Emaciation, sympathetic excitation, Basedow.
Periodic fever, migraine, ciliary neuralgia.
Circulatory disturbances: pulsations, pounding, fluttering, intermittence of heart.
Skin eruptions, especially seborrhoic.
Disturbances of secretions of mucous membranes; dry constipation, acrid secretion of the nose and eye.
Chief time of aggravation 10 to 11 A.M.
Worse from sun’s heat.
Worse before the menses.
Worse at the sea.
Head symptoms worse from mental effort and close work.
Depression aggravated by consolation. Aversion to bread.
Sacral pain better through pressure.
The dose is usually with the high potencies (15, 30). Even in the drug provings in the healthy, the high potencies have yielded considerable symptoms. In the constipation the lower potencies (3-4) have been found effective.
Kalium muriaticum, KCl, is not proven. Its use arises merely from the theoretic conceptions and clinical reports of Schussler. Schussler places it into connection with fibrin. Fibrinous exudates from mucous membranes and serous surfaces are therefore its leading indications.
The gray white coating at the base of the tongue is said to be an indication in inflammations which exist primarily in the nasopharynx. It is entirely possible that the halogen fraction of this preparation is responsible for the especial affinity for the throat.
But it is also generally an inflammation in the stage of exudation which is taken into consideration in kali. mur. With the few remedies of Schussler the extent of application must necessarily be very great, and consequently the indications are in generalities. The use of the D 6 in bursitis paraepatellaris has been verified by myself.
Of the later additions by homoeopathic observers there should be mentioned also the digestive disturbances from fatty, heavy foods. Here the gray-white coating of the tongue as an accompanying symptom would be easily understood.
The potassium salt of chloric acid, acidum chloricum, HClO3, is frequently confused by virtue of the defective nomenclature with the more harmless potassium chloride, our kal. muriaticum. The last, KCl, is often even today in the materia medicas designated as kali chloratum, while this is the name of chlorate of potassium, KClO3. This ClO3 anion, because of its energetic capacity for oxidation, is a strong poison, first in line for the blood. It converts hemoglobin into methemoglobin and renders it incapable of performing its task of taking up and giving off oxygen. In this process of methemoglobin formation the iron of the hemoglobin acts as a catalysor, activates the liberated oxygen so that a pure, hardly reversible oxidation of hemoglobin occurs. Thereby the divalent iron is converted into the trivalent. (Oxyhemoglobin, on the contrary, is only a loose addition compound of O2 with hemoglobin.) In the herbivorous the toxic action by the formation of methemoglobin is much less than in the carnivorous. This perhaps depends upon a difference in the h-ion concentration of the blood. Moreover, it is striking that, through the decrease of alkalescence of the blood, the formation of methemoglobin, which is a pure oxidation, there is a destruction of the red blood cells. Disturbances may appear through the formation of thrombi and emboli, especially in the kidneys.
SYMPTOMS OF INTOXICATION
From medicinal use, at times, severe toxic symptoms occur from great doses which lead to asphyxial death and, as an irreversible process, naturally give no indications. To these belong the gray-blue discoloration of the skin and mucous membranes, asphyxia with burning and pressure in the chest, vomiting of bilious masses, meteorism, hiccough, swelling of the liver and spleen and as a consequence of blood destruction, hemoglobinuria and methemoglobinuria, anuria and uremic coma. Disturbances of general sensation as fatigue, apathy, headache vertigo, insomnia, restlessness, changing sensation of heat and cold with recognizable fever, small, rapid pulse, accompany acute and subacute intoxications. The symptoms of destruction of the red blood cells, as icterus and hemoglobinuria, are indeed mentioned in homoeopathic materia medica as indications for hemolytic and septic processes but deserve little confidence so long as no clinical confirmation is available. To the subacute intoxications as well as to those from persistent use of gargles belong: mucohemorrhagic diarrhea with much tenesmus and meteorism. They have given occasion for employment in dysentery and intestinal affections similar to it in occasional cases.
For a prolonged action of kal. chloricum, two principal directions come into consideration, the kidneys and the mouth. The urine and saliva are the two principal sites of excretion for the poison. In the urine part of the kal chloric. appears reduced to KCl. One knows that the toxic action of kali chloric. is provoked much easier of the damaged kidney. In acute parenchymatous nephritis with many casts and much protein, kalium chloric. in the 1-3 potency is recommended by the Americans, as R. Haehl reports. Outside of the urinary symptoms, one must take consideration of the above-mentioned general disturbances of the remedy, particularly the congestive headache in the forehead and temples and the severe vertigo. Frequent nosebleed is explainable from the action of the blood and is a further indication. The nose bleed should alleviate the above- mentioned head symptoms and the irritable hypochondriacal disposition. Also in chronic parenchymatous nephritis in which the choice of the remedy is very difficult due to the scantiness of the symptoms, I have repeatedly employed kalium chloricum in the D 6 and have gained a favorable impression. Nephritis during pregnancy is a special indication. Pains in the region of the kidney are observed in the course of intoxication, the output of urine is mostly diminished, but there is often much urinary tenesmus.
Of the mouth symptoms the marked salivation, great dryness of the mouth and esophagus and foetor ex ore are cited in toxicologies. In the homoeopathic provings the saliva is reported as sour, the taste altered in diverse manners, but especially inflammatory manifestations of the entire oral mucosa up to ulceration and glandular swelling are depicted, moreover, a feeling of coldness on the tongue and in the throat. (The last is to be valued only as a local symptom since kalium chloric. solutions produce a feeling of coldness as well as a faint bitter taste.) The easy bleeding from the inflamed gums harmonizes with the general tendency of the remedy to hemorrhage.
On the other hand kalium chloric. solution is a favorite gargle in inflammations of the mouth and throat, and formerly, when one was not as exactly informed of its toxic actions, it was used more than today in stomatitis, angina and diphtheria, but particularly in mercurial stomatitis where it was often used for protection in mercury cures. Through an oxidizing and disinfecting action this influence was explained without further consideration. But a kalium chloricum solution does not act antiseptically and will oxidize organic substances at body temperature only when the oxygen is activated through a catalysor. Intermediate reactions of the tissue cells in any case participate in the local effect. So long as we do not know these exactly, the similarity of the inflammatory effect on the mucous membrane is to be perceived as a result of these intermediate reactions and is a useful therapeutic guide. Another explanation will be employed as the totality of the effect is revealed in its details.
If now such an oral or throat inflammation concerns a patient with parenchymatous nephritis, then, the choice of kalium chloric. is emphasized.
Striking is the similarity of the chief trends of subacute kalium chloric. action with that of mercury: mouth and throat, kidney, intestinal mucosa. And further, the type of inflammation is similar in respect to many symptoms in the two remedies. There is also similarity in the skin manifestations, since kalium chloric. (outside of skin bleeding) can also provoke a papular erythema.
From this similarity in external manifestations, in which an antagonism in cell chemistry may be present, is guided the use of kalium chloric, in mercury poisoning.
The choice of kal. chloric can occur at the present time from the organ affinities and objective symptoms as might be expected in an agent which has early toxic actions. Guiding symptoms for the remedy are not as yet known, and of the modalities the improvement by nose bleed deserves only partial confidence.
A drug provings of kalium chloricum is found in Martin’s work: Arch. f. homoopathische Heilkunsst, Bd.16, p. 181.
Parenchymatous nephritis with congestion of head which is relieved by nose bleed. Stomatitis. Dysentery like stools. Mercury poisoning
The acute actions of HCl gas are entirely like those of chlorine gas. We designate as acidum muriaticum, HCl, hydrochloric acid, a solution of HCL. Pure acid contains 25 per cent HCl; acid. hydrochloric dilutum, one-half as much.
Even before Hahnemann, acidum muriaticum was valued in putrid fevers as he reported in his apothecaries lexicon from pre- homoeopathic times.
For the chief homoeopathic employment of acidum muriat. in adynamic fevers, the provings from the Hahnemannian circle. give some support. Moreover, H. Schulz mentions a self- investigation of Bobrik in which a similar action appeared in the vascular system.
Characteristic for the acidum muriat. fever is the extraordinary weakness, especially, in the legs; the patient slides down in bed, sleeps while sitting up, the lower jaw falls, the tongue is dry, heavy, trembles and is shriveled. Stools and urine pass involuntarily, or the emptying of the bladder is difficult; thirst exists during the chill more than in the fever; the patient tosses here and there in bed; the pulse is rapid and weak, every third beat intermits (as in natr. mur). the extremities are cold; chilliness prevails and the patient is stupefied. Such is the picture in typhoid and malignant, septic, infectious diseases which holds as indications for acid. mur. Naturally not observed in this degree in the provings are weakening of the pulse, increased rate, heightened tension intermittence, attacks of palpitation, many other vasomotor disturbances, febrile chilliness and heat, dead fingers and blue nails. But in severe intoxications appear similar states of prostration. Perhaps one can bring this into connection with a rapid decrease of alkali reserve.
Similarly as with potassium chlorate, acidum mur. causes inflammatory manifestations in the mouth and throat. The halogen affinity for the throat also comes into evidence here; still the use in diphtheria and similar diseases is rare. Aphthous mouth affections and severe inflammation of the throat with a tendency to bleeding in conjunction with adynamic fevers of an infectious septic type can assist in the selection of acidum muriat.
The physiologic task of hydrochloric acid in the gastric digestion permits one to suspect that the long-continued use can also provoke disturbance of digestion. There develop aversion to eating, especially for fleshy foods, desire for stimulating foods; the taste is disgusting, foul; gas and fluids are eructated; there is an empty sensation in the gastric region and particularly in the esophageal region which is not improved by eating; in the intestine there is colic from gases which at times alternates with an invlountarily discharged diarrhea. The stool passes involuntarily during the attempt to urinate. Hemorrhoids are inflamed a blue-red, they burn and are very sensitive to touch. Warm applications are said to relieve; cold, to aggravate.
Ulcers on the skin and mucous membranes show slight tendency to heal; their surroundings are painful, the secretion foul and decomposed. Decubital ulcers are example of this type.
Acidum mur. is little used, and then best when inflamed hemorrhoids are present. In severe forms of disease, for which the remedy should be adapted, a convincing performance of the remedy is not as yet known.
It is usually recommended in the lower potencies.
Pharmacologically, we have nothing to do with the action of the elementary fluorine molecule. The chemical preparation of the element is very difficult since it combines with nearly every substance with which it comes in contact but especially with water, forming hydrofluoric acid, HF. For actions on the organism only compounds of fluorine come under consideration, for the most part, acidum fluoricum, furthermore calcium fluoricum, CaF2, and at times sodium silicofluoride, Na2SiF6.
The elementary relationship with the remaining halogens, chlorine, bromine, and iodine, we find of significance only because the actions of fluorine can be observed less than with chlorine and bromine in the form of a gas. We are able to see modified effects only because of the very firm combination to acid or salt. Prevailing for the effect picture is the molecular-chemical relations of fluorine compounds to constituents of the organism.
There are two viewpoints to be stressed:
(1) The calcium compound of fluorine possesses in contrast to the calcium compounds of the remaining halogens an exceptional position, for it is insoluble in water. There is also an easy but final precipitation of calcium by fluorine and a deposition of CaF2 whereby under the usual conditions the calcium cannot be reactivated again. This connection to calcium is significant through the normal appearance of fluorine in large amounts where calcium is also deposited, as in the teeth and bones. If it happens that the fluorides in the organism are made active, then thereby the physiologic paths of calcium particularly its places of deposit, will be involved as a point of contact.
(2) Active fluorine in the form of fluoric acid, HF, has an extraordinary capacity for destroying silicates. This is due to the fact that the fluorine is charged negatively to such an extent that even hydrogen is withdrawn from firm compounds. Use of the destruction of silicates through fluorine is made technically in glass etching. It is the sole halogen hydrogen compound which also attacks the generally indifferent silicic acid compounds: SiO2 + 4 HF = SiF4 + 2 H2O. Thereby is the possibility given for the mobilization of silicium in the organism through fluorine. This would show us the way to the first understanding of the extremely striking similarity of acidum fluoricum and calc. fluoricum with that of silicea. If the indicated silicea fails in its action perhaps because of overdosage, then according to homoeopathic experience the fluorine compounds render good service; one knows this type of therapeutic relationship in which two similar agents follow each other well in homoeopathy as a complementary relation. But only extremely rarely are the numerous complementary drug relations chemically so well established as in this case. On can consider that a deadlocked silicic acid metabolism is again mobilized or activated through fluorine if it is only converted at the place from the usual SiO2 into SiF4.
This exceptional position of fluorine in the halogen series is very important for the medicinal trend of effect, as can be perceived in the chemical connections to calcium and silicium, and, in any case, is associated with the fact that fluorine has the lowest ordinal number in the halogen series. Also in the other affinity series, at times, the element with the lowest atomic weight, whose valence electrons are believed to be on the first eight ring, comes to have a special position, as for example, magnesium in contrast to calcium, strontium and barium; and again lithium in contrast to sodium and potassium; or oxygen in contrast to sulphur, selenium, tellurium; or nitrogen in contrast to phosphorus, arsenic and antimony. On this also depends the greater tendency to complex molecular compounds.
APPEARANCE AND PHYSIOLOGIC ROLE
A very widespread, even though slight, content in fluorine goes through the entire organic and inorganic nature. It can be found in soils and water, in plants and animals. Geologically, it belongs to the lithosphere, especially as the calcium compound, CaF2, fluor spar, and as the complex sodium-aluminium compound cryolite. It is hard to say what role fluorine plays in inorganic nature and in the plants. In any case it enters the animal body by means of plants Naturally, in the newborn, small amounts are found in various tissues and this permits one to conclude the significance of a certain physiologic role for the element. The bones and teeth are richest in fluorine, and in the alter, more in the enamel than in the dentine, in the second line one finds it participating in the skin, hair, and nails and finally also the blood, muscles and brain. Again, in the results of the elementary analysis of the organism we find the first indication of the working direction of the substance. Naturally, we cannot conclude further examination from the appearance in that there is a physiologic effectiveness on, but still there is a certain amount of probability. But in any case it is very striking how much the supportive substance is favored. In feeding animals sodium fluoride, NaF, it is the bones and teeth which show many times the normal amount of fluorine. So it is also understandable that the fluorine content in man is found increased with older ages. The content in active fluorine need not be much greater and an increased deposition as complex calcium compounds in the tissues is to be considered. This presumes an inactivated deposited calcium salt; but it is not probable that with this the physiologic role is exhausted. To calcium comes the great significance of rendering harmless the extremely poisonous active fluorine ion and in this process a good part of active fluorine action may well rest upon a sudden withdrawal of active calcium ions. Recently an influence of fluorine on muscle function has been demonstrated. It promotes the esterfication of phosphoric acid with carbohydrates in muscle by the depression of lactic acid formation.
A noteworthy peculiarity is the habituation to fluorides. It has been demonstrated even for the lowest forms of life, for example, yeasts. One has employed this fact in order to make yeasts insensitive to fluorides and then to add disinfecting fluoride compounds and so render the yeasts free from other germs. According to H. Schulz, however, an habituation to fluorine effects also appears in man. It is noted in workers in glass factories in which fluoric acid is used. H. Schulz experimentally confirmed this with cats. From the experience in glass factories, fluorides have been recommended in beginning tuberculosis but without more than a symptomatic improvement being noted. Here one must think of the significance of calcium and silicia for the healing of tuberculosis.
SYMPTOMS OF INTOXICATION
The local and acute toxic actions of fluoric acid and the fluorides have as usual only a subordinate significance for our drug picture. Corrosions with fluoric acid on the skin give, in a slight degree, itching, burning, desquamation of the epidermis; in stronger grades, suppuration, vesicles filled with pus, indurated and slowly scarring ulcers. Two per cent sodium fluoride solution instilled into the conjunctival sac produces turbidity of the cornea, according to Tappeiner and, under certain conditions, scar formation. A corrosion of the upper part of the mucous membrane of the gastro-intestinal canal is the result of concentrated acidum fluoricum, but it may also develop with fluorides where an acid reaction exists, whereby fluoric acid is formed as in the stomach, and corrodes the mucous membrane. In fatal intoxication, the outstanding autopsy finding is the gastric corrosion. Burning and constriction of the esophagus, gastric pressure, eructations, vomiting and general weakness are the external evidences of this intoxication. Outside of vomiting, in studies with sodium fluoride in man and animals, marked salivation is noted, and nausea and headache in man when sodium fluoride has been used as a food preservative. In animal experiment, moreover, appear lachrymation and particularly all types of cramps (muscle trembling, periodic twitching, tonic contractions, trismus, general spasms), somnolence, general weakness, acceleration and deepening of the respiration, lowering, of blood pressure, slowing of the pulse. Tappeiner and Hugo Schulz, report also a nephritis from fluorides; and Siegfried, a focal fatty degeneration of the liver from sodium silico-fluoride.
More essential for us are the actions which have been demonstrated by small doses of fluorides continuously introduced. Since, earlier, when foods were preserved with sodium fluoride, nausea and headache and salivation had been observed, Rost studied this question by animal experimentation (according to the Handbuch der experimentellen Pharmak., Bd. III, p.287): In growing dogs an 8-12 weeks introduction of 0.2-0.5 g. of sodium fluoride daily produces in spite of a diet liberal in calcium a ricketic like process limited almost exclusively to the distal ends of the bones of the forearm and carpal joint, stiffness of the joint, and painfulness when the animal rises. In animals, fed in the same way but without the addition of sodium fluoride, the remainder of the litter remains healthy. The findings were the same in seven series of studies. In another but still unpublished study the author gave growing, meat fed dogs, after the eight week of life, gradually increasing amounts of sodium fluoride up to 0.5gm per day. In the bones and teeth of these animals were noted severe osteoplastic and osteoporotic alterations. At the site of attachment of muscle normally used frequently (as the carpal joint and the skull) thickenings developed in the form of crests or exostosis which finally became distinctly visible in the form of knobs. The teeth were carious and fragile; there were severe disturbances of the jaw. These bony and dental alterations, together with the already mentioned painfulness of the carpal joints on arising, were never absent in animals treated with sodium fluoride. Here we see the anatomic substrate of chronic fluoride intoxication exactly on those structures which are normally rich in fluorine, and, on the other side, we find good basis therein for the connections to bony formations which develop in the homoeopathic picture of action. Not only the connection of fluorine to calcium but also that to silicic acid can be of significance for it. In older animals treated with sodium fluoride, the deposit of white calcium fluoride was distinctly visible.