In experiments one saw an increase of secretion in the isolated stomach from the sodium salts. Sodium ions in combination with univalent ions produced a flow of juice, in combination with divalent anions, an increased secretion of mucus. The biliary secretion should be depressed by the sodium ion.
Drug provings of natr. carb. are found in: (1) Hahnemann: Chron. Krankh., 2 Aufl.,Bd.4, 1838.
(2) Kurtz: Allg. hom Ztg., Bd. 26, P. 249, 1844 (refers to Vogler: Use of Mineral Waters, particularly of Ems, 1840).
The natr. carb. type is characterized through chilliness but also intolerance to heat of the sun, by bodily relaxation and a state of mental exhaustion due to brain fatigue and depression, and furthermore by digestive weakness.
The coldness of natr. carb. is depicted in practically the same words as kali carb.: sensitive to the least draft and change of weather, against fresh air; cold extremities. The chilliness of natr. carb.- just as the headache and palpitation- are better from eating. In this cold type we see, perhaps, something that appears common in cation preponderance and in the alkali and earthy alkalies subordinated to the hydrogenoid constitution. But natr. carb. is at the same time especially sensitive to the sun’s heat, which causes headache and vertigo and is very exhausting. But also the sequels of sunstroke are subject to the influence of natr. carb. Finally it is reported of the temperature and weather influence that the natr. carb. patient is anxious before and during storms.
The state of bodily and mental exhaustion is not so much that developing from overexertion but offers more the picture of a malaise from overindulgence. All symptoms are aggravated by mental effort. There exists an incapacity to think, for any mental labor, poor comprehension, forgetfulness. The lack of vitality expresses itself in the absence of resistance to sensory impressions, hypersensitivity to light and particularly to loud noises. The behavior is depressed, music causes melancholia, crying. The patient withdraws from friends and company, even from his family. The depression is worse after eating.
This is associated with the digestive weakness. Hypochondriac- depressive frame of mind is indeed the disposition of many dyspeptics. Likewise the sleepiness is related to a state of exhaustion which is prevalent in men who overindulge and to whom regular work is unusual: sleepy particularly after noon and from heat; on the other hand, the night sleep is disturbed; sleepless before midnight from dreams, dreams much (amorous and anxious); awakens early about 5 a.m. with feeling of weakness and desire for food. (According to H.Schulz, they soon fall to sleep and soon awaken again,, sleeplessness with hypochondriacal thoughts and then falling to sleep, towards morning a feeling of insufficient sleep).
To this there is added a laxness of the limbs and joints and above all, weakness of the joints of the feet, parts sprain easily, stumbling. In the knee there is a feeling of tension.
To the entire picture there is added the pale face with dark circles under the eyes and puffy lids;the delicate skin permits freckles to appear easily. There exists a tendency to sweating on the involved parts with pains, from the slightest exertion and during sleep, and particularly on the hands and feet.
Concerning the organ systems, while the respiratory organs have preference over the digestive with kali carb., the reverse is true of sodium carb. The clinical recommendation of sodium carbonate in digestive weaknesses arises from Hahnemann. The digestive disturbances are provoked through the least dietary failure. The symptoms consist of acid eructations, distentions, pressure and various unpleasant sensations in the stomach (as from a stone, cutting, nagging, pulsation, soreness). They are worse after eating and better when the food has left the stomach. On the other hand, the feeling of weakness and the demand for food appears at unusual hours ( at 5 in the morning and 11 at night), and the general symptoms as chilliness, headache and palpitation are improved by eating. Gastric function is deranged. Cold drinks aggravate or are given as the cause of the gastric disturbances. Farinaceous foods and vegetables are borne the most badly and they cause diarrhea. Against milk there is an aversion and this too causes diarrhea. According to Kent, natr. carb is useful in nurslings who are nervous and cold and have aphtha and sore mouths. In general, the boweLs are constipated and without desire for stool; large hard stools or stools like sheep dung are evacuated with great effort; or there occurs sudden urgency for stool and the stool is evacuated with haste and flatulence. H. Schulz also reports from studies on his pupils with three to five cg. natr. carb. siccum given in the morning before breakfast, an alteration of intestinal activity. After fourteen days the provers had attacks of colic, constipation alternating with diarrhea, others profuse diarrhea. More over, there was one unclear symptom reported; evacuation of yellow, jelly-like masses (like masses of orange) from the bowel, independent of the stool.
OTHER ORGAN ACTIONS
In the second line the mucous membranes of the respiratory passages and the genitalia are influenced. This agrees with the reports on the action of strong alkaline springs containing sodium (Ems, Salzbrunn, etc.) The great mucus-releasing action of soda seems to reflect itself more biologically in a stimulation of the mucous glands through natr. carb.
Nash mentions particularly postnasal catarrh as an indication. The symptom of foul odor of (thick and yellow-green) nasal secretion refers to involvement of the posterior nasal divisions. Expectoration of much mucus from the throat, worse from the least draft, reveals the pharyngeal catarrh. Dry cough on entrance to a warm room from outside (frequently an indication for bryonia) may suggest it in a chronic catarrh: The symptoms: cough with labored breathing, better on sitting up, and cough with coldness in the left side of the chest, concur strikingly with the reports on kali carb. Still, the entire symptomatology of natr. carb. in the upper respiratory passages has no great significance; the direction is apparently the same as with kali carb., but significantly more weakly expressed.
Of the female sexual organs, an acrid, yellow, copious leucorrhoea should be mentioned. A remarkable symptom in women cited as a cause of sterility is: discharge of the semen immediately after entry. At the same time the chilly, relaxed, sensitive-to-sun, nervous and dyspeptic state should be present. Natr. carb. does not have a definite type of menstruation, though it is scanty, late, but even too early menses have been reported. The downward pressure in the abdomen is more characteristic for other drugs (sepia, lilium tigr., murex) than for natr. carb. For differentiation is the heaviness in the lower abdomen, worse on sitting, in the natr. carb symptoms.
A rarely employed trend of natr. carb. is designated by the skin symptoms: vesicular eruptions on the knuckles, tips of the fingers, toes, flexor surfaces of joints, also on the body patchy or circinate. The skin should also be dry, wrinkled and rough, especially on the backs of the hands and feet. An inflammation of the exterior of the nose as well as heel ulcer are mentioned as indications. The external action of soda on the skin seems to have influenced the symptomatology here.
According to the depiction of Kent in respect to natr. carb. there would be a remarkable similarity with kali carb. because he describes most of the symptomatology of the two drugs with almost exactly the same words. The general picture : Old dyspeptics with constant eructations, sour stomach and rheumatism: the bent back is weak, sensitive to cold, their digestive and rheumatic- gouty complaints become worse from change of weather, can be found repeated in kali carb. It is the picture of cachexia alkaline as occurs perhaps through the prolonged misuse of Bullrich salts. The loss of resistance against all types of influences, especially against sudden noise, which causes the patient to tremble, nervous excitation and palpitation with great exhaustion, tremulous weakness from slight bodily or mental exertion; the seating on the involved parts, the puffiness, tendency to edema; also paretic states (lids, swallowing) the numerous identical symptoms in the respiratory, digestive and genital apparatus and mucous membranes; palpitation on lying on the left side, rheumatic pains in the extremities; an early morning aggravation; all such details, for which one naturally seeks many in vain in other writers, approximate each other in the Kentian symptomatology of kali carb. and natr. carb. more than the above-cited most important trends of action give semblance. If we permit each drug to stand beside the other in a flood of complete symptomatology without clinical evaluation, then, the unimportant symptomatology in the one picture cannot be differentiated from the important of the other because of the similar text. It is therefore necessary not to confuse the pictures.
Natr. carb. in general is not given below the sixth decimal (trit).
SUMMARY Type :
Chilly, bodily relaxed, mentally exhausted. Sensitivity of the senses, depressive hypochondriacal.
Chief Directions: Digestive weakness; catarrh of mucous membranes.
Worse from drafts, from cold, also heat of sun; worse before and during storms; worse from mental exertion; music brings on weeping; improvement of general complaints (chilliness, headache, cardiac palpitation) from eating; gastric symptoms and depression at first aggravated by eating and improved after completion of digestion; sensation of hunger at unusual hours (5 A. M. and 11 P.M.).
The pharmacology of lithium sands always under the influence of false hypothesis. Lithium carb. has been stamped a gout remedy because it is supposed to dissolve uric acid. But this again involves an erroneous deduction from the test tube to the living organism. Actually, lithium urate is only slightly more soluble in water than the other alkali urates. One can neither dissolve urate stones in the bladder by great concentrations of lithium carbonate nor bring the uric acid held in the blood and the body tissues, especially in the joints, to increased excretion. The so-called lithium springs in general cannot come in to consideration for this crude chemical effect because they cannot attain the concentration in the body which would be necessary; and in urecidin where one gives several sodium salts at the same time with a lithium salt, one can say nothing of a lithium action through substitution of sodium by lithium. If lithium has an influence on the uric-acid diathesis, then it does not obtain this in any case through quantitative chemical changes in the precipitation and solubility relations in the organism. From experimental investigations a peculiar manner of action of lithium in contradistinction to sodium is not known up to the present. Clinical facts from which one might proceed are, in any case, not available.
C. Hering made the first provings. Confirmed best are the symptoms from the urinary passages: very frequent micturition that disturbs the sleep and burning in the urethra; painful and difficult urination (tenesmus); pain in the neck of the bladder and pain which goes into the spermatic cord after urination. Furthermore, in the provings are observed a turbid urine with much mucous deposit and a reddish-brown sediment in the urine; also scanty, dark and very acrid urine, voided with difficulty and pain. In connection with this there stands still another provings symptom: pressure in the cardiac region before urination, which ceases after voiding. For this reflex relief after micturition there is also clinical support.
It is probable that the rheumatic-gouty component which lithium carbonate seems to share in common with the other alkalies stands too much in the fore-ground in the drug picture due to the influence of earlier and no longer maintainable hypotheses. First a gradual stiffness over the entire body is reported. The knees and lower back should be particularly weak; then itching around the joints, rheumatic pains in the shoulders, arms, and fingers, in the arch of the foot and extending up to the knee, selling and sensitiveness of the finger and toe joints (only during rest, better from movement; still this modality is by no means positive.). These rheumatic symptoms have been made the basis of treatment of chronic arthritis when the cardiac complaints are also present. About the heart are reported pains of various types (beating, sticking, pressure, dull stitches) and trembling and palpitation which may extend to painful palpitation up in to the head and between the shoulders. Simultaneously, the inspired air causes a feeling of coldness in the chest. Characteristic for the cardiac complaints should be that they are worse before urination and cease after it. They should also be worse before and at the beginning of the menses.
The above-mentioned symptoms in the urinary passage have been brought into connection with an action upon the uric acid diathesis and especially concretions in these organs. A certain diuretic action is common to all alkalies in consequence to their rapid excretion in the urine. Whether a direct stimulus action on the urinary passage by lithium can occur is not known at present.
Another trend, that of the dyspeptic symptoms, places lithium carb. in line with the other alkalies and especially close to natr. carb. They are gnawing and uneasiness in the stomach, feeling of fulness in the temples, and headache. Of the headache it states, exactly as with natr. carb. that it improves or ceases from eating. Likewise the nagging sensation is improved by eating. Moreover, sensitivity of the stomach against the least pressure and also sour stomach is reported.
A striking symptom is repeated in all materia medicas: hemianopia, invisibility in the right visual field. This symptom was observed on the second day of the menstrual period and associated with poor vision for reading. Whether it deserves to be repeated in the materia medica is very doubtful and in any case a clinical confirmation from its use is not known. The same holds for the asthenopia taken as an indication from the same event.
All in all, the lithium carb. picture stands with a large number of question marks, because the provings are very insufficient.
Lithium carb. is employed mostly in the lower triturations.
Ammonia, NH3 and the compounds of the ammonium cation, NH4, form an important step in nitrogen circulation, which occurs between the atmosphere and the bioshpere.
In the air the inert nitrogen is merely a nonreactive dilution agent for oxygen.
In organic life nitrogen appears predominantly at the ammonium step. To this it is led by single types of bacteria (for example azobacterium), by fermentative and not completely understood means. From the complicated nitrogen compounds of the organism it is led back to simple ammonium compounds or their oxidation products as nitrites (NO2) and nitrates (NO3) to the air and soil. Another source of nitrogen compounds is the atmosphere in which oxygen compounds of nitrogen develop through electrical discharges and then reach the earth with the rain.
The elaboration from ammonium salts and nitrates which also become reduced to ammonia is cared for by the plants. Animals have at their disposal highly elaborated nitrogen products which they can convert in a specific way for their own purposes. Since the lower nitrogen compounds (ammonia and nitrates) again develop from living organism and can be changed again into molecular nitrogen through other bacteria, so a constant new formation of bound nitrogen is necessary for the maintenance of life. And since practically in this circulation many nitrogen compounds are destroyed, one adds artificial synthesis as ammonium salt fertilizers.
AMMONIUM IN THE ORGANISM
One cannot speak, of a necessary complete metabolism of ammonium in the human organism as it need not be introduced nor utilized as such, but it is only occasionally taken in (for example in cheese) and is then almost completely synthetized in the liver to urea (CONH2- NH2). Only traces of ammonium salts (0.026- 0.015 milligram percent [N]) escape synthesis (or are on the way to synthesis?) and circulate in the blood. But in any case it is not enough to come in to consideration for the maintenance of the pH of the blood. When an increased excretion of ammonia in the urine takes place in acidosis, this is explained in that the kidney ammonia is formed by necessity from the ammonium mother substance and indeed for the neutralization of the acids excreted, whereby the fixed alkalies can be spared. An increase in the actual ammonium content of the blood appears only in the final toxic stages of acidosis. In muscle work ammonia is freed from the ammonium mother substance (adeninnucleotide). But it is chiefly liberated from the ammonium mother substance through a ferment of the kidney, the renal ammoniacase. This amoniacase has its optimal action in an acid medium so that acidification increases the amount of the ammonia liberated and neutralizes the urine.
So one can speak of physiologic role of ammonia only in the phase of excretion: buffering of the urine with a sparing of free alkali. Still, it is worthy of note that ammonia is liberated in the decompositions accompanying muscle and nerve activity. Since this process is probably irreversible, the weakening and paralyzing influence of ammonia on muscle and nerve can be explained. Furthermore ammonia develops in the erythrocytes, a fact which again furnishes proof of a damage to the erythrocytes through an excess of their metabolic end-products.
Accordingly, only traces of free ammonia are associated wtih the normal activities of cells and in the event of insufficient possibility for detoxication to urea, diverse toxic effects of free ammonia can easily occur. That the respiratory passages stand in the first place is explained by the volatile nature of ammonia fumes which furnish the first and best occasion for contact with the functioning cells. If one reflects that an excess of ammonia is excreted from the organism also through the respiratory passages, so the easy involvement of these mucous membranes by ammonia finds its explanation.
PERIPHERAL AND CENTRAL ACTION (RESPIRATORY ORGANS AND VASOMOTORS)
If one departs from the crude from the corrosion of the mucous membranes which this volatile alkali can provoke through swelling and solution of the mucous membrane just as another alkalies cause, then there still remains a complete series of irritant effects on the mucous membranes of the respiratory passages. The most acute effects of the vapors are: edema and occlusion of the glottis, asphyxia. With the rapid resorption and penetration of tissues the actions of ammonium compounds on the respiratory organs are very acute. They go from catarrhal irritant manifestations from small amounts to severe inflammation wtih swelling and formation of exudates in the larynx, bronchi and pulmonary alveoli, aphonia, spasmodic cough, paroxysmal dyspnoea with piping, snorting rales in the lungs, epithelial shreds or blood in the sputum and pain in the larynx and under the sternum.
Characteristic of the acuteness if ammonia action on the respiratory passages is that central irritative manifestations appear with collapse symptoms: small and slow pulse, pallor, cyanosis, sinking of body heat, chills, oppression, precordial anxiety: also vertigo, uneasiness, delirium and often spasms.
Exactly this union of inflammation of the respiratory passages and the reflex central vasomotor collapse, the union of an expectorant and analeptic, characterizes the chief actions of ammonium preparations in homoeopathic use. The common use of expectorants which is based on an increase of amount and fluidity of the bronchial secretion, as with all alkalies, and depends up on the alkalescence of the mucus does not sufficiently characterize the individuality of ammonium action. Only through the differential symptomatology of single preparations will the selection of a suitable remedy avoid arbitrariness. The inclusion of a cataleptic action is an important but still very general characteristic. Again, the recognition of such an obvious fact, as is here made clear in the similarity of the pathologic (toxic) actions and the therapeutic actions, is the point of departure and the indicator for an exact selection of the suitable drug in the individual case.
The analeptic action of ammonia and the ammonium salts (together with volatile oils as smelling salts) is again well known to the laity. The stimulus on the nerve endings in the nose provokes indirectly a reflex excitation of the respiratory center. At first the respiration will naturally be depressed in expiration, which will then be followed by single deep inspirations. In this respect, for obtaining such a therapeutic effect, observation of the dose and the sensitivity of single patients is of great importance. Otherwise, there may be an alarming reflex depression of respiration and the cardiac vagus as well as spasm of the glottis and, especially in nurslings, severe asphyxia and collapse. Here, too, the toxic and the therapeutic actions stand very close to each other.
Occasionally ammonia is used as the skin irritant agents, as camphor. Burning, redness and vesicle formation are the local effects of ammonia water. Here, too, the stimulus will be conducted by centripetal nerves. Ammonia stimulates the free- lying sensory nerve elements (in contrast to the motor) in a special way which after some time passes over into prolonged anesthesia.
For the action on the peripheral and central nervous system, it is perhaps of significance that traces of ammonia are set free in nerve activity and an excess as well as a toxic split-product, perhaps, influences function; moreover one should also consider the great lipoid solubility of ammonia (the possibility of saponification of fats).
If the sensory nerves are preferably involved in acute action, then this is to be traced to their accessibility. The occasionally observed spasms in ammonium poisoning must be considered of central origin. And so much more remarkable is the report of Lewin 21 that in conclusion to ammonia intoxication, long-maintained muscle weakness, indeed even complete paralysis of the lower extremities is observed. Also a persistent aphonia indicates an after-effect and a conclusion that from a long- maintained influence the motor apparatus is not spared. This is less significant for the usual ammonium preparations than for the understanding of the characteristic actions of the clearly related preparation, causticum.