The basal metabolism, also the oxidative processes, are increased through hypertonic NaCl solution. According to Verzar, the oxygen consumption is greater than the CO2 excretion, which signifies a decrease of the respiratory quotient (that is, a plus in the oxidative processes, over increased carbohydrate and fat burning).
H. Schulz conceives that in the organism chlorine through CO2 is made free from sodium chloride and then chlorine acts oxidizing. If this is not proven, still in any case, a marked oxidation may be presumed in the development of HCl from NaCl.
SODIUM CHLORIDE FEVER
Closely bound with the increase in protein destruction and the oxidative processes is the much studied sodium chloride fever. The increase of temperature through concentrated salt solutions in small children (either orally or parenterally in three-gram amounts) is observed. According to experimental studies on rabbits it is concerned with an increase in heat production and of protein transformation. From the fact that calcium compounds in small amounts suppress sodium chloride fever, one has falsely concluded that it is not a sodium ion action. Not a disturbance of the isoionia, and indeed a relative predominance of the sodium ions, is assumed as a cause. With other sodium salts, as the carbonate and phosphate, the fever is not obtained Likewise the fever goes parallel with the height of chlorides in the blood. Indeed, after the marked use of NaCl there is marked output of calcium. This is naturally a necessity of the organism for the maintenance of the fixed alkali reserve. Calcium is, as we know, a very general defense against cell intoxication through its thickening action. If one assumes that NaCl fever occurs through lessening of calcium action, then this would probably occur via the vegetative nervous system to the nerve centers. In agreement with this is the fact that the fever does not occur when the splanchnic nerve is cut and that (out side of calcium salts) the fever can also be suppressed by choline and pilocarpine. The last signifies an excitation of the para-sympathetic and one concludes reversely that NaCl induces an excitation of the sympathetic in the sense of adrenalin, and that adrenalin fever can be placed at the side of NaCl fever. Moreover, calcium here acts as an exciter of the parasymphathetic or a depressor of the sympathetic which is opposition to the usual presentation. It is primarily probable that the increase of temperature is to be ascribed more to the halogen anion than the sodium cation. The detoxification through calcium is not proof that it is concerned with a toxic action on the entire molecule of NaCl.
But there is still a further antagonism to be mentioned in respect to the two univalent ions, sodium and potassium. Biernatzky reports that the output of potassium is increased through the intake of sodium chloride. Since the potassium action in general corresponds to a parasymphathetic effect, then a prepoderance of the sympathetic would be explained by the introduction of NaCl. However, NaCl fever cannot be removed through potassium salts. Thereby the antagonism of sodium and potassium ions is chiefly conditioned in that sodium is the outer and potassium the inner ion of the cell.
If one perceives in the anisoinia the cause of the NaCl fever, then this still does not say that the intermediation of the disturbance over the sympathetic would be fundamentally different from the direct cell influence of NaCl. It is much more to be assumed that the alteration immediately on the cells corresponds to a febrile metabolism, that moreover the vegetative system actually only intermediates the process through the nerve regulatory centers as they play between sodium chloride molecules and cell receptor organs. We may assume as in the experimentally founded parasympathetic and cardiac muscle effects of potassium- that here also a physiologic circle exists in which the result is dependent upon where the NaCl acts at the disturbing moment. Thereby it is clear that other quantities and states of form are necessary on the receptive organs than on the nervous centers, in case a direct way can be found for the latter.
Further, it would not be contradictory to the above designated way in which sodium chloride produces fever, if the liver should have a special role. This has been assumed by some authors because Rolly has shown that sodium chloride fever appears only when glycogen is present.
Apparently very similar to NaCl fever are the relations between glycosuria and hyperglycemia which can be experimentally produced through NaCl. Here also it is probable that the disturbance in ion equilibrium is vegetatively conducted to the nerve centers. How far the connections to glycogen and to the other metabolic alterations are here related to large doses of sodium chloride is still undetermined.
SODIUM CHLORIDE DEPRIVATION
Perhaps the favorable action of sodium chloride free or sodium chloride poor diet, which has recently been so widely advised in various diseases (tuberculosis, lupus, migraine) through a number of food reforms, is to be based on the above-mentioned metabolic and ion relationships. NaCl deprivation would accordingly increase the CO2 tension in the blood, would displace the fixed acids in the blood and promote calcium ions. But it is also possible that other explanations will be found for this successful dietetic therapy.
The salt-poor diet in nephritis has another basis; it is a sparing and unloading therapy for water economy because in nephritis the capacity for excretion of NaCl is depressed or subnormal. Consequently, by the introduction of salt, the urinary output will be depressed and the retention of water and NaCl in such cases of retention of water and NaCl will favor edema. Deprivation of NaCl in such cases of retention often again increases the urinary output.
But in our discussion we can say little about the therapeutic actions of salt deprivation because we seek, as the basis of our therapy in the use of NaCl, positive actions, the tensions of the organism. On the other hand, we cannot assert that the diseases which are favorably influenced through salt withdrawal are caused by an excess of salt. The reason is that the withdrawal of salt might, and probably is a nonspecific procedure for the transformation of metabolism as a fast or thirst cure.
CRUDE SALT ACTIONS
A laic use is to take concentrated doses of salt in order to arrest hemorrhage, in particular hemoptysis. This has been supported by the reports of v.d. Velden that strong injections of sodium chloride increase the coagulability of the blood. (An increase of coagulation has also been reported for natr. sulf. by Reverdin). Whether therein a forcible re-orientation in water economy plays a role, perhaps the rapid excretion of sodium chloride with corresponding amounts of water out of the circulation into the tissues remains to be seen. In any case an antagonism against calcium does not come into evidence here since it is exactly the calcium ions which are necessary for coagulation and, moreover, it is not known that a subnormal concentration of calcium promotes coagulation, but indeed the contrary.
It is a crude action of salt when the secretion of sweat is depressed by the oral or intravenous use of NaCl. By this means the night sweats of tuberculosis can be removed for a short time. A water retention with the ingestion of NaCl by the tissues gives a close explanation but probably not the entire one.
In seeming contrast to the favorable action of NaCl deprivation in tuberculosis stand the not-to be denied results of sun baths, sea air and sea baths in torpid glandular tuberculosis. Here of significance is that the exudative diathesis shows an increased capacity for NaCl in the skin connective tissue. The slowing of NaCl metabolism in this important regulator can be removed through the external action of sodium chloride.
The excretion of alkali carbonates besides water from the sodium chloride water (as Wiesbaden, Ems) is claimed for the surface of the respiratory mucous membrane whereby there is a mild liquefaction of the mucus. So the alleviating action of this spring water has been explained in chronic catarrhs; the alkali fraction is the essential element here.
Sodium chloride increases the secretion of the saliva and gastric juice, an action on which its use and effect as a condiment depends. But not only hypertonic but also hypotonic solutions provoke an increased secretion of gastric juice, while isotonic NaCl solutions are without influence. On the contrary, the very salty foods again act depressing on the gastric secretion. To some extent the salt introduced at meal time is available for the production of HCl in the stomach. For the remainder, the necessary chlorides are taken from the blood and the CO2 tension of the blood increases during this withdrawal phase, as Cl and CO2 stand in an important exchange and equilibrium relation to each other. By excessive withdrawal of chlorides (for example, marked vomiting, with loss of HCl in pyloric stenosis) the alkalosis of the blood can increase so far that a gastric tetany occurs.
CL. ION AND ACID BASE EQUILIBRIUM
But for the maintenance of acid base equilibrium the chloride anion is just as important as the Na cation. Here NaCl is a ready reserve of great breadth and indeed, according to the requirements of intermediary metabolism, the paths of Na and Cl may separate. The Cl can easily be exchanged for the anions arising in metabolism as the carbonates and phosphates. Through is easy excretion, the chloride can spare the anions arising out of the oxidation of organic materials, but on the other side can easily lead to excretion if they are introduced in excessive amounts; then chlorides themselves may be held back. This reciprocal relationship, suitable for equalization, is indeed, only one of many for the maintenance of regulation of the intermediary metabolism. Such purely quantitative chemical processes are subjected to disturbances only under extremely unusual conditions and then only through mass substitution or massive deprivation. The acid base equilibrium in the body fluids is ordinarily not endangered. But if a one-sided demand is placed upon this regulation, perhaps on the chloride content of the organs cells, then functional disturbances will arise there So it might be considered that, through its exchange relationships with the anions of combustion metabolism and as it participates in a regulatory manner in oxidation processes, chlorides can be involved by disturbances in their course if they are excessively retained. These, then are the preconditions for a medicinal influence, perhaps, with a preparation of sodium chloride in which not the amount but the activity of the liberated fraction gives expression.
REGULATION OF NaCl METABOLISM
Such a medicinal influence would, however, be scarcely possible if it had to be exerted directly on the tissues and the receptive organs. The disturbances of Na and Cl economy notoriously occur in them, but a direct medicinal alteration simultaneously at so many points is hardly probable in itself. Actually underlying the normal NaCl metabolism is a central regulation which is mediated partly through hormones, and is partly of a pure nervous variety.
One knows that the storage in the tissues (chiefly in the subcutaneous connective tissues with the two passages of discharge, to the blood and to the outside in sweat) as well as the excretion is extensively influenced by the vegetative nervous system. Very distinct is the influence of the vagus on the formation of gastric HCl. Subordinate centers for the nerve control exist in the medulla oblongata and in the inter-brain. The so-called salt-puncture in the floor of the 4th ventricle (vagus nucleus) effects an excessive excretion of salt, under certain conditions without the participation of water excretion.
Of the endocrine glands the most important regulator of NaCl economy is the hypophysis. Hypophysin causes a streaming of NaCl fluid out of the tissues into the blood and increased NaCl excretion, even in the first phase which proceeds with a sparing of water. In the second phase the excretion of both water and chlorides is increased.
In hypofunction of the thyroid, chlorides are retained in the tissues, and by doses of thyroid the chloride stream from the tissues into the blood and the excretion is increased. Reversely adrenalin effects a chloride retention in the tissues. The influence of insulin seems to be indirect through its influence on water economy and acid formation.
Thereby the importance of the endocrine system for NaCl metabolism is demonstrated, but a uniform trend in the meandering paths of hormones and vegetative nerves is still not distinct. Therefore the manner of action of sodium chloride as a drug remains almost completely shrouded in darkness. The physiologic role of NaCl as a regulator of water economy and the acid base equilibrium in metabolism and the depicted results of disturbances in the NaCl economy make it possible for us merely to outline the field with rough borders in which a medicinal excitation through preparations of sodium chloride seems possible. Only the investigations with such preparations in sensitive men with a labile NaCl balance will permit us to find further helpful indications for the employment as a drug.
The provings of natrium muriaticum are found: (1) Hahnemann: Chronische Krankheiten, 2 Auff, Bd.4, 1838.
(2) Archiv. f. hom. Helikunde, Bd. 19, H. 3, p.120, 1842.
(3) Watzke: Oesterr. Ztschr. f. Homoeopathie, Bd. 4, p.1, 1848.
As the point of bodily departure for natrium muriaticum we may take an unbalance of water economy in the organism. The disturbances in the movements of fluids seem to permit alterations of the state of tension of the vessels and all secretions. On this basis are to be considered the neuropathic trends of the drug picture. The disturbances in the partition of fluid and in the circulation cause symptoms which are usually suggestive of anemic-chlorotic states. Emaciation and bodily as well as mental exhaustion up to cachectic states, pallor and dryness of the skin, suggest that behind the external picture of the expressed natrium mur. type there are deep general disturbances in the sense of the old dyscrasias and that these are more presumed than exactly described.
The type – usually feminine-is chilly, still heat, especially the heat of the sun is badly tolerated; easy exhaustion on bodily and mental effort, even on speaking. Very characteristic is the mental state, an irritable depression, cries easily, attempts at consolation aggravate, even cause rage; is easily depressed; grief and disappointment, deep and long; unpleasant thoughts are persistent. The natrium mur. patient will not cooperate, hides the cause of his depression, and has an aversion to company. In this depression lies something tense, the forced, hidden basis comes to light in impulsive ill-humor. Occasionally the internal tension is revealed in forced laughter. It is this rhythm which characterizes the depression from secret anger or grief. The frame of mind is also dependent upon the degree of constipation, and is especially bad after the period. The irritability of the natrium muriaticum patient expresses itself in a special sensitivity toward external impressions, particularly sudden noises. Children are bad when they are addressed.
The capacity for mental work, the ability to concentrate and the memory are impaired; thoughts are easily diverted, indeed, as the result of depression, are of the tense state.
The time of aggravation of natrium mur is from 10 to 11 A.M. at the time of marked use of energy. At this time appears the so- called anemic school headache. The headaches are provoked not only by mental effort, but also by overstraining the eyes, near vision, obviously in insufficiency of the internal rectimuscles, even when complete correction of the refraction error has been made. Further characteristic is the aggravation during and especially after the period. This holds not only for the headache but also for other symptoms. The headache of natrium mur. is predominantly in the forehead and temples, often onesided; it is severe, beating as from a thousand small hammers, and is preceded by darkening of vision, spots and jagged flashes of fire before the eyes; every movement, even of the eyes, aggravates; in general the eyes are markedly involved. Rest, lying gown, sleep, relieves. The periodicity, especially at the time of the menses, the chronicity, the pale face with vertigo, nausea and vomiting, moreover, the attacks of numbness and prickling in the lips, tongue and nose, complete the picture of migraine. Thereby the salt-poor diet which exerts a favorable influence of many migraines (Bircher-Benner, Gerson) should be compared. But also cases of suppression of the migrainous attacks through massive doses of salt are observed. All this means that in many migraines there is a disturbance of NaCl economy, and probably a chloride retention is present. The ocular and periodic associations indicate it best. The asthenopia with feeling of weakness and stiffness of the eyes leads, in prolonged close work, to swimming of the letters on reading and to vertigo and headache. Frequent are the so-called ciliary neuralgias. The menses are irregular, often delayed. Feeling of weakness is present in all extremities, but the sacral and lumbar regions are especially painful with a desire for firm support, for pressure against a pillow. A marked downward pressure of the uterus occasions the patient to sit down.
CIRCULATION AND FEVER.
The circulatory disturbances are those similar to anemia. With coldness of the lower extremities go rushes of blood and severe pulsation to the head and chest. Cardiac palpitation shakes the entire body, worse on lying on the left side, every movement accelerates the circulation, and the general pulsation expresses itself in the head in the hammering headache; fresh air relieves. The vasomotor disturbances may increase to fluttering of the heart with attacks of faintness and intermittent irregular pulse; every third beat is absent. The vascular excitation in the sense of a sympathetic status gives the first indication for its utility in Basedow’s disease whereby one thinks of the chlorine component. To this vasomotor syndrome, to which may be added sweating of the hands-loss of power, emaciation and disturbances of blood supply lie at the basis. Fever with a tendency to periodicity also appears in the picture. In old cases of malaria, overtreated with quinine, particularly in the English homoeopathic school, natrium, muriaticum is recommended apparently on the basis of old folk use. There it should not only be given in the massive ordinary doses, but for a persistent action the higher potencies have proven better. For the fever, the beginning with the increasing chill starts about 10 in the morning; the thirst increases with the fever and the headache increases to bursting, and then improvement with the outbreak of sweating is reported.
The chronic acceleration of metabolism through natrium mur. is expressed in the emaciation. Yet the appetite is good. With this a further association with Basedow’s disease is given. With natrium mur. appear many disturbances of gastric digestion, uneasiness before eating, feeling of fullness, acid burning with cardiac palpitation, sweating on eating. For the gastric digestion it is to be observed that it is also possible for the NaCl influence to act upon the cells preparing HCl, either in a curative or disturbing manner. Special aversions in natrium mur. are against bread and particularly rye bread, further, against fat; longing for salt, and great thirst.
SKIN AND MUCOUS MEMBRANES
Emaciation and disturbances in the circulation determine the appearance of the natrium mur. patients. The complexion is pale, yellow, or an earthy gray. The skin is not well supplied with blood, only slightly elastic, usually, not a waxy, puffy pallor, but a gray, dry withering. The dryness prevails, as we note also in the mucous membranes in which the imbalance in the secretory relationships are also characteristic. The facies may also appear greasy and shiny because the sebaceous secretions are also altered. The defective blood supply causes a tendency to all kinds of impurities, eczema, especially of the seborrhoic type, vesicles and acne particularly in the folds of the skin (elbows, behind the ears) and sites of transition, particularly at the border of the hair. The tendency to acne may be ascribed to the chlorine fraction and recalls bromine and iodine.
The one mucous membrane suffers from dryness and the other from acrid secretions. The lips and mouth are dry even to wrinkling; the tongue has island-like patches (geographic tongue); particularly dry is the rectum; thereby the characteristic constipation with hard, dry, crumbly stools which are difficult to evacuate, and which eventually irritate the anus and provoke sticking and burning. The degree of constipation is said to go hand in hand with the psychic depressive symptoms. Acrid, copious, watery secretion is noted in the eyes and nose. Here to be recalled is the fact that the lachrymal secretion is an especially high chlorine containing secretion. The coryza easily leads to persistent loss of smell and taste. Cough is accompanied by flow of nasal secretion and severe flow of tears, many times also with voiding of urine, and is always worse on lying down. In the catarrhs of the upper air passages one recalls the sodium chloride water as of Ems, in which a liquefaction of the slimy secretion is said to occur. Also an acrid, watery leucorrhoea occurs in natrium mur.
Many complaints, especially the constipation, are said to be aggravated by a sojourn at the seashore.
Type: general symptoms, and modalities are of determining significance for the selection of natrium mur., the organ relationships being of subordinate significance.
Type: Mostly females, emaciation in spite of a good appetite, pale gray cachectic appearance, dry skin and mucous membranes, chilly but intolerant to the sun’s heat, physically and mentally exhausted. Tendency to migraine, basedowism; periodicity, aggravation during and after the irregular menses. Mental symptoms; irritable depression.