits at the disorganization of tissue. The physical processes which call for it are usually of a sub-acute type, and somewhat lacking in irritability. This lack of sensibility is quite marked in some parts, either the urine or the stool may pass without the patient being sufficiently sensible of it.
The dominant sensations are those of low grade processes in poorly vitalized tissues, and attain their greatest prominence where secretion is going on. Raw or erosive burnings with soreness are most distinctive. In the stomach it is likened to the slaking of lime; in the skin we have it in the kind of an indolent ulcer which secretes an acrid, thin, gray watery pus, and is also the set of jerking or twitching pains. It is also indicated in deep, old burns, which heal imperfectly or leave bad results in so doing rawness in the throat.
The nervous system shows some striking peculiarities in that the patient has less control over his emotions; he becomes oversympathetic; the least thing makes him cry; he is timid, mistrustful or peevish, sometimes going over into a state or irritable weakness of profound mental depression, such as is seen after grief or sorrow. He is very sensitive to cold, but any slight exertion heats him immoderately, showing that the thermic mechanism has been weakened.
The tendency of Causticum to show its effects in single parts or groups is nowhere better illustrated than in its febrile phenomena. Here we see coldness or heat of one side, one foot or any other single part, while the sweats appear over the painful or affected parts and after stool. Coldness like a lump of ice in the epigastrium (Bovista). The chill and sweat are better from drinking, and the heat is accompanied by urging to stool. All of them are worse in the evening.
Symptoms which appear in well defined or very limited areas, such as cough with sore streak down the trachea, or sensation of water running in a narrow line downward from the clavicle, make one think of this medicine and its predilection for single or unassociated manifestations.
Under its action the skin becomes dirty white and the face assumes an extremely sickly look. The acridity of the drug is much in evidence for it causes decided soreness and rawness in the folds of the skin and promotes the growth of warts; the latter are very prominent on uncovered parts, particularly the edges of the eyelids and the finger tips. It is one of the best remedies for the ill effects of suppressed eruptions.
Motion and rest have an important bearing in the Causticum case. Many symptoms are better from slow motion and worse during rest. The menses cease at night while lying down (Pulsatilla); it seems to be necessary to move about to keep the flow going. The stool passes better when standing, an odd but true symptom.
Dry cold weather does not agree with the Causticum patient; under its influence he catches cold and becomes hoarse. In this respect it greatly resemble Aconite and Spongia, both of which are affected similarly by clear, cold, and the Causticum cases are particularly so; they take cold and then become drowsy therefrom, thus greatly resembling Gelsemium, but the causative factors are quite different.
The cough and spasmodic symptoms are better from a drink of cold water, but the pains are better from heat.
Most of the symptoms are worse in the evening, after eating and from coffee. You should, therefore, not allow patients to drink this beverage while taking Causticum.
Whatever its composition may be, it, to all intents and purposes, belongs to the potashes, and symptomatically, holds a position midway between them and Lachesis, which is, if I am not mistaken, an alkaline venom. It has many symptoms like those of this snake venom, but the modalities are different, besides Causticum gives no hint of poisoning the blood.
We should also compare Gelsemium; it has the same general prostration, drooping eyelids and sleepiness, but is intolerant of heat.
Physostigma has the same loss of power over the voluntary muscles, as well as the aggravation from clear, cold water, but it is a left-sided drug, and has great aversion to drinks.
Phosphorus parallels many of its symptoms, but it has aggravation from lying on the left side; is a hemorrhagic remedy, and is decidedly better in the cool air.
Rumex contains potash, and is remarkably similar; it is distinguished by a cough which is excited by inhaling cold air or a ticking in the throat pit.
In reviewing the case we have:
1. Lack of control of the will, giving rise to involuntary actions, spasms, etc.
2. Paralysis and relaxation, especially of single parts, eyelids droop; involuntary urination; paralysis of vocal cords; inability to expectorate (it must be swallowed); can’t get under secretions in lungs.
3. Symptoms come in single parts or isolated groups. Partial chill, heat or sweats.
4. Aggravation from dry, cold air in clear weather.
5. Worse in the evening on awaking, and from coffee.