In the numerous cases of petroleum intoxication reported in the literature are found many manifestations outside of those described, for example, paraesthesias, neuralgias, tremor, bronchitis, pneumonia but with the varying type and purity of the preparation not much can be determined from these isolated reports. In homoeopathic literature is a detailed instance of poisoning described by J.O.Muller 513 in which vertigo and headache, moist itching eczema on the posterior scalp, furuncles, phlegmons, ear discharge, subjective auditory sensations and bronchitis stood in the foreground. A chronic poisoning with the appearance of patches of vitiligo 514 of interest in regard to the isolated report in the homoeopathic drug picture is: brown and yellow patches on the skin.
PETROLEUM DRUG PICTURE
1. Hahnemann: Chron. Krank., Bd. 3, p. 5, 1828; 2 Aufl. Bd. 4, p. 479, 1838.
2. Benson: Trans. Hom. Medorrhinum Soc., St. of N. Y., p. 297, 1868, according to the Allg. Hom. Ztg., Bd. 82, p. 80 (this describes on- ly the headache and gastro-intestinal disturbances after 10 drops of D 1).
Petroleum stands very near to graphites in the skin action. This consists of the well-known unhealthiness of the skin, the smallest injuries suppurating and the suppuration extending. Itching and burning are early symptoms before the eczema appears. Scratching is said to aggravate before the eczema appears. Scratching is said to aggravate the pain and the itching is relieved only upon the appearance of bleeding. It consists of a painful sensitivity of the skin of the entire body, even the clothing hurting the skin. The skin is rough and cracked, especially at the ends of the fingers. Eczema of the hands is said to be characterized especially by an aggravation in winter, and to heal in summer. This winter aggravation is not apparent from the provings, where only freezing of the hands is mentioned. It may be assumed that this modality entered the picture through observation of patients.
Apart from this chronic fissured eczema which may give occasion for secondary infections, furuncles, etc., a less chronic from of vesicular and nodular eruptions appears on the most diverse parts of the body, preferably behind the ears, on the hairy scalp with falling out of hair, on the scrotum and about the anus with fissures, to which is added itching, burning and weeping, worse at night and from scratching.
If one carries over the reported experiences from paraffin workers, then the dorsal aspects of the feet and hands are preferred while the palms and soles remain free. This indicates an affinity for the glands of the hair follicle. To this may be added that petroleum preparations are employed externally against the falling of hair. Judged by the provings the sweat glands are not so markedly involved, still offensive sweat, particularly from the axilla is an indication. The ulcers have sticking pains. In bunions there is burning and sticking “as though they would become ulcerated.” The external and internal use in frost bites finds support in the sensation of cold “as though the ball of the great toe was frozen,” in burning and coldness in single parts, in the winter aggravation and from cold, in respect to skin inflammation.
The blepharitis is a particular localization of the eczema. Here it may be said that petroleum involves the inner angle, graphites more the outer angle of the lids. The connection here to the hair follicle glands is also obvious. From the Hahnemannian proving is the symptom: “Inflammatory swelling of the right inner angle of the lid as in the development of a lachrymal fistula, a swelling so large that the right side of the nose was dry for several days” has given the occasion for lachrymal sac suppuration and fistula. In the ear are noises as if from water, rushing as from wind, or ringing as from the pealing of bells and frequent knock- ing with difficulty in heating; however petroleum is less used in otosclerosis than graphites; petroleum comes in consideration more in a chronic catarrh of the Eustachian tube.
The gastro-intestinal complaints of acute petroleum poisoning are difficult to evaluate because of their indefiniteness and local nature. If one looks carefully into the provings on the healthy, then symptoms recur which are always encountered in the carbon- silica group: aversion to fat, meat, cooked foods, odor to the breath, bitter, acid, or foul taste in the mouth, white coated tongue, flatulence, dullness and vertigo after eating. The ever- recurring nausea is stressed more strongly than in the other agents of this group, and indeed is associated with the greater central nervous system influence of petroleum, which will be mentioned later. The chief symptom of petroleum that the gastric complaints (painful spasm and burning) necessitate eating and are relieved by eating also appears in the symptoms of graphites, but does not have the same importance there. Emptiness in the stomach, ravenous hunger also at night, temporarily relieved by eating and persistent nausea, moreover, the type of diarrhoea which is only in the morning and persists for many days, with frequent urging, appearance of hunger sensation soon after eating, probably stands in close connection with the characteristic syndrome which seems to arise from the vegetative centers. With this belong the symptoms: vertigo, worse from riding and passive motion, with collection of water in the mouth, pallor, chilliness and cold sweat, cardiac palpitation, faintness, profound heaviness and pressure in the occiput. If one adds to these the constant nausea, weak, empty, cold sensation in the abdomen, cold sensation ” as if from a cold stone in the cardiac region,” then the indication “seasickness” becomes under- standable. Nausea and vomiting on riding should also suggest petroleum during pregnancy.
The watery daily diarrhoea with offensive flatus (also evacuation of mucus) accompanied by abdominal pain, moreover aggravation from farinaceous foods, naturally suggests a fermentative dyspepsia and likewise from the non-homoeopathic side, petroleum is taken into consideration as an intestinal antiseptic. 515 Less than with the other medicinal substances of the carbon-silicea group is the defective assimilation with its chronic effects, with stress upon the constipation and weakness of expulsion although weakness of the rectum is also observed. This peculiar deviation, a shifting of the action toward the side of nervous regulations is probably to be ascribed to the volatile constituents of petroleum.
SENSORIUM AND PSYCHE
If we presume the syndrome similar to that of sea-sickness is due to a central action of the special volatile constituents of petroleum, then this will be emphasized by single psychic symptoms: forgetfulness, confusion, absent mindedness with the particular: “loses his way on streets well known to him.” Then the sensory deception of reduplication of the extremities and “believes there are people besides him who are not actually pres- ent” and “the entire air is filled with peculiar forms.” The last hallucination was a striking similarity with that reported by Lewin from benzine. The occasional observation that wine and smoking causes extraordinary intoxication also shows a cortical influence. The mental state can be characterized in the following manner: grief and fear act strongly and disadvantageously: excited over details, cannot calm himself, easily offended, easily aroused. The inability to disregard irritating matters, the indecision and dissatisfaction creates a depressive hypochondriacal state.
The symptoms on the respiratory organs, urine and sexual organs have little characteristic in petroleum which would necessitate the recounting. Likewise the occasionally observed hemorrhagic nephritis in petroleum intoxication has obtained no therapeutic significance. Rheumatic drawing and stiffness in the back and the extremities, cracking and easy dislocation of the joints (particularly the lower jaw which Stauffer cites as an indication for the disposition to luxation), aggravation of many pains before and during storms and from cold have given occasion for perceiving a chronic rheumatic agent in petroleum. However one finds similar symptoms in all chronic remedies, of which petroleum is one, and certainly the clinical significance of petroleum does not lie in this field.
Chief Trends: Skin: itching, burning; scratching aggravates. Unhealthy skin; chronic raw and fissured eczema; worse in winter, tips of fingers and dorsal aspects. Subacute: vesicles and nodules (relation to hair follicles). Preferred sites: behind the ears, on the hairy scalp, scrotum, anus, blepharitis. Offensive sweat, particularly in the axilla, frostbite.
Eye: Blepharitis and lachrymal sac suppuration.
Ear: Difficulty in heating and ear noises (from tubal catarrh?).
Gastro-intestinal: Aversion to fat, meat and cooked foods. Constant nausea. Gastric spasm and burning necessitate eating; eating transiently relieves. Empty sensation, ravenous hunger; hunger soon after stool. Diarrhoea only during day with cutting abdominal pain, frequent urging (worse from vegetables). Sensorium: vertigo (worse from riding) with symptoms like collapse (collection of water in mouth, pallor, chilliness, cold sweat). Occipital pain, heavy as lead; cold sensation in the abdomen (and in the cardiac region), seasickness.
Psyche: Confused, absent minded (loses the way).
Sense delusions: reduplication of parts; peculiar forms in the air. Long maintained action of anger and fear, easily excited over details, depressive hypochondriacal.
Aggravation through riding, in winter, perhaps before and after storms. Improvement from eating.
It is most commonly prescribed in the D 6, the one with which I have had experience. Still it is prescribed in the third and has been recommended in the 30th decimal dilution.
WOOD AND ANIMAL CHARCOAL
Wood charcoal is obtained by the dry distillation of wood. In his provings Hahnemann 516 employed that from birch, others have used copper beech. The product (caput mortum) of the dry distillation of the wood consists for the most part of carbon, but it also contains ash constituents, amongst which potassium carbonate is the most important. In general we may attribute the actions of carbo vegetablis to the carbon.
According to Hahnemann’s prescription animal charcoal is prepared from beef leather; later it was prepared from flesh or bones and in modern medicine blood charcoal is preferred. Indeed the admixtures vary according to the original material.
Animal charcoal shows physico-chemically and biologico- therapeutically extensive similarity with wood charcoal. For this reason it is sufficient to merely mention some differences.
In the original form animal charcoal is porous, more finely divided than wood charcoal. Therefore it has a different adsorption coefficient for various materials. According to L.Jaque and E. Zunz 517 animal charcoal adsorbs diphtheria toxin and antitoxin strongly while neither is adsorbed by wood charcoal. They found also that the adsorption of diphtheria toxin in the organism is reversible, but in the test tube irreversible. Serum protein can prevent the adsorption of diphtheria toxin and antitoxin by animal charcoal. In the organism the relations from the concurrence of several adsorbents around an absorpt are different than in a test tube. As a crude adsorption agent in dysentery animal charcoal is often preferred.
Even Pliny mentioned the use of wood charcoal in carbuncles. The employment of wood charcoal in old ulcers for the removal of odor, as a lavage for the offensive odor of the mouth, or the removal of odor from the stool in spring diarrhoea was common before Hahnemann. In addition to this adsorptive action of wood charcoal, Hahnemann knew still a chemical action and contrasted it with a “dynamic,” which first appeared by trituration with sugar of milk in one part to a million. Today we would include the actions entirely under the physical. The fine state of division of wood charcoal permits its extensive use in industry as an adsorbent.
At glowing heat amorphous carbon withdraws the oxygen from most oxides and therefore is a good reduction agent in chemistry. On the other side carbon can act as an oxygen carrier and through the delivery of absorbed oxygen can produce oxidation.
The crude absorption action has, as said above, been long known and therapeutically utilized many times. It has not, as Poulssen 518 believes, been displaced by the modern treatment of wounds, because for example in a filthy carcinoma charcoal is to be preferred even today over the modern disinfectants. Likewise the use in tooth powders is supposed to be disadvantageous, according to Poulssen, because the sharp particles penetrate and tattoo the gum. In this respect I can say from personal experience with the finely divided linden charcoal that such a bluish discoloration of the gum margin is to be feared at most when the gum has been previously loose.
Adsorption therapy has been reintroduced i recent times by Lichtwiz 519 and a number of works have appeared on the absorption of poisons by charcoal. 520 Even in 1830 the apothecary Thouery took one gram of strychnine (10 times the fatal dose) with 15 grams of charcoal powder and remained well. Sabbatini 521 avoided the poisonous action of strychnine by an intravenous injection of six times as much colloidal carbon. Like other colloids charcoal is employed in excessive acid secretion in the stomach as well as fermentative processes. Lichtwiz employed it for obesity. In the adsorption of bacteria charcoal has been fou- nd far superior to other adsorbents. In infectious intestinal catarrhs, in particular dysentery, the use of wood or animal charcoal (of bolus alba) is now very extensive.
THEORY OF BIOLOGIC COLLOID ACTIONS
The adsorptive action of unpotentized wood charcoal is employed in suitable cases, particularly in filthy ulcers. But of great signficance for us are the finer actions which wood charcoal unfolds in the organism only in the higher grades of dispersion. In principle they rest indeed on the same physical properties as in colloidal charcoal. But as with all colloids an optimal action is possible only at great dispersion, because it occurs only (perhaps at the 5-6 decimal potency) when the size of the particle has been attained that can be compared to the serum. Through absorption it will be brought into a crude state of dispersion and flocculated, that is, brought near to flocculation.
This signifies the exclusion of the so-called complement, that constituent or much more state of normal serum which plays an essential role in the occurrence of immunity, in the defense from bacteria and foreign protein. This would also indicate that the power of resistance of the blood serum is reduced when the carbon particles have reached a sufficiently small size to groin to reciprocal action with the serum. But if the serum defense power (” complement”) is brought against the protein poison (“antigen”), then a complement binder such as collodial carbon is in a position to serve as a complement linkage and intermediator. But to do the colloidal carbon particles, either by their size or number, must appear as an activator. For the promotion of defense the greater dispersion and a moderate number of particles at the suitable time will be desirable. These theoretic reflections would hang in the air if we didnot have factual knowledge of the corresponding and related silicic acid. For the understanding of the septic tendency in the drug picture of wood and animal charcoal these basic ideas of the mechanism of action may be taken over.
One can represent the influence of colloidal carbon on the cell colloids in a similar manner. With the size of the particles which again may be compared to the 5-6 potency, they will occlude the membrane pores of the healthy cell, prevent gas exchange, depress and alter the diffusion of ions in a definite way. This comes under consideration primarily in the red blood cells. A defective oxidation of the blood and organ cells will result and surcharge of the blood and organ cells will result and surcharge of the blood with the metabolic end product carbon dioxide cause the blood to become venous. One can also think of this important action of colloidal carbon as occurring in that the cell membrane, perhaps the red blood cell, is finely coagulated through adsorption, which prevents the normal metabolic exchange. Now it is exactly the ratio of the carbon dioxide in the blood which offers the best proof for the fact that with small doses the reverse occurs as from large doses. With excessive carbon dioxide pressure the blood becomes decidedly and finally permanently incapable of metabolic exchange, and suffocation is the final result. On the other side it is exactly a moderate amount of carbon dioxide in the blood which is the physical stimulus to the red blood cells to increased function, to more animated movement and increased gas exchange. The activity of smaller amounts and smaller fragments of carbon than those which provoke defective oxidation in the healthy can be considered directly as the stimulus which the finest and diffusible carbon particles in the cells effect on cell function or thereby take the intermediation of the slight increase of carbon dioxide into consideration or both act as a stimulus at the same time-but in any case there is no difficulty in comprehending the stimulating action of smallest doses of carbo vegetablis in morbid venous states.
CONNECTION TO CARCINOMA
A similar alteration of the metabolism in the epithelial cells, depression of the oxidative and predominance of the fermentative process, must be taken into consideration in the development of carcinoma from many types of carbon substances. The same has already been shown for the related silicic acid. In the now rare but common 150 years ago, chimney sweeps cancer, which usually involved the scrotum and extended to the testes, but still showed little disposition to extensive metastasis, the constant injury by soot was in any case an important condition. Even if trauma and traces of arsenic in the soot might have cooperated still the experiences on industrial and experimental tar, paraffin, and aniline cancer show that the products of coal distillation favor the development of cancer. And it is indeed no accident that these same impure carbon products ever recur in antiquity in the external and internal treatment of cancer. Wood and animal charcoal have not only proven themselves in respect to deodorizing adsorption action in sloughing ulcers, but from the internal use of animal charcoal, noteworthy results were obtained over 100 years ago in carcinoma of the uterus. 522 For the further explanation reference should be made to the studies of W. M.Sykow and A. Sticker 523 who have observed depression of growth of carcinoma and sarcoma cells from these carbon materials. Homoeopathic experience in any case has steadily treasured plant and animal charcoal as a worth-while cancer remedy.
CARBO VEGETABLIS DRUG PICTURE
1. Hahnemann: Reine A.M.L., 2 Aufl., Bd. 6, p. 120, and Chr. Kra- nkh., 1 Aufl., Bd. 4, p.1.
2. C. Wesselhoeft, Trans. of Amer. Inst. of Hom., p. 198, 1877.
METABOLIC WEAKNESS AND VENOUS STATE
The characteristic in the drug picture of carbo vegetabilis is the metabolic depression with particular stress on the defective oxidation and tendency to venous stasis. Thereby even the wood charcoal itself is a product of incomplete combustion. A connection between the direct property and the indirect actions is clear here.
Out of the metabolic weakness the following general symptoms are derived: great fatigue, often up to faintness; early in bed or on beginning to walk the extremities go to sleep readily; general lassitude of the extremities soon after arising from bed, rapid sinking of the power. The faint-like weakness in which the patient is cold, with pale or blue skin, almost pulseless, indeed is covered with a cold sweat and even the breath is cool and associated with the desire to obtain air, is the extreme expression of the frailty which occurs in carbo vegetabilis. Such a collapse often leads to the choice in the course of acute diseases (in the older therapies usually called asiatic cholera), still often in emaciated, cachectic, particularly in old people, when incomplete recovery follows some preceding disease. In general all complaints in carbo vegetablis show a tendency to chronicity. The special action on the co-existing cardiac weakness in carbo vegetablis is perhaps to be attributed to the admixture of kali carb. The symptoms of weakness from any exertion even from arising in bed indicates what a deep disturbance in metabolism is present.
The combination with venous stasis gives symptoms such as chilliness and coldness of the body, thirst during the chill, full puffy face, blue skin, cold knees, especially at night on awakening, coldness from the knees, downward, cramps in the soles of the feet, pallor of the face, sluggishness, slowness in every- thing, slow thinking, weakness of memory, sudden failure of memory being characteristic. During the day there exists great sleepiness, at night consequent to bodily unrest sleep occurs late; insomnia or alarming dreams. Offensive sweating of the feet as it appears in other carbon compounds and silicea. The head is full and heavy, headache from heat; pressing and dullness occur in the occiput, moreover a spasmodic tension in the head which is sensitive to external pressure for example from the hat, the eyes ache from efforts to see, dark spots move before the eyes. Likewise there is vertigo from the least movement of the head or it may occur after sleeping. Anxiety and restlessness prevail in the disposition, particularly evenings (aversion to dark) and there is marked irritability.
Further signs of the depressed gas exchange and the venous state of the body are: tendency to relaxed veins, varices passive, dark, thin, prolonged bleeding and involvement of the tissues on slight cause. Such people are easily chilled. Burning at various places in the skin indicates the beginning of the venous state. As a result of the varices the patient wishes to sit with the legs elevated. Bleeding occurs readily and there are foul ulcers with burning pain and abundant foul pus. The ulcera cruris are usually flat with bluish surroundings; frostbite may also be suitable for the remedy. Bluish hemorrhoids appear, pain, itch, burn or bleed and with every stool there is bleeding or itching and burning; evacuation of sticky acrid moisture, particularly at nighr. Varices also appear on the vulva and provoke itching and burning as well as soreness and aphthous ulceration. From a similar alteration from venous stasis in the internal sexual organs perhaps arises the thick, yellow-green offensive corrosive leucorrhoea, as far as it is not conditioned by carcinomatous ulcerated surfaces. Menses in general appear too early, are too copious and last too long, the menstrual flow is pale and at times the blood spots the parts from one period to another in a way resembling carcinoma. Burning in the back or in the hands and soles of the feet during the menses, weakness and relaxation of the lower abdominal organs are further indications. Often persistent daily nose-bleed with pale face is present and may be associated with varicose alterations. the gums also bleed readily, are sensitive and loose. As with so many remedies, one finds here also reports on alveolar pyorrhoea for whose avoidance the external application of finely powdered linden charcoal is worthy of mention. The tongue is sensitive, and especially noteworthy are aphthous sites on the glossal mucous membrane.