Central action of ammonia and ammonium salts is well known: they have already been mentioned for the respiratory and vasomotor center. On the blood pressure a central exciting action is observed 22. Ammonia salts likewise act centrally on sweat production. Therein it is to be recalled that ammonia is also excreted through the sweat; there exists a connection between the receptive organ and the nerve-center action. Formerly, liquor ammonii acetici (spiritus mindereri) was employed as a fever and sweating remedy. That after ammonium intoxication a long- maintained fever occurs can be indirectly explained through the destruction of protein.
ACTION ON BLOOD
Traces of ammonia are found as split-products in the erythrocytes. The lipoid solubility of ammonia explains their great hemolytic property which is characteristically potentiated in combination with saponin. From direct contact with ammonia, the blood at first becomes dark red, then through destruction of the red blood corpuscles, there is lacking and finally a rubyred. Such blood effects can appear only in very acute flooding with ammonia. But typical symptoms of intoxication find accord in the homoeopathic drug picture of ammonium preparations with septic and scorbutic states with a tendency to bleeding.
Finally, diverse but not characteristic digestive disturbances are observed as chronic effects of prolonged contact with ammonia or ammonium carbonate.
VOLATILITY OF PREPARATIONS
With all ammonium preparations, fresh preparations are important, especially in the fluid ones, because they easily yield ammonia. Mostly is this the case with ammonia water (ammonium causticum) which dissociates electrically only to 4 per cent (NH3 in H2O <-> NH4 Plus OH -) and is only hydrolytically dissolved and constantly gives off ammonia. It is similar with the combinations of ammonia with weak acids as in ammonium carb. (NH4) 2Co3. For this reason, especially in the lower potencies, triturations are preferred, as Hahnemann also advised. Somewhat more stable is ammon. mur., salmiac, NH4Cl. The bromide and the iodide require, on account of their easy destructibility, fresh preparation, for they yield ammonia, bromine, and iodine, all of which escape into the air.
Ammonium causticum adapts itself only for the attaining of the most acute ammonium actions: as an analeptic with collapse symptoms; in hemolytic manifestations with bleeding; as an antidote in snake bite, which also provokes hemolysis with central nerve actions; in acute inflammations of the larynx and throat with accumulations of mucus, if swelling and exudation cause suffocative phenomena or spasm of the glottis; under certain conditions also in diphtheria- but always with great caution because the poisonous and therapeutic actions lie close to each other.
The late effect of ammonia, especially aphonia, great exhaustion and muscle weakness, pains in the shoulder and thigh muscles, are less two edged indications, and flexor cramps have also been reported. Even if the simile relationship is quite obvious, still the practical use of ammonium causticum in homoeopathy is quite rare because of its stormy and rapidly transient effect.
Exactly as potassium and sodium hydroxides are unsuitable for therapeutic purposes and the carbonates are much more useful for more prolonged acting alkalies, so is this the case with ammonium carbonicum, the preparation which unfolds the ammonium effects most extensively and clearly. The complex ion, ammonium, behaves entirely as a simple alkali ion. The slight stability, great volatility, and its role in the body physiologically limited to the destructive phase, give it an accent in contradistinction to sodium and potassium, that the action is more transient, toxic and less constitutional.
In this respect ammonium carb. shares the general alkali constitution: relaxed fibre, tendency to corpulence, always tired and fatigued, slow manner or reaction or defective power of reaction; weak heart, labored croupy breathing, downcast, particularly around the menstrual period, in which headache, toothache occur with diarrhea on the first day and which are usually too frequent, too profuse and of dark clotted blood. The tendency to bleeding of dark blood (from the mucous membranes) is to be especially stressed in ammon. carb. in connection with its hemolytic properties.
Just as outspoken as with the other alkalies is the hydrogenoid constitution of ammon. carb.: great sensitivity to cold and water (from the latter, bodily uncleanliness, which appears as a clinical report), easy chilling, aggravation before damp (and stormy) weather, from the use of water in any form.
To this is added, more incidentally, a depressed, anxious frame of mind, ill humor in bad (stormy) weather, mental distraction, poor memory, errors in speaking and writing or counting; sleepiness during the day, at night fearful, awakening from sleep.
The headaches have little characteristic, a feeling of heaviness and beating as well as a sensation as if the brain were loose in the cranium having been reported; it is relieved by external pressure and in warm rooms, but these are insufficiently verified; the aggravation before and during the period has already been mentioned. (There has been reported an aggravation of the headache in evening and morning; this last aggravation after sleep seems to prevail with stupefaction and symptoms and weakness and make ammon. carb. resemble lachesis).
This constitutional weakness, slight ability for effort, expresses itself in asthenopia and the appearance of spots before the eyes when the eyes are strained. The fatigue and lassitude in the extremities and in the musculature in general in the provings proceed up to paresis and painfulness: heaviness and paretic weakness of the arms, the arms and fingers, which morning and night feel dead and stiff on grasping; trembling of the hands; cramps and numbness in the fingers; pains of fatigue in the hip and thighs, especially in the morning in bed; spasms in the feet and calves; heaviness and great weakness in the legs, many drawing, tearing and crushing pains in the extremities are a few of the reports. Although they have no great therapeutic significance for ammon. carb. itself, they indicate the involvement of the locomotor apparatus as an incidental trend of ammon. carb. actions. There is a failure of the musculature, which on the one side tends toward paralysis (in which respect one should compare the toxic after- effects), on the other side to many so-called rheumatic pains wherein the cold and moisture sensitivity of ammon. carb. cooperates casually. The physiologic excretion of ammonia in muscle and nerve activity perhaps creates bridge for understanding. This trend of action is more significant therapeutically for the employment of causticum.
The defective power of reaction as a basic trend of the ammonium carb. picture permits the agent to be perceived in homoeopathy as well as a type of analeptic, and is the basis of its reputation in adynamic states with fever, for example pneumonia with low temperature, dulness and apathy when the patient is too weak to cough and expectorate,, and shows rales and cyanosis. Also in malignant scarlet fever with adynamic symptoms the remedy is recommended when eruption comes on to partial development because of the defective power of reaction. A scarlatiniform type of eruption is described in the Hahnemannian provings. Also erysipelas in old weak people with cerebral symptoms, dulness and stupor, is mentioned.
The toxic action on the blood is combined with this adynamia and terminates in hemolysis. The picture is not peculiarly specific but there exists a great tendency to dark, fluid hemorrhages, that is, impaired coagulation; appearance of vari-colored spots in the skin, blood-flecked sputum, easily bleeding gums like those of scurvy, bleeding from hemorrhoids, with the menses early, profuse and dark, epistaxis in the morning on washing. This last indication of a milder nature is used most. As a warning of irritative of manifestations in the skin is severe itching with burning vesicles and pustules after scratching, likewise severe itching and burning in the anus are cited.
ACTION ON THE RESPIRATORY ORGANS
From this picture of general actions is removed the main organ direction of ammonium carb.: on the respiratory organs. The inflammatory manifestations, which may extend from the nose to the bronchioles and pulmonary alveoli, characterize themselves as far as ammonium carb. is concerned through the early disturbance or failure of central regulatory functions (respiratory or vasomotor center) frequently in association with defective equalization or compensation of the respiratory embarrassment by the muscle weakness of the heart. For the pneumonia (that is, usually bronchopneumonia) the adynamic state with very embarrassed, rapid, noisy respiration, proceeding to pulmonary edema and collapse, have already been mentioned. In this threatening state of failure of the respiratory regulation functions, one can make use of the very acute action and active ammonium iodide (fresh preparation!). Also for the suffocative feeling from the larynx, the simultaneous linking through the iodine is often preferred, for example also in the presence of goiter.
The cough of ammonium carb. whether it is conditioned through laryngitis, tracheitis, or bronchitis, is quickly combined with dyspnea, feeling of suffocation, sensations of fatigue, weakness, and heaviness in the chest, audible palpitation, anxiety, often cold sweat, trembling, inability to speak, and lachrymation. Universal is the nocturnal aggravation, especially toward three in the morning. This time of aggravation agrees with that of kali carb. and is the time of highest physiologic demand in the vagal division of the vegetative system. The patient awakens at this time with an attack of irritative coughing, dyspnea and cardiac weakness or palpitation.
The dry irritative cough of ammonium carb. is also aggravated by every effort and on entrance into a warm room. A scratchy feeling as if from a foreign body is frequently present. Huskiness and aphonia accompany the localization in the larynx; blood- flecked sputum frequently, the bronchitis. In inflammation of the nose the occlusion of the nose at night is so high grade that the patient is awakened out of sleep by the respiratory oppression. In the persistent coryzas the secretion should be acrid, burning, and watery. (The dry, spasmodic, nocturnal irritative cough arising from the throat combined with burning in the throat and feeling of suffocation will often find ammonium bromatum given wherein the bromine linkage is leading for the throat organs and the reflex spastic nerve irritation. The nocturnal aggravation on lying and particularly toward three in the morning is also present here. The spasmodic element is strongly stressed, therefore also the use in whooping cough.)
OTHER ORGAN ACTIONS
The symptoms on the gastro-intestinal canal which may be provoked through a chronic influence of ammonia or ammonium carb., like many gastro-intestinal disturbances, have no therapeutic significance because nausea, acid burning, hunger and rapid satiety as well as pain in the gastric region give no differential signs in particular of ammonium carbonicum.
It is the same with the urinary symptoms, increased urgency with irritative manifestations of cutting and burning, increased urine and copious red or white sediment. The menstrual type and the accompanying manifestations at the time of the menses have been mentioned under disturbances of a general type. An acrid, corrosive leucorrhoea is an accessory manifestation of subordinate significance.
Accordingly for the selection of ammonium carbonicum are essential:
1. The relaxed, tired type with defective power of reaction, with weakened musculature of heart, especially depressed and hypochondriacal at the time of the menses, tendency to dark bleeding and the signs of the hydrogenoid constitution, sensitivity toward cold, damp weather and water.
2. The chief trend is toward the respiratory passages with failure of compensation through the cardiac power and regulating brain centers tendency to respiratory paralysis and collapse of the vascular system.
3. The modalities: aggravation: outside of the already mentioned general (cold,, damp weather, application of water, menses), especially for cough and respiratory disturbances are the nocturnal and in particular 3 A.M. aggravation moreover from excretion and in warm rooms. There is reported a preference of the right side for ammonium carb.
Provings of ammonium carb. are found in (1) Hahnemann: Chronic Diseases, Bd. II (7 proving conductors); (2) Homoopathische Vierteljahrsschrift, Bd. X, 1 (12 provers).
Study with large doses: (3) Wibmer: Wirkungender Arzneimittel und Gifte, Bd. 1, p. 131, 1831.
(A characteristic proving has not yet been made).
RARELY USED PREPARATIONS
Ammonium iodat. is not proven. Ammonium acet. and ammonium nitr. only with large doses (Wibmer).
Of ammonium bromatum: (1) Cushing: Trans. of Amer. Inst. Homo. 1870, 2nd morning, also 1890.
Outside of the already mentioned spasmodic laryngeal symptoms, for ammonium bromat., eye inflammation is especially mentioned; moreover, an irritation under the finger nail which is relieved by biting on it.
Ammonium phosphor. is mentioned for chronic gout without the symptoms of even a short proving giving the occasion. (C. Voigt: compression of the precordium and chest, nausea, thirst; hard, small rapid pulse, collapsed circulation: fulness and tension in the head, heaviness in the extremities, uncertain, stumbling gait). Allen’s report of facial paralysis is likewise not exactly suited to awaken confidence.
If ammonium benz. is recommended for gout of the great toe, then, this refers more to the benzoic acid component.
Salmiac, NH4Cl, dissociates as the salt of a strong acid and in contrast to the carbonate is stronger electrically and less hydrolytic. The lack of odor of this salt suggests that no ammonia is set free. Therefore in the organism the liberation of ammonia is less stormy so that the elaboration to urea and the excretion through the urine and sweat in general is more extensive.
With larger doses an increased excretion of a urinous smelling sweat is observed. Moreover, the disturbances of the digestive canal appear stronger: coated tongue, scurvy-like alterations in the gums, burning sensation in the stomach, nausea, constipation, more rarely also diarrhea and colic besides nausea and vomiting and from persistent use emaciation.
SPECIAL ASPECTS OF AMMONIUM MURIATICUM
One may expect from ammonium muriaticum a more prolonged ammonium action and moreover in the liberation from hydrochloric acid and its neutralization (through sodium) an approximation of acidum muriaticum and natrium muriaticum. Likewise magnesium muriaticum is recalled particularly by the gastro-intestinal symptoms.
The general type with relaxed fibres and loss of power corresponds also to ammon. mur., but on the other hand it lacks the hydrogenoid trend, the aggravation from damp and cold; likewise it lacks the nocturnal aggravation.
In ammon. mur., in contrast to ammon. carb., there exists a great tendency to periodic febrile states. Thereby the chill should predominate (stronger evenings) and the thirst is absent; at night the sweat appears. With this is associated the characteristic symptom of ammon. car.: sensation of coldness between the shoulder blades. This is particularly guiding in the catarrhal processes.
The periodicity (the seven-day type is observed) has also given occasion for use in malaria -like states. This tendency to febrile states is probably to be traced to the chloride fraction. Generally there exists in ammon. mur. a greater erethism in the vascular system, an unrest in the circulation.
The symptoms of the respiratory passages are indeed like those of ammon. carb. but less stormy, joined with less disturbance on the part of the heart and the central regulatory apparatus. Dyspnea and feeling of suffocation are not so prominent. In place of this the direct influence on mucous secretion appears more in the foreground in ammon. mur. (In ammon. carb. the collection of mucus with rales is secondary and conditioned more through weakness, especially of the heart.) Indeed, ammon. mur. is used by the old school exactly for an increase in mucous secretion. In order to loosen cough, to lighten expectoration, large doses are necessary. The indication is dry, irritating cough with stitches in the chest, worse on lying on the back or on the right side, worse toward morning; noon and evening the cough is loose with copious expectoration and rales.
The laryngitis is combined with huskiness and burning. Burning in small spots in the chest is reported. The colds have an acrid, hot, watery secretion which leads to nasal occlusion as well as loss of smell but not to paroxysmal respiratory oppression as with ammon. car. Likewise in the throat, in the tonsils, there is merely a simple catarrhal swelling with abundant tenacious mucus present with ammon. mur. Through stimulation of secretion, glandular swelling in the throat should find alleviation, indeed even in persistent goiter.
Among the gastro-intestinal symptoms, deviating from ammon. carb., the constipation with crumbling stools is noteworthy, a symptom which recalls natrium muriaticum and magnesium muriaticum and which may be ascribed to the anion. With ammon. mur. the stool is often coated with shiny mucus. Green, slimy diarrhea are more rarely encountered, hemorrhoids, itching, sticking, burning, soreness in the rectum are accessory manifestations, similarly as in ammon. carb. The other gastro- intestinal symptoms are just as non-characteristic as with ammon. carb.
A chronic hepatic swelling with burning and sticking appears as a clinical indication together with sensations in both hypochondria. That the liver is the site of ammonium detoxication is hardly enough to make this indication plausible. An old indication of prostatic hypertrophy has been incorporated in homoeopathy without foundation.
The menses are of the same type as with ammon. carb., and still the bleeding should occur more profusely at night with ammon. mur. A protein- like leucorrhoea or brown, slimy discharge after urination is incidental.
The more prolonged, more deeply penerating ammonium action than in the ammon. mur., picture is found in the number of neuralgic complaints: most important is a sciatica, worse from sitting, somewhat better from moving, lessening on lying, a tensive and contracting-like pain; moreover neuralgia in amputations; coccygodynia, like a bruise; lancinating, drawing and cutting pains in the fingers, toes and heels, the heel pain better from rubbing.
(1) Hahnemann: Chronic Diseases; Bd. 2.
(2) Gumpert: Medorrhinum Zeitung d. Vereins f. Helikunde in Preussen Bd.III, 179.
(3) Rechnitz: Medorrhinum Jahrb.d.K.K. Oesterr., St. 31, 224.
(4) Wibmer: Wirkungen der Arzneien und Gifte., Bd.1.
(5) Blocker: Beit.zur Heilkunde, Bd. II, 150.
Ammonium action more prolonged in ammon. mur.; more vessel erethism; periodic febrile states.
Type : Lax fibre, loss of power.
Catarrhs of the respiratory passages(secretory action); neuralgias; constipation with crumbling stools; peculiar symptom: feeling of coldness between shoulder blades.
As ammonium compounds in general the lower up to the sixth decimal are employed.
For 100 years the fight has proceeded about this drug which Hahnemann prepared with the aim of obtaining the caustic principle as pure as possible, or as we would say, to bring the OH action out clearly. His original tinctura acris sine kali 24 was later given up in favor of this preparation.
He described the preparation of causticum as follows: 25 Calcareous earth, in the state of marble, owes its insolubility in water and its mild disposition to the combination of an acid of the lowest order, which the marble yields as a gas in a glowing fire, and it may be assumed to contain in its composition another substance than fused lime, which, unknown to chemistry, shares with it its corrosive property just as it shares the property of solubility in water with lime water. This substance, although not an acid itself, loses its caustic power to it, and allows, through the addition of a fluid (heat stabile) acid with which it is combined in the earth with close affinity, separation by distillation as watery causticum.
IF one takes a piece of freshly fused lime of about two pounds, immerses this fragment in a vessel full of distilled water, for one minute, and then places it on a dry cloth, when there it soon, with the development of much heat and peculiar odor, called lime vapor, falls in to a powder. One takes of this powder about two ounces and mixes with it in a (warmed) porcelain mortar, a solution of two ounces of potassium bisulphate (bisulphas kalicus) which has been heated to glowing, melted, and then again cooled and pulverized, in two ounces of boiling hot water, and transfers this thick magna in a small glass cylinder, into a wet alembic with the tube of the latter whose nozzle lies half under water and distills with gradual approach of a coal fire from below, that is, with sufficient heat to distill to dryness. This distillate, amounting to about one and one-half ounces, of water clearness, contains in concentrated form the already mentioned substance, causticum, which smells like caustic potassium alkali, tastes astringent on the tongue and markedly burning in the throat freezes at a lower point than water and markedly promotes decomposition of animal substances lying in it; by addition of barium chloride it yields no trace of sulphuric acid and on the addition of ammonium oxalate shows no trace of lime.
For 100 years, exactly as today, one has never again asserted from chemical facts that this distillate lacked any content of effective substance and stated that nothing but distilled water could arise from it. And indeed not only the opponents of homoeopathy, who would then as now ridicule the phantasy of homoeopathy, but likewise then as now the so-called critical homeopaths have done so.
Recently Joachimoglu would reduce homoeopathy to an absurdity with this example of meaningless assertion. But nevertheless practically all homoeopathic physicians have not ceased to use this preparation and have had more trust in their own observations than in chemical deliberations.
Even the trustworthy chemist, Buchner, author of a homoeopathic pharmacopeia, showed in 1836 that causticum contained free ammonia. Later, in 1860, Gruner confirmed this, when writing the homoeopathic pharmacopeia which is still official in Wurtemburg. The apothecary Wangner, in Basel has again found ammonia in the distillate. A completely insufficient opposition satisfies many who consider this new finding an error.
For this reason at my request the Johannes-Apotheke of Stuttgart have repeatedly prepared causticum and controlled it exactly. The method of Hahnemann was followed as closely as possible in respect to his apparatus. Even a retort of the old form was used.