The disturbances of the mucous membranes are for the most part to be compared wtih those of the skin. The mucous membranes are dry and covered with tenacious deposits or crusts; thus in the nose where the crusts are offensive the picture of a chronic atrophic catarrh occurs. It is the same in the posterior nasal or pharyngeal space where dryness, burning, tenacious mucus and crusts, stitches as from splinters on swallowing, stitches towards the ears on swallowing, suggest the chronic retro-nasal and pharyngeal catarrh. A sensation as if the uvula were too long or as if a membrane hung down from the soft palate which compels constant clearning the throat is noted in particular. There is constant difficulty with the throat and the easy chilling signifies an ever-recurring exacerbation. The headache of alumina, dullness and constriction, better on lying down depend partly on the constipation, partly on the chronic catarrhs.
The hoarseness of signers and speakers with tickling in the larynx has been mentioned above because it gives more the impression of a weakness of the innervation of the vocal cords. Chronic, dry hacking cough and tormenting attacks of coughing in the morning with the ultimate evacuation of a little tenacious mucus can appear in a chronic pharyngitis as well as laryngitis. The dryness of the mucous membrane is characteristic. As on the nose, ulcerative processes may also occur at times in the pharynx and result in yellow brown, offensive secretions and bleeding; the slowly appearing tissue alterations are said to make the tonsils stony hard. Lupus and scirrhous carcinoma are also added as clinical indications for the mucous membranes. The internal and external use of alum in tongue and uterus carcinoma is ancient.
On the eyelids the symptoms suggest a chronic granular conjunctivitis and blepharitis: dryness, lids as if stuck of the eyeball, itching, agglutination of the eyelids, photopobia, itching, burning falling out of eyelashes; thickening of the mucous membrane and ectropium as resultant manifestations.
On the mucous membranes of the female genital organs a tenacious, acrid egg white-like or yellow leucorrhoea is worthy of note. It is persistent and so copious that it runs out upon the thighs. Aphthous ulcers in the vagina, ulcerated and hardened os uteri, indeed even scirrhus of the portio from the chief indications. Noack recalls that Hufeland warned against the continuous use of alum in excessive menstruation and metrorrhagia because it brings about induration and scirrhous uteri. Indurations of the breasts are also cited for alumina and alumen.
The menses are scanty but exhausting, bodily and mentally. Kent recommends alumina in women at about 40 with a pain in the pelvis and a beating down sensation consequent to relaxed ligaments; likewise in delicate women with gonorrhoea who are improved by palliative measures but show recurrences.
Similarly the recommendation in male chronic gonorrhoea has been maintained since the first proving (Hartlaub) up to Kent and thereby the painless discharge of small drops of material remaining yellow, not the usual milky-white discharge, should be associated with ulceration of the urethra.
For completeness there are some reports on the digestive organs. Gastric complaints with nausea and sour stomach, aggravated by potatoes, is an oft-repeated symptom. On must naturally remember however that it came from the prover Nenning whose reports, according to Hahnemann, should always be taken only with care. But the modality “aggravation from eating potatoes” seems to have been clinically proven. Perhaps the dryness of the mucous membranes and the difficulty in swallowing are responsible for it. Furthermore aversion to meat and smoking, desire for indigestible things as chalk, charcoal, etc, is reported. The aggravation from stimulants obviously refers to the nervous symptoms. Otherwise the gastric and intestinal symptoms, except the functional weakness of the rectum, are scarcely characteristic. Clinically gastric and intestinal ulcer as well as enterocolitis as reported.
Since antiquity alum has been used as an antidote in lead poisoning, and thus alumina is also held as suitable to prevent sensitivity to lead. According to the general manner of action, and particularly according to the type of constipation the homoeopathic adaptability is easy to understand, particularly since alumina is chiefly mentioned in colic (better from warmth) with retraction in the umbilical region.
Cold sensitive remedy.
Acts slowly and on chronic processes, must be given a long time.
1. Central nervous system:
Psychic: disturbances in the sphere of ideas and judgment, compulsive ideas and impulsive acts, confusion up to disturbance of the ego.
Disturbances of coordination, paralysis, paraesthesias.
Trophic disturbances in the skin and mucous membrane up to ulcerative processes and indurations.
2. Chronic catarrhs of the mucous membranes (with dryness)
Leading Symptoms and Modalities:
Early morning aggravation for the psychic and spinal cord symptoms as well as for the symptoms of chronic catarrh.
Aggravation from dry cold weather.
Aggravation from eating potatoes.
Persistent constipation, even soft stools evacuated with great difficulty, must use great effort in order to void.
DOSE: Potencies from D 4 to C 30 are usual. According to my own experience I must hold D 30 as active. The slow unfolding of the action is to be noted.
Aluminium potassium sulphate, AlK(SO4) 3, in its action correspond entirely to alumina. As special symptoms are cited: a pressing pain on the vertex, better from firm pressure on the place and from frequently changed cold applications; furthermore, cardiac palpitation when lying on the right side. the vertigo in alumen is present when lying on the back, and is accompanied by weakness at the pit of the stomach, better on opening the eyes and by turning on the right side.
In the catarrhs the yellow bland secretions (from eyes, vagina, urethra) are stressed, which is perhaps traceable to the potassium sulphate fraction. This also holds for the chest catarrhs of old people with abundant tenacious morning expectoration and great weakness of the chest so that the mucus is difficult to raise, occasionally spitting of blood as well as asthma. The yellow secretion of chronic gonorrhoea is understandable better as a potassium sulphate action rather than of alum. Furthermore, very painful ulcerated hemorrhoids and in general intestinal bleeding (in clots in typhoid) are ascribed to alumen. Widening of the veins appears more marked than in alumina. Likewise more is said of inflammatory and ulcerated processes in the mouth. Finally according to the provings swooning-like sensation of faintness, nausea, gastric pain with bending double, deathly pallor, blue lips, cold sensation and subsequent great weakness especially in the back belong to the picture of alumen observed with the 6th and 12 th potency. A rare sensation in the vertebra in alumina “as though hot iron was thrust through the lowest vertebra” appears similarly in the report in alumen: “as though cold water was poured down the spinal column”.
Of the trivalent element boron which belongs to the group with aluminium, in homoeopathic practice only borax, the sodium salt
of tetraboric acid, Na2B4O7 + 10 H2O, is in use. Boric acid, H3BO3 a very weak acid because it dissociates according to the equilibrium H3BO3 =H2BO3 + H, has been proven with large doses by Biswanger but actually its actions are known only from accidentaly poisonings.
DAMAGES AND INTOXICATIONS.
As a mild antiseptic for washing and instillations boric acid is widely used. That it is not harmless may be seen from the fatal poisonings when large amounts of boric acid are retained in the body cavities. Exact investigations of Rost Rubner and Forster have show that daily doses of 0.5-1.0 impaired the utilization of food (the weight and nitrogen content of the faeces increase) and the destruction of food substances increases, particularly the burning of fat. Moreover excretion from the intestinal epithelium is increased. With continuous introduction of 3 grams daily in healthy persons after 5-12 days there is a considerable loss of weight which according to Rubner can be traced to increased loss of fat and water. Boric acid is only slowly excreted and in kidney patients a definite injury may be expected. On the basis of these investigations boric acid is prohibited as a food preservative in our country, but not in many other lands.
Apart from the actions mentioned boric acid solution on longer use causes gastro-intestinal irritation, pain in the epigastrium, vomiting and diarrhoea and skin eruptions. Biswanger observed moreover, increased urinary urgency with increased amounts of urine and pain in the region of the ureter. He proved several boric acid alkalies among them borax with the intention of showing the non-effectiveness of small doses but even on himself after pustules some time progressing in a circinate manner appeared on the right thigh, an impetigo figurata, which finally extended over the entire extremity and passed to the left leg. The eruption lasted 8months and healed leaving a residual of dark red spots, 2 months later the boric acid containing remedies were discontinued.
In occasional acute boric acid poisonings loss of appetite, weakness, increased temperature, pallor, collapse, apathy, headache, vertigo, ear noises, nausea, sweating on the abdomen and at times vomiting of greenish masses are observed. The tongue is dry and coated. In addition to boric the urine contains protein. In a fatal case after retention of the irrigation fluid in the pleural cavity there was an extensive erythema with subsequent pearl shaped vesicles.
In other cases salivation, gastric pains, feeling of chilliness and heat, hematuria, bladder spasm, sleeplessness from preceding headache, delirium, hallucinations, disturbances of vision and speech, collapse and skin eruptions (erythema, urticaria, papules, petechia) were observed.
Cases of poisoning after the introduction of tampons of dry boric acid in the vagina are reported. The symptoms were: sensation of formication on the hands and feet, later on the face; mental gloominess, marked nervous depression; burning of the skin with hard swelling; all movements were painful. The patients were cold, sensation of icy coldness in the vagina, a calm collapse. Finally a case with multiform erythema of the trunk which extended to the arms and a painful swelling of the upper lids with conjunctivitis and photophobia was observed.
Rabbits die from 4 grams of boric acid in 17 hours with acceleration of the pulse and respiration, gastro- enteritis, lassitude, dogs with paralysis of the nervous and muscle systems.
According to Jaksch after the employment of boric acid solutions on esees spasms on the musculature which are not rarely followed by a paretic-like weakness. Furthermore he speaks of a hemorrhagic diathesis, hemorrhages in to the skin and serous cavities. Poulsson mentions a dark discoloration of the gums resembling a lead line. Animal experimentation shows that increasing central paralysis may be the cause of death.
Apart from the acute actions in the form of gastro-enteritis and more rarely nephritis also diverse skin manifestations, nutritional disturbances with emaciation appear, and the most diverse nerve actions so far as one can form a picture of boric acid poisoning from the incomplete material available up to present.
In general the same actions are ascribed to borax. From antiquity borax has had the reputation of promoting menstruation and causing abortion. Today this action is in general denied.
The excretion of borax occurs through the saliva, milk, urine according to Lewin. The excretion through the milk is worthy of note in respect to action upon the mammary glands and the influence upon nurslings, moreover from the fact that borax in a concentration of 0.01-0.04 Percent makes the coagulation of casein difficult.
After the internal use of borax in epilepsy in tow personal cases Gowers observed in whom the treatment was continued 8 months and two years respectively a psoriasis-like eruption on the trunk and extremities. At most the eruption differed from psoriasis only through slighter thickness of the scales.
I have made this observation the point of departure for the supportive treatment of psoriasis with daily washing with borax and am satisfied with the results obtained.
In the school borax as well as boric acid finds use at present only as a mild local antiseptic, in particular in the dermatomycosis (herpes tonsurans, favus, and especially thrush) and in aphthous stomatitis. The last indication concurs in a striking way with an important homoeopathic one.
Recently the ancient treatment of epilepsy has been again renewed with born preparations. In order to avoid the untoward effects of large doses, tartarus boraxatus (1-6 g pro die according to the age) is suggested.
Provings of borax are found:
1. Annalen der Hom. Klin. von Hartlaub. u. Trinks, Bd. 3, p.309, 1832.
2. Hahnemann: Chr. Krkhten, 2 AUFL, 1836.
3. Binswanger: Pharm. Wurdigung der Borsaure, etc. Munchen, 1847. 4. Ztschr. d. V. d. h. Aerzte. Oesterr. Wien. Bd. 2, 9H, p. 217, 1858.
5. Woodward: U. S. Medorrhinum Invest., vol 8, p. 495 (the last however, with the medicinal use of D 1 trituration in catarrhal fever. Thereby symptoms from the uterus and vagina were observed).
In borax one must remember that we are confronted with a sodium salt of boric acid. In the effect picture both components come into evidence.
In the psychic actions two outstanding sodium characteristics again appear, the hypersensitivity towards unexpected noises and alarm and the aggravation form mental labor. Thinking is difficult, indeed, and even causes nausea in the borax patient. The aggravation from cold wet weather, though not outstanding, designates ti as a “cold” remedy. Otherwise borax more than natr. carb. has an anxiety and nervous excitability which according to Kent often lasts until 11 in the evening and then should cease with the beginning of sleep. Likewise the poor humour, indolence, dissatisfaction with the bowels are said to be prominent. The patient dreads the time at which he must change from one activity to another; is easily terrified. Anxiety, excitation and vertigo are mixed with descent and swinging movements. Going down stairs causes vertigo, confusion and headache; the baby shows an anxious expression, grasps and cries when it is put down, carried down stairs or swung. This aggravation from downward motion holds as the leading symptom of the borax picture. We have in this lability of coordination an accord with the chief trend of the group neighbor aluminium and indeed can ascribe it to the boron constituent, particularly since disturbances of the central nervous system especially with vertigo are repeatedly reported in boric acid poisonings.
Epilepsy is considered an indication also in homoeopathy. The symtpms cited give some indication of what cases are suitable for borax. In single cases I have given 0.5 g doses 2-3 times daily and have seen some success. With finer indications one should make an attempt with the lower potencies.
TROPHIC AND NUTRITIONAL DISTURBANCES OF NURSLINGS
In connection with this another symptom is common with aluminium must be mentioned: the spider web sensation which is perceived as if a spider web were on the face. A certain basis for parasthesias are found in the toxicologic material on boric acid. Also in the second effect trend, trophic skin and mucous membrane alterations borax is to be compared with alumina. However borax strikes less deep; in place of the ulcers of alumina there are aphtha. Then in borax the sodium fraction conveys an accent to the mucous membranes of the digestive canal and thereby general nutritional disturbances especially in nurslings. The emaciation from poor utilization of the food with increased loss of intestinal epithelia has been mentioned above as a result of the prolonged use of boric acid. In small children for whom boric acid is especially suitable a marasmatic state is present: the face is pale or earthy colored, the entire skin pale, lived, and wrinkled, the child is relaxed and emaciated, cannot digest the food, vomits and has diarrhoea. Characteristic is an aphthous state, the mouth is sore, bleeds easily, the aphthae extend apparently throughout the entire intestinal anal and indeed are said to be responsible for complaints on other mucous membranes. In any case here we are confronted by trophic mucous membrane disturbances. The mouth of the nursling is so sore that it cannot nurse. They retch, cough and vomit sour mucous and have abundant light yellow slimy stools; slimy masses “like cooked starch” are passed without stool. To this is added that borax also influences the milk secretion of the mother; the milk is too thick, taste badly and coagulates rapidly. The child has an aversion to milk which causes diarrhoea. If here one recalls the trend of action in impairing the coagulation of milk outside of the body and that borax is excreted through the milk, such an action can be understood and moreover the merit of borax medication for the nursling through the lactating mother. Likewise another mammary gland symptom may be mentioned here: on nursing the mother has a pain in the breast from which the child is not nursing, or painful sensation in the breast when it is empty. In lactating young mothers, if the secretion of milk does not cease, the use of borax solution externally gives results. It is in the sense that the clinical indication “galactorrhoea” is meant.
FEMALE SEXUAL ORGANS
The functional, trophic and sensory connections between the mammary glands and the female genitalia can perhaps cover the bridge to borax effects on the female sexual organs. The long maintained view that borax in large doses is an emmenagogue and abortifacient has not been entirely imagination. In the homeopathic school borax has always been held as an important remedy in sterility. Thereby a characteristic menstrual disturbance is present: dysmenorrhoea membranacea, severe labour- like pains before and during the flow as through the uterus had been pushed out of place or sticking pains as if from a knife, the pains ending with the extrusion of the membrane. To this is added and egg-white-like or starch paste-like leucorrhoea with a sensation as though warm water were running down the leg or an acrid leucorrhoea appears for two weaks between the periods. The menses are too early and profuse. Nausea with faintness is observed in women and also belongs here. The libido is reduced. If such a general state, together with the borax mental disposition and nausea occurs in sterile women, then the indication in sterility can be founded on several grounds even if we cannot explain the deeper connections of all these manifestations. Moreover a sensation of enlargement and sticking pain in the clitoris reported.
OTHER MUCOUS MEMBRANE AND SKIN SYMPTOMS
The most important symptom on the urinary organs: the child cries each time before or at the beginning of urination; also a feeling of soreness in the urethra on urinating and afterwards (especially on contact). The urine is hot. The painfulness of urination was traced by Kent to an aphthous state of the mucous membrane. Moreover unsuccessful attempts at urination with (or from) cutting pain in the urethra is noted; furthermore acrid offensive urine.
Chronic catarrhal states of the nose and eye-lids are described as for alumina. The chronic granular conjunctivitis here is said to be associated with inward turning of the eyelashes (trichiasis) and entropion. The chronic catarrhal state whows thick, greenish mucus and crusts, ulcerated nasal folds and easy bleeding. ON the skin are vesicular, itching eruptions, but also, as we have seen above, psoriasis-like manifestations. The report “erysipelas” remains unexplained, and is doubtful. The skin in borax is said to be unhealthy; the hair mats easily.
Without connection stands: cough with expectoration of mouldy odor and taste, mouldy smelling breath; sticking, right sided cutting pains, high in the chest; dyspnoea on climbing stairs. Hoarseness from sudden chilling is said to be relieved for some time by dissolving a pea-sized piece of borax in the mouth.
1. Nervous system.
Anxiety, excitation, vertigo (epilepsy) Sensitive to sudden noises.
Aggravation from downward motion.
Paraesthesia (spider web sensation) and trophic disturbances (aphtha).
2. Nutritional disturbances of nurslings; sore aphthous mouth, marasmus.
Vomiting of acid mucus, light yellow slimy diarrhoea.
Child cries before and during urination (aphthae?).
Aversion to mother’s milk.
(Nursing pain in the empty breast of the mother; galactorrhoea.).
Dysmenorrhoea membranacea, sterility, egg white like leucorrhoea.
Leading Symptom: Aggravation from downward motion. Aphthae.
DOSE: The remedy has found little employment so that the best dose has not been definitely determined. The D 3 is usually employed.