SEPTIC-GANGRENOUS STATES AND CANCER
The slight vitality of the organism and the slowed circulation prepare the soil for bacterial action and self intoxication. Septic and gangrenous trends in the drug picture refer to the defective defensive power in the blood. The secretions are all offensive. The ulcers, for example the varicose, are unhealthy, and there is burning pain. In inflammations, phlegmons, which take on a gangrenous or septic form, in ulcers with marginal gangrene, carbo vegetablis comes into consideration, as well as in senile gangrene which begins in the toes. In many less stormy cases of sepsis carbo vegetablis comes to mind. Ecchymoses and bleeding from the mucous membranes are in this group. Also severe inflammations of the parotid and metastasis to the testes are reported. To these belong the malignant tissue injuries which may involve other glands, for example the breast, and show a tendency to ulceration. More frequently however wood or animal charcoal is considered in cancer of the digestive passages while in uterine carcinoma the related creosote accomplishes more.
CARDIAC SYNDROME —————– The tendency to collapse explains the persistent palpitation with alarming fright about the heart, the rapid, thready, intermittent pulse and dyspnoea. Symptoms as burning in the chest, pressure, oppression, heaviness and soreness in the chest, fullness of chest, labored and short breathing, rales, refer to the stasis in the respiratory organs. Asthma of old people with cyanotic skin is regarded as a good indication. Throughout carbo vegetablis is a good indication. Throughout carbo vegetablis is a passive hyperemia of the respiratory organs which often goes gradually and insidiously from the nose to the larynx and bronchi, especially
in old people. The persistent hoarseness is aggravated by speaking and at night. The cough of chronic bronchitis withy or without emphysema or lung stasis is spasmodic, in single cases dry in spite of audible rales in the lungs, but often a slimy purulent sputum is evacuated; foul expectoration and breath indicate the progressive suppurative process. With the spasmodic cough the sputum may be bloody and a sensation of weakness and burning develops in the chest, the painful stitches going to the head. In general the cough is worse at evening and in bed, from cold, from evening air, after eating and talking. Chilling, bronchitic and asthmatic states appear especially in damp warm weather. This is comprehensible because humid weather particularly embarrasses gas exchange and for this reason the general modality has special significance for carbo vegetablis. Desire for open air stands in accord with this. Because of the spasmodic cough in which nausea and vomiting can occur, carbo vegetabilis is also recommended in whooping cough. That carbo vegetabilis is also recommended in whooping cough. That carbo vegetabilis is an important remedy in cough and dyspnoea of cardiac origin is probably due to the admixture and participation of kali carbonicum.
Of the symptoms from the digestive canal we have on the externally visible exit and entrance lesions, aphthous oral ulceration already been mentioned. The abundant development of gas is associated with the venous stasis in the intestine. The abdomen is distended and tense. One half to one hour after eating the stomach is full of gas, tense like a drum, each article of food is converted into gas, the hypochondrial region is sensitive where the clothes touch. The gaseous collection produces a burning, pressing gastric spasm with great sensitivity in the pit of the stomach, moreover, sticking or sore pains in the hypochondria and the picture of retention of gas and decomposition of gas can be combined with a considerable grade of dyspnoea. The crampy pain radiates into the chest, the burning in the stomach extends to the back and along the vertebral column; recumbency aggravates the flatulence. Characteristic is the relief from eructation and emission of flatus. Likewise other complaints than merely those of the stomach and intestine are thereby relived. In the abdominal plethora characteristic for carbo vegetablis in which the increased gas tension of the venous blood contributes to the increased collection of gas conditioned by the sluggish digestive process, there is excessive flatulence with offensive foul flatus. Such conditions develop especially readily after prolonged rich living; dull morning headache, white or yellow brown coated tongue, morning nausea, vomiting and gastric weakness, burning in the stomach, offensive rancid eructations, disgust for meat; aggravation from fat, which causes rancid eructations, increased flatulence and acid eructations after eating, particularly after the use of milk, desire for acids. The simplest diet causes distress, flatulence naturally being outstanding. The typical symptoms which indicate complete depression of the normal digestive activity can also indicate carbo vegetabilis even if it has other causes; even if it involves a persistent state of this kind and a carcinoma of the gastro- intestinal canal is present, carbo vegetabilis comes into consideration. Alcohol in any form is said to be borne badly in the typical state of carbo vegetabilis, particularly provoking rush of blood to the head. One gastric symptom seems especially noteworthy in carbo vegetabilis, namely: rising of fluid from the stomach into the mouth. In the atonic stomach it does good service. A feeling of sinking in the stomach, which is relieved by eating belongs here. The atony of the intestine makes itself obvious in constipation, difficult stool with strong urging or thin slimy stool; the last is excoriating and foul, and may be comprehended as resulting from the decomposition of the intestinal content and the influence of abnormal split products due to the impaired digestion. The discharge of acrid, sticky moisture from the rectum has been mentioned in discussing the hemorrhoids. But the symptom also refers to other affections of the rectum, namely carcinoma, just as the discharge of blood. For carcinoma of the rectum there is also the characteristic frequent, involuntary putrified stools with subsequent burning.
On the urinary and male sexual organs carbo vegetabilis has no characteristic symptoms. In skin eruptions it comes much less into consideration than the related drugs. Itching and moisture on the scrotum and thigh and similar skin affections are the suitable trends of action here. It is much less applicable in otosclerosis than graphite; deficiency of cerumen, occlusion of the ears, ringing and noises in the ears have also been reported from it.
By way of repetition the character of the pains is burning. But at the same time general or partial sensation of cold is characteristic. The pains in carbo vegetabilis are dependent mostly upon venous stasis and inflammation and often are associated with anxiety particularly at night.
The type of patient suitable for carbo vegetabilis determined by the weakness with defective oxidation and venous stasis. Old, decrepit people, weakened by disease, are particulary susceptible to its action. The tendency to “decomposition of the blood,” of the transition of inflammation into foul septic and gangrenous forms, reflect themselves in the general report: all secretions are offensive and acrid. The failure in the venous part of the circulation readily leads to faintness, weakness and collapse. The drug picture is a sub-form and type of the carbo-nitrogenous constitution in itself.
1. Depression of oxidative metabolism. Venous stasis, faint-like weakness, cyanosis, collapse.
(Marked desire for fresh air. Aggravation from damp warm weather.) chilliness, cold from the kness down.
Relaxed veins (relief from elevation of the legs) Chronic ulcera cruris.
Tendency to passive dark bleeding.
Oral aphthae. Alveolar pyorrhoea.
Transition to septic and gangrenous states.
Carcinoma and malignant parotid metastasis.
2. Stasis catarrh of the respiratory passages, worse at evening and from speaking. Dry cough with rales in the chest, attacks of spasmodic coughing; putrefactive processes, foul sputum and breath. Asthma and dyspnoea of old people with cyanosis.
3. Abdominal plethora. Complaints of meteorism. Improvement from eructation and discharge of flatus. Atony of stomach and intestine.
Dyspepsia with putrefactive processes. Eructation of water into the mouth. Aggravation from fat. Intolerance of alcohol. Hemorrhoids, carcinoma.
Chronic stasis in old decrepit people.
Psychic: nocturnal anxiety; slow.
Burning pain; internal burning but external coldness (especially from knee downward.) Faintness.
Desire for fresh air.
Acrid offensive secretions.
Eructation of water into the mouth.
Aphthae on the tongue.
Aggravation in damp air.
Aggravation in evening and at night.
Aggravation from fat (and alcohol).
Relief from eructations and emission of flatus.
Relief from elevation of the legs.
DOSE —- Carbo vegetabilis has proven itself in the D 6 and D 30.
1. Hahnemann: Reine A.M.L., 2 Aufl., Bd. 6, p. 161, and Chron. Krankh., 1 Aufl., Bd. 4, p. 68.
2. Weise: Rust’s Magazine, Bd. 22, I, p. 198, 1926. The greater effectiveness of carbo animals on the lymph glands is stressed fairly uniformly. Hard painful glandular swellings in which suppuration impends are said to be favorably influenced, also ve- nereal buboes. In ulcus molle, carbo animalis promotes healing after too early incision. In tumors of glandular organs, tumors of the parotid and testes and mammary gland and uterine carcinoma, it has been emphasized as well as plant charcoal. The cachexia and the marked reduction of vitality makes carbo animals even more suitable for the senile marasmus than carbo vegetabilis.
Carbo animalis is also preferred in the states of weakness which are dependent upon lactation as well as great exhaustion after the menses.
A report: copper colored eruption (especially on the face) has given occasion for the use of carbo animals in syphilis.
Single differentiating symptoms still require confirmation, for example, the report of a special sensitivity to open air, which indeed would be opposite to that of carbo vegetabilis. A feeling of looseness of the brain especially in the suffocating cough, is also cited for carbo animalis. Opposite to the burning in the stomach and chest of carbo vegetabilis, a sensation of coldness in the stomach and chest is said to prevail in carbo animalis. The digestive weakness with complaints from almost every food is stressed more strongly in carbo animalis than in carbo vegetabilis, as well as the feeling of emptiness and sinking in the stomach (particularly in lactating women) which is not relie- ved by eating.
The tendency of decomposition of the blood, the transition from inflammation to the septic form is not less in carbo animalis than in carbo vegetabilis. Here also the discharges are offensive Moreover it is particularly in the purulent gangrenous lung processes that carbo animalis, like carbo vegetabilis, is recommended: when there is green, purulent, offensive expectorat- ion and especially with carbo animalis, cavities associated with sensation of coldness in the chest. In other respects the burning pain is often repeated in carbo animalis. As a detail for carbo animalis, there is also the clinical report; sticking pains, which can be traced to a pleuritis.
Carbo animalis is also employed in the 6th and 30th potency.
According to its chemical composition and medicinal actions, kreosote stands between wood charcoal and carbolic acid, the simple phenol. It is a mixture of various phenols, a product of the distillation of beech-wood tar and indeed the fraction which distills over between 200-220. It is predominantly composed of polyphenols, that is, benzol derivatives with several OH groups. Its chief constituent, guaiacol, is the methyl ester of dioxybenzol (also a diphenol). Other constituents are cresol and creosol, also methylated phenols.
MANNER OF ACTION, INDICATIONS AND CONTRA-INDICATIONS
Like all phenols this mixture has a markedly irritating up to destructive cell action through protein coagulation. It’s antiseptic property approximates that of phenol, the corrosive action is less. Since the introduction of kreosote into the therapy of tuberculosis by Reichenbach 524 in 1830, it has long been erroneously considered as an internal antiseptic. In this respect it is indeed impossible, without manifestations of serve poisoning to obtain the concentration of kreosote or guaiacol in the organism which is necessary to depress the growth of tubercle bacilli or indeed to kill them. At the same time guaiacol is rapidly split in the body, made harmless through conjugation with sulphuric acid, and excreted as ethyl sulphuric acid. In animal experiments all of the many kreosote and guaiacol preparations with which the market is flooded, have shown themselves inactive in experimental tuberculosis. If still a favorable action in tuberculosis is observed from kresote or guaiacol, such as the improvement of appetite and the state of nutrition, lessening of cough and expectoration, at times also the reduction of fever and the night sweats, then this can be explained only as an indirect action on the economy of the organism. Since kreosote is also excreted in small amounts through the respiratory passages, for it is easy to note in the odor of the exhaled air, one may pres- ume a mucous membrane stimulus as an intermediate factor. Through this the accompanying bronchitis and the mixed infection could be favorably influenced. At times kreosote and guaiacol have been employed in putrid bronchitis. On the other hand the late stage
of tuberculosis with greater destruction and tendency to hemorrhage is held as a contra-indication, a distinct proof that the dose selected is too strong for these cases. On the other hand it is exactly in homoeopathy when the destructive processes in the respiratory passages are present, the late stages of phthisis wi- th fever, night sweats and cachexia, which are considered suitable for kreosote. On the whole the clinical indications and the contraindications and the so-called untoward actions in kreosote, as always are very instructive. On the one side it can, as many related benzol compounds (for example salicylic acid), reduce the fever even by application to the skin; but the chill can be followed by very high fever. On the one side there is the stimulation of gastric function which can be compared to the bitters, on the other one sees the impairment of gastric function from prolonged use and therefore sought aid in guaiacol compounds which are not split in the stomach, but only gradually destroyed in the intestine, entirely over-looking the acute irritative manifestation in the gastro-intestinal canal as burning, pains in the epigastrium nausea and vomiting and diarrhoea. All this divergence of action is solved when one takes consideration of the quantity, the repetition of the dose and the sensitivity of the patient.
Even from the local application of kreosote in carious teeth, th- ere readily arises inflammation of the surrounding tissue, indeed a severe stomatitis. It is exactly in dental pains from caries with inflammation of the neighboring tissue that the homoeopathic use of kreosote has often proven itself. The increase of menstrual bleeding which makes necessary the discontinuance of the drug during the menstrual period, finds the opposite as a homoeopathic indications, as a tendency to hemorrhage. States of excitation and headache are on the one side “untoward” actions, on the other side supporting therapeutic indications.
The role of tar products in the development of cancer has already been discussed. On the other side the external use of kreosote in malignant ulcers has been extolled from time to time ever since 1834. 525 The cancer treatment of E. Salzborn has guaiacol valerianate as the chief constituent and is given twice a week in milligram to centigram doses. 526 In homoeopathy kreosote has always been an important remedy in carcinoma.
The excretion of sugar in the urine is not found in the symptoms of intoxication or untoward actions. However in homoeopathy kreosote is held as one of the best remedies in diabetes. We should recall that adrenalin just as guaiacol, is a pyrocatechin derivative and, as is well known, has a prominent role in sugar metabolism; moreover its artificial introduction produces hyperglycemia and glycosuria.
KREOSOTE DRUG PICTURE
Provings are found:
1. Reichenbach: Das Kreosote in chem., phys. und med. Bezeihung,
2 Aufl. Leipzig, 1835.
2. Syrbius: Allg. Hom. Ztg., Bd. 12, p. 33, 1837.
3. Wahle: Arch. f. Hom., Bd. 16, H. 2, S. 152, 1837.
4. Wichorn: Ztschr. d. Verbascum d. Hom. A. Osterreichs, Bd, 2, S. 24, 1857.
CHARACTER OF ACTION
Kreosote differs from wood charcoal chiefly in the more marked inflammatory manifestations on the mucous membranes and skin while the venous status is minimized in the picture. The tendency to putrid inflammations and ulcers, to malignant degeneratious, to bleeding, the transition to cachexia stands in the center. The discharges are foul and acrid, indeed corrosive. Therein the stronger inflammatory stimulus (exactly as with carbolic acid) comes into expression. The reduction of power of resistance in the tissues expresses itself much more in the symptoms similar to disturbances in the skin and mucous membranes are induced which are similar in their results on tissue nutritions as the metabolism of diabetes, and valuable indications may be had in this field.
The irritative manifestations on the skin and mucous membranes can run through all stages; on the skin from itching and burning to vesicles and pustules; the skin becomes unhealthy, its nutrition is bad, it tends to ulcerate and becomes gangrenous. The itching is especially severe at evening and may provide occasion for the use of kreosote in prurities senilis; even more frequently the remedy is successful in pruritis vulvae, particularly on a diabetic basis. Here the irrtation appears from the acrid discharge. Carbuncles and gangrene in diabetics (besides arsenic) likewise suggest kreosote. The tendency to bleeding in injured, nonresistant tissue is expressed in the bleeding from small wounds.
In the digestive canal the inflammatory tissue injuries begin in the mouth. The teeth rapidly become carious. When the inflammation proceeds from there and produces severe toothache, kreosote in the D 3 and D 6 often proves useful. The gums are sore, spongy, and bleed readily; salivation is increased. A bitter taste prevails. Nausea, retching, and vomiting of undigested food several hours after eating or the regurgitation of sweetish water in the morning suggest kreosote much more than the other irritants of mucous membranes. Here also belongs reflex vomiting from other organ maladies or in pregnancy, but still, more frequently the severe inflammations of the gastric mucous membrane form important indications. Ulcerative processes with bloody vomitus, particularly of a malignant nature, can be at least improved by kreosote. The gastric pains are severe, burning, constrictive but a nagging fasting pain in the morning with vomiting is also observed and this diminishes after eating. Food remains in the stomach long after eating and causes pressure. This refers to gastroectasia consequent to narrowing in the duodenum where kreosote as well as carbo vegetablis brings improvement. The abdomen is distended, acrid, very offensive also bloody diarrhoea as well as persistent constipation is reported; moreover large painful hemorrhoids. Much pain in the rectum and tendency to bleeding permits one to think of carcinoma, though the rectum less than the stomach and much less than the uterus is the preferred site of kreosote. Severe gastro-enteritis with atrophic, marasmatic children with dental disturbances, and rapid decay of the teeth are given as clinical indications.
FEMALE SEXUAL ORGANS
Most frequently kreosote is used in putrid and malignant ulcerative processes in the female genital organs, particularly carcinoma of the portio. A foul, yellow or flesh-like (bloody) acrid leucorrhoea which corrodes the external parts is suggestive here. It makes the clothing stiff, indicating the high protein content. Foullochia can also give occasion for the drug in puerperal fever. Burning and corrosive itching on the vulva, between the labia and the thigh, worse on urination, with swelling of the parts seem partly dependent upon the leucorrhoea and partly intrinsic. Itching of the vulva, in the vagina and the anus are good indications in diabetes. The menses appear too early, last too long, are dark, often acrid and offensive. The bleeding is intermittent, ceases on walking or sitting and reappears on lying. Itching in the vagina can increase the libido sexualis. Intermittent bleeding appears after coitus. Before and during the menses, difficulty in heating and ear noises are reported. Downward pressing backache and sacral pain and great feeling of weakness accompany the uterine maladies.
Of the irritative manifestations on the respiratory organs the progressive destructive processes are the chief indications for kreosote. Abundant, purulent sputum after each cough may lead to the choice of kreosote in bronchitis foetida, bronchiectasis, lung gangrene, persistent lung inflammation after grippe, also in cavernous tuberculosis with hemoptysis and night sewats. In the chest much burning, pain and oppression is felt, pressure on the sternum with respiratory embarrassment. Hoarseness appears, but carbo vegetabilis is then more frequently in place.
MORE RARELY USED ACTIONS
In severe poisonings the urine is diminished in quantity and colored brown. Nephritis and hemoglobinuria occur. However these end effects do not suggest a preferential trend, much less a stimulative state and one susceptible to improvement by kresote. In the provings a frequent and particularly very sudden urge to urinate is recorded and the urine is often very copious and colorless, or offensive and cloudy. In the enuresis of children in the first sleep, kreosote is recommended. The polyuria is only a very weak support for the connection to diabetes. The similarity here lies much more in the type of nutritional disturbance in the tissue.
It should still be mentioned that kreosote is recommended for the beginning cataract in diabetes. A number of symptoms of cloudy vision are observed in the provings. But whether they arise from the refractive medium of the eye or are associated with the frequent vertigo of acute kreosote action is not determined.
Vertigo with congestion, pulsation, stupefaction and confusion of thought, depression, great sensitivity of the mind with tendency to cry, hopeless despondency, nervous excitability before the menses, are the first signs in acute poisoning of the sensorium and psyche but are of subordinate significance in the selection of the drug. The dissatisfied and contradictory behavior which is mentioned particularly for children, finds no support in the provings.