Indeed one can imagine that with a certain grade of dispersity and with a certain amount of the particles, the cells will be enveloped by a foreign layer of absorption and thereby the metabolism depressed; that on the other hand by a high grade dispersity and lesser amounts the particles act directly on the cells to which, for example, graphites particles have a special affinity by virtue of their charge and their peculiar surface, and thus are able to promote or intermediate very directly (Catalytically) in the gas exchange or the general metabolism. In the one case a cell damage is found, in the other an elective cell excitation to increased function, by the same element, but in varying state of division.
Surface reactions on colloids, absorption catalysis, play a major role in the organism in carbon dioxide assimilation, respiration and fermentation. It is no accident that in carbon materials we find the chief trend of action on the gas exchange, on the fermentative process. Since O. Warburg 506 has demonstrated the preponderance of the fermentative processes over the oxidative in the cancer cell, we also understand the influence of carbon materials on carcinoma much better.
GRAPHITES DRUG PICTURE
Provings of graphites are found:
1. Hahnemann: Chron. Krkht., Bd. 2, p. 147; 2 Aufl., Bd. 3, p. 291.
2. Buchner: (Eine kurze Bemerkung uber eine Selbstprufung Storks, zit., Allg. hom. Ztg., Bd. 47, p. 40).
3. Piper: Allg. hom. Ztg., Bd. 18, p. 125.
The monograph of H. Goullon, Jr. (Leipzig, 1872), is purely clinical and to be judged only with great caution. According to the results of provings on the healthy the drug picture of graphites has its basis in defective internal metabolism which expresses itself in slowing of all functions, particularly those of the skin and intestine.
As general symptoms we find in the provings: chilliness, easily chilling, fear of open air and drafts, coldness of the feet, in the evening offensive sweating of the feet in bed, often offensive sweating on the least exertion, night sweats, great desire for sleep, drowsy morning sleep, anxious alarming dreams, “going to sleep” of single parts, pallor of the face. Great emaciation is also reported as well as, from the other side, a fat, pasty habitus. Moreover the last is more characteristic because in general graphites shows a greater depression of dissimilation and in approximation to charcoal more stasis in the venous circulation in comparison to silicic acid. In American literature graphites is characterized as “fat, chilly and constipated.”
A number of other general symptoms such as constant pulsation in the entire body, aggravated by each movement, transient facial heat, rushes of heat, circumscribed burning at the vertex, sudden jerks in the heart, the rush of blood to the head are probably not from graphites itself but may be ascribed to the admixture of ferrum.
As far as the mental state is characteristic for graphites, it is a melancholic disposition: indecision, inconsolable grief with much crying, anxious unrest, fear of disaster; more rarely irritability and ill humour. The manner of psychic reaction, corresponding to the relaxed type, is sluggish. Definite headaches are not present in the general state of depression conditioned by graphites; constriction and tension in the occiput is mentioned.
FEMALE SEXUAL ORGANS ——————– Closely connected to these general manifestations are the characteristic constitutional symptoms in women. The menses are too late, too scanty, too pale; added to these is the clinical indication: sterility with delayed menses. Sensation of coldness in the vagina, aversion to coitus strengthen these indications. Many complaints are worse during and after the menses, particularly the constipation. The reports vary concerning the leucorrhoea of graphites: watery thin, as well as white, acrid, profuse, gushing leucorrhoea is reported. The watery, profuse and at the same time acrid leucorrhoea seems to be the most characteristic. For the explanation of this leucorrhoea there is the erosion of the cervix, because such fissuring is characteristic of graphites.
The disturbances in metabolism begin in the assimilative phase but more markedly involve the dissimilative. On the gastro-intestinal canal, the digestive symptoms are almost word for word those of silicic acid. In the middle of the intestinal actions stands the persistent constipation; just as with silicea there is reported in graphites “effort even from soft stool” though this is concerned with the transient action from large amounts. The report: undigested stool soon after eating one may well ascribe to the admixture of iron. In constipation the evacuation results after great effort, then it appears in single lumps covered with mucus. Defective assimilation, poor gas exchange, predominance of retention processes express themselves as follows: abdominal distension after eating, so that the hypochondria are sensitive to the pressure of clothes; aversion to cooked foods, hot drinks and meats, against salty and sweet foods; fullness in the abdomen accumulation of gas, excessive emission of offensive flatus, pressure in the abdomen. Similarly as with silicea there may be at times excessive hunger and marked thirst. Morning nausea and vomiting, however, is an exception. Burning in the stomach which necessitates eating is reported; it may be that this symptom is to be traced to the admixture of iron or arsenic. Nocturnal cramp-like gastric pain accompanied by dyspnoea is also said to be relieved by eating and by the drinking of warm milk. In this respect graphites is to be considered in pyloric and duodenal ulcer. Perhaps it acts on the cicatricial formations. The taste in the mouth is reported as bitter or acid, by another as foul; in any case it is not characteristic.
The stasis in the gastro-intestinal canal in graphites involves the portal circulation more than with silicea but not to the extent of charcoal. Large hemorrhoids appear with soreness so that sitting is hardly possible; to this may be added burning fissures between the hemorrhoids which we have already learned are typical of graphites. The external application of graphites D 1 prepared with an ointment base may support the action. Itching eruptions about the anus likewise belong to the skin actions of the remedy.
Graphites acts especially prominently on the skin and its appendages. We are not closely informed on the connection of the skin manifestations to the defective general metabolism and the depression of intestinal functions; and we know just as little about why the functional disturbances localize with preference in the skin. One may conjecture here as with silicic acid that foreign colloidal particles which escape from the gastrointestinal canal are removed through the activities of the skin. The chemically inert though purest form of carbon has a special affinity for this mode of excretion. The skin manifestations of graphites are considerably dryer and less purulent than with silica.
Most characteristic in graphite is the persistent dryness of the skin and lack of moisture, tendency to rhagades and unhealthiness of the skin. Outside of fissured dry eczema moist crusted eruptions also appear with preference on the flexors of the extremities or behind the ears, moreover on the sites of transition from skin to mucous membranes and the vicinity of the genitalia. The secretion should be honey-like, coagulated, acrid and offensive; the itching is worse from heat and the warmth of the bed. (Here the similarity to sulphur which is the outstanding mobilizer in retention processes is distinct.) The nasal orifices are particularly involved, so that the nares are sore, fissured, crusted, ulcerated and the nose is swollen; its secretion is offensive, purulent, crusted. The usefulness of graphites for the avoidance of recurrent erysipelas is explained by the favorable action on rhagades. Likewise the localization on the border of the lids in the form of a blepharitis is frequent and the lid borders are thickly covered with crusts; also cited are: scabby eruption on the chin and about the mouth, soreness of the nipples with vesicles thereon, soreness between the fingers and the toes, itching on the hairy scalp, moist, scabby eruption on the scalp, the hair falls out also on the side of the head; the hair is stiff and brittle; the nails on the fingers and toes are thickened, distorted and split.
From the predominantly dry character of the skin symptom of graphites, one will not neglect this remedy in psoriasis. Goullon sees a special indication for graphites in the herpetic-like eruption.
The skin manifestations described suggest that graphites, like silicea, must be taken into consideration as a remedy in scrofula, particularly since it is a remedy in scrofula, particularly since it is a remedy with a prolonged effect and has outstanding suitability for the chronic case. Hahnemann, indeed, counts it amongst his “antipsoric” remedies. In addition also to graphites is ascribed the tendency to swelling and hardening of the glands, many symptoms in the eyes and ears as well as in the upper air passages, these providing many similarities to the symptoms of scrofula; inflammation of the sclera with burning, sore readily bleeding angles of the lids, photophobia; inflammation from inwardly growing eyelashes, trichiasis, moreover offensive discharge from the ear which smells like herring brine, either from the middle ear catarrh or an eczema of the external auditory passage; dryness of the nose, itching in the larynx. In this respect one must state that while graphites as well as silicea is to be counted to the outstanding remedies for scrofula, still it is suitable only for definite phases. The selection is primarily according to the constitutional view-point as well as from the type and localization of the skin manifestations.
CONNECTIVE TISSUE ACTION
The action of graphites on scar tissue is extolled. It is said to soften old scars. We find a similar influence also in silicea. In ulcera cruris graphites again is indicated by the hard borders and the thin, acrid, offensive secretion; it bleeds readily and has a thin, sanguinous discharge. Styes, chalazae sebaceous tumors, fibroma, and scirrhus, as well as hydrocele have likewise been cited as indications. In tendon contraction, Dupuytren’s contracture, graphites may be tried. In the connective tissue action must also be included the employment in otosclerosis, with difficulty in heating which is better in noise and from riding, with various types of ear noises and dryness of the inner auditory passages.
According to all reports graphites belongs to the chronic metabolic remedies which, like sulphur and silicea, are directed preferably toward the skin and digestive functions. They can be subordinated with reservations, to the carbonitrogenous constitution.
Constitution: Fat, chilly, constipated, pale, pasty, inert, depressed.
All functions impaired.
Chief Trends: 1. Skin.
Dry, unhealthy, itching, worse from the warmth of bed. Rhagades, fissured eczema. Moist crusted eruptions with honey-like, tenacious, acrid, offensive, secretions.
Predominant sites: flexor surface of joints, behind the ears, muco-cutaneous junctions (recurrent erysipelas!), region of genitalia, hair and nails. Scars and connective tissue action: keloid, swellings; otosclerosis: heating better in noise and on riding.
2. Gastro-intestinal canal.
Persistent constipation. Hard faeces covered with mucus.
Abdominal plethora. Aversion to cooked foods, meats (also to salty and sweet foods).
Occasionally ravenous hunger; burning and cramp in the stomach, relieved by eating.
Hemorrhoids with fissures and anal eczema.
3. Female sexual functions.
Delayed, scanty, pale menses. Sterility.
Leucorrhoea, watery, profuse, acrid (cervical erosions).
Nothing universal; in general worse from cold. Worse at the time of the menses, particularly the constipation.
Itching worse at night, in the warmth of the bed.
Many gastric complaints improved by eating, others aggravated (abdominal plethora).
The 6, 12, and 30 D potencies are usually employed.
The chronic skin processes with the suitable constitution are suited for testing the higher potencies.
Crude petroleum is a natural product of the earth, arising probably through the slow destruction of fossil rests of animals and plants. Chemically it is a mixture of carbon compounds of the allopathic series or paraffin series (which are derived from methane, CH4) and some aromatic or cyclic carbon compounds (derived from the benzol ring C6H6) and other compounds. The composition of petroleum is therefore different according to the source. The petroleum from Galicia, Transylvania and Roumania is medicinally employed, that is, a petroleum containing few constituents of the low boiling point. The part used begins to boil at 90. With this the petroleum ether (boiling point between 50-60) and the characteristic benzine (boiling point between 70- 90) is excluded. On the other side the substances boiling at over 300, the solid fractions of petroleum at ordinary temperature, vaseline and paraffin are omitted. However many injuries to paraffin workers, of which shall still speak, are ascribed to those constituents which appear in the common fuel petroleum. On the other side the paraffin cancer may be placed at the side of tar cancer. Paraffin and tar stand very close, only the points of departure for these products are different: in paraffin, the crude petroleum; in tar, the coal.
We cannot expect a uniform chemical composition in the natural mixture “petroleum” but merely an approximate control through the specific gravity and the boiling point. Hahnemann 507 described a method by which one can purify it from admixed bituminous elements (from the “fluchtigen Gewachsolen” as he states) by mixing with alcohol and filtration as is done with rock oil. Preliminary purification by sulphuric acid was also known to him.
The modern method of preparation of the potencies no longer corresponds to the original prescription of Hahnemann because he made dilutions to the 1:1 million, that is C 3, with sugar of milk and only subsequent potencies with dilute alcohol. On the other hand both the pharmacopoeias, Gruner as well as Schwabe, use only liquid dilutions from the beginning.
Apart from intentional provings upon the healthy we have knowledge of the actions of petroleum only from the usual occupational poisonings. Exact experimental animal investigations have scarcely been performed with petroleum.
The chief organ affinities of petroleum are similar to those of the simple carbon substances (for example, graphites), on the skin and the gastro-intestinal canal. To this is added, in petroleum, a particularly marked influence on the sensorium, indeed on the cortical centers. This cerebral action according to Lewin, 508 who made personal observations in the petroleum districts of Pennsylvania, is due chiefly to the petroleum districts of Pennsylvania, is due chiefly to the readily volatile, that is, low boiling carburetted hydrogen which is generally inhaled in the gaseous form. The gastric form of intoxication and the skin manifestations according to Lewin are to be ascribed to the heavier constituents with higher boiling points. The residue of crude petroleum which is no longer present in the medicinally employed petroleum acts most severely and rapidly on the skin. In the paraffin fraction it even amounts to malignant tumors.
The skin affections from both external as well as internal introduction according to Lewin consist of acne-like, thick, hard nodules with inflammatory surroundings; moreover, inflammatory infiltrations as furuncles and diffuse inflammation resembling erysipelas. Burning and itching are constant symptoms. Lewin places the point of origin in the sebaceous glands and hair follicles, respectively the perifollicular tissue. He places the petroleum affections, the so-called oil itch, at the side of those which occur in refinement of oils, tars, asphalts, etc.; the skin glands are occluded and thereby inflammation occurs. 509 Still it is to be remembered that these impure mixtures almost always contain sulphur.
The detailed picture of the skin manifestations in paraffin workers has been given by Ogston. 510 It reads:
“Eruption of nodules and vesicles on the skin involved appears very soon in those who are concerned with this occupation for the first time; the eruption lasts some weeks or months and then generally lessens. Exceptionally in some persons the eruption does not disappear in that it takes on a chronic character and produces such an outspoken and persistent affection of the skin that the general status is disturbed thereby and makes the cessation of work necessary. The acute form of the eruption which soon appears in those who are subjected to the influence of crude paraffin, covers the hands, wrists, arms, feet and legs with light red nodules, very close together, usually largest and most numerous on the wrists or where the clothing is in close contact. The dorsal aspect is especially involved, the palms and the soles of the feet may be entirely free. Similar nodules appear to a slighter extent on the face, the neck and other parts of the body with which the oily stuff comes in contact. The exact examination of the skin of those affected yields the following chief characteristic of the eruption: the light red nodules, hard on contact, soft on pressure, slightly variable in size, which corresponds approximately to a barley corn, round and embrace a single hair follicle and the area immediately surrounding it is inflamed, reddened and hard. The hair is considerably elevated from the apex of the nodule and the opening of the hair follicle is considerably widened and easily visible to the unaided eye (about the size of a needle puncture in a sheet of paper). The widening extends deeply into the follicle which contains the core of the inflamed nodule and whose retention contribute to the ring like hardening of the inflamed zone. The open orifice of the follicle shows masses of desquamated epithelia which are dry and fragile in place of fatty and tenacious. The nodule has little tendency to pass over into suppuration, and as is usual in the maggot the contents cannot be expressed, however the redness and hardness gradually lessed and after they have existed a short time, finally diminish and leave the hair follicle widened and its mouth open so wide that the retained epithelial mass is visible and indeed even more distinct through the continuous retention and accumulation of the filth. In actuality the acute form of the eruption consists in successive stages of formation at the same time from complete development to regression; thereby the skin in between them shows the dark openings of the follicles which have already broken down or are in the process and the skin still shows pliability and elasticity in contrast to the manifestations of the chronic from of the disease.
In all paraffin workers the opening and widening of the hair follicles exists to a certain extent as long as they remain at their occupation and the dark points on the skin of the hands and face immediately strike the observer. Individuals with dark color of the skin and hair are especially affected in this way while light people with blond or reddish hair are relatively unaffected. In exceptional instances single dark, hairy persons show the openings of the follicles so markedly that they are compelled to give up their occupation and seek another trade.
When the disease takes a chronic form, it shows the following characteristics: the back of the feet and toes, the hands and fingers and between the fingers, but not over the joints, shows a peculiar honeycomb appearance; thereby the skin is elevated, thickened, inelastic so that the flexion of a finger is difficult painful or impaired. The elevated honeycomb-like places are of natural color and not inflamed (outside of areas where the acute form gives the already described appearance but consists of thickly grouped series of hair follicles with hardened cutis between and around them.
The follicles are filled with dry brittle accumulations of epithelial desquamation and so markedly that they are easily visible through the widened mouth of the follicle. The openings are sufficiently widened to be accessible to the end of the usual sound. The hairs diminish from these areas, probably atrophying from pressure of the epidermal masses, while cracks and bleeding fissures course through the hardened part and in occasional cases as a follicular abscess somewhat alters the picture. The joints of the fingers and toes, the palms and the soles remain uninvolved. In the chronic patient the appearance is pale, the tongue is coated and the loss of weight may be traced to the result of sleepless nights which are caused by the constant irritation and the pain in the skin of the involved extremities.
We will see that the homoeopathic reports on the skin action of the petroleum also contain burning and itching, the vesicles and the nodular eruption, furuncles and inflammatory infiltration, moreover some exact reports on the total state of the skin and eczema. Intentional provings are responsible for these details.
In the gastric form of petroleum poisoning it is to be remembered that it involves chiefly a local irritative manifestation from oral administration. Lewin mentions: burning, thirst, vomiting, colicky pains and diarrhoea (the stools containing petroleum), icterus; then painful urination, odor of petroleum to the breath and the skin, albumin and casts in the urine. In a poisoning after rubbing it into the scalp for a young girl for the removal of lice, there appeared a severe hemorrhagic nephritis. 511 The excretion of petroleum in the urine of the intoxicated is debated by Lewin but is expressly stressed by v. Jaksch. 512
The cerebral actions are described as dullness, headache, vertigo, then collapse, loss of consciousness, more rarely stupor, spasms, maniacal states or resembling intoxication before the appearance of unconsciousness, fainting and hallucinations, also palpitation, small accelerated pulse, gasping respiration, asphyxia, miosis or mydriasis and general weakness.
Benzine which consists of the constituents of crude petroleum with low boiling points and indeed those no longer in medicinally used petroleum, but still to some extent approximates its volatile constituents. According to Lewin on inhalation of the fumes it causes, amongst other things, hallucinations of heating and vision. “A patient saw various shaped animals and small men or it seemed to him that the entire room was filled with waving silk threads which flickered here and there.” This report is repeated because of the similarity with some hallucinatory symptoms which are found in the drug picture of petroleum.