Persistent confusion, headaches, especially of a pressing and constricting type mostly at the vertex, as from a weight, worse from shaking and from alarm, worse after coitus and use of the eyes, better from lying down and from sleep; vertigo, worse at evening, on standing and walking, pains as though the eyeballs were pressed together and back into the head, impaired vision (in masturbators?) easily provoked visual disturbances, hypersensitivity to noises, complete the details of the picture. If calc. phosphor. is frequently used successfully in the headache of school children, so the phosphate fraction is the essential.
Easy premature falling out of the hair is known from phosphorus poisoning. It and alopecia areata are clinical indications for phosphoric acid. The hair also becomes grey prematurely. One might say that the phosphoric acid patient is subjected to grief, care, sorrow and depression to an unusual degree.
ORGAN AND METABOLIC SYMPTOMS
Especially important is the previously mentioned connection with the male sexual system and the phosphaturia. The excessive seminal discharge with impaired potency, prostatorrhoea on defecation indicate that atony prevails in phosphoric acid while in phosphorus the increased irritability is stressed in sharp contrast to sexual weakness.
The phosphaturia does not depend upon increased output in the urine from increased intake or increased phosphoric acid formation through protein destruction. Phosphaturia is better characterized as a calcariuria because in it there is
an increased excretion of calcium through urinary as well as intestinal organs. Furthermore this implies a disturbance of acid-base equilibrium, which is closely bound to the vegetative nervous system. Phosphaturia can be regarded exactly as a partial manifestation of a vegetative neurosis. Naturally one will not consider the therapeutic action of phosphoric acid or an alkali phosphate as a crude chemical balance but more in the sense of a change in vegetative processes. It need not involve a definite independent phosphaturia. More commonly the excretion of an alkaline urine, light in color, copious in amount and becoming turbid from the precipitation of earthy phosphates has been ever again reported as an indication for phosphoric acid when the typical nervous, particularly sexual-neurasthenic symptoms are present. The frequent nocturnal urination likewise belongs to these nervous symptoms.
The gastro-intestinal symptoms distinctly indicate their vegetative origin; white, watery, painless diarrhoea, not particularly exhausting, indeed, at times bringing considerable relief, with marked formation of gas, distention, fermentation, colic and abdominal noises. The conception of a disturbance of cation equilibrium associated with a vegetative disturbance from phosphates seems likely. Acid eructations, vomiting, sour rising belong to the same group. The complaint of gastric acidity however gains more significance with natrium phosphoricum. The dyspeptic disturbance of acidum phosphoricum is described in the following manner: “after each meal pressure in the stomach as if from a weight with sleepiness so that he can do nothing”.
The close connection of phosphates with calcium metabolism permits one to understand that phosphoric acid is also suitable for crude tissue disturbances, although here the calcium compound is more often employed. Thus the diarrhoea may have a ricketic basis. Acidum phosphoricum is particularly useful in periosteal inflammations with a severe pain, worse at night, “as if the bone had been stabbed with a knife” as well as for pains in amputation stumps. According to its entire rhythm acidum phosphoricum has a middle position between phosphorus and calc. phosphor. and this should be considered in its employment for tuberculous diarrhoeas or bone affections.
That acidum phosphoricum is preferred over pure phosphorus in diabetes has already been mentioned. In favor of the choice is the fact that a psychic factor essentially contributes in the etiology. The copious, light urine is an external simile relation; weakness and heaviness in the extremities has also proven itself in practice.
The clinical indications in the respiratory organs are very similar to those of phosphorus; however phosphoric acid lacks the hectic character of phosphorus while the apathy, stupefaction, stupor and adynamic type of fever stands more in the foreground. This fever together with a sleep from which the patient can be awakened by speaking, but gives only short answers because of the great need for rest, may assist in the choice of acidum phosphoricum in pneumonia as well as in typhoid. Profuse night and morning sweats are important accompanying manifestations.
A feeling of weakness in the chest on speaking, which also occurs in sternum, is mentioned by Hahnemann. Moreover, pressure behind the sternum which makes breathing difficult, dry cough from tickling in the chest, worse at evening, on lying down, hoarseness and a salty expectoration are cited as details.
The modality of relief from warmth refers chiefly to the chest symptoms. The nervous symptoms are improved by sleep, even when it is brief, as well as by moving in the open air.
Like phosphorus but sluggish.
Bodily and mental weakness and exhaustion.
Etiologic: grief, sexual excesses, lactation, too rapid growth, night sweats, diarrhoea.
Predominantly a picture of sexual neurasthenia with phosphaturia; sexual atonia; depression, apathy, inability to think. Better from sleep, even when it is short, and from moving in the open air.
Frequent nocturnal urination.
Painless, white, watery, not particularly exhausting diarrhoea (with considerable colic and gas). Complaints of gastric acidity.
Bone pains, “as though the bone was stabbed with a knife” worse at night. Amputation pains.
Diabetes. Psychic causes. Heaviness and weakness in the extremities.
Adynamic fever with stupor (pneumonia, typhoid); profuse night and morning sweats.
Chest symptoms (weakness in the chest, oppression of breathing, tickling cough) better from remaining in the warmth.
DOSE : The usual potencies are from the 1-6th; on the other hand Dahlke prefers the 12-30th.
The secondary alkaline disodium phosphate, Na2HPO4 is meant. It is not surprising that in sodium phosphate the gastro-intestinal symptoms stand in the center. This aspect of phosphate action is increased through the sodium component.
The chief indication is the complaint of acidity which occurs after the excessive ingestion of sugar and fat; sour taste, sour eructation, sour risings, sour vomiting. The diarrhoea is green or yellow, painless as with acidum phosphoricum.
Schussler conceives a connection to lactic acid and moreover to its decomposition into H2O and CO2. Natrium phosphoricum should therefore be directed against excess of lactic acid and should also be a suitable remedy for diabetes. As a further characteristic he reports a yellow color of coatings and secretions, in particular a thick yellow coating on the tongue and generally over the posterior part of the mouth; likewise the ocular and nasal secretions, expectoration and leucorrhoea should have this yellow creamy nature and moreover the coating on ulcers. Schussler even proceeds farther from the totally unproven conception that natrium phosphoricum has a particular relation to the white blood cell picture, that it is indicated in swelling of the lymph-glands, and even a remedy for leukemia. If one compares the results of Farrington’s proving on 19 provers and almost exclusively with potencies, including the very high, then practically nothing can be found therein to confirm this indication. The clinically proven report of “sour burning” was discovered by Neidhard.
If the provings, at present very scanty, are reviewed then the agreement with those of natrium carbonicum and phosphoric acid is very great. The depression, particularly after the loss of semen, anxiety and poor memory, especially recall phosphoric acid. Dilatation of the pupil is a special report which has also been made for acidum phosphoricum. Just as phosphoric acid, so natrium phosphoricum has frequent nocturnal emissions which are followed by weakness of the back and trembling of the knees.
A further trend of action is alleged to be available for gouty rheumatic disorders. According to Schussler natrium phosphoricum should keep the urates in the blood dissolved and absence of natrium phosphoricum should give the occasion for the precipitation of urates. There is not the least basis for such a hypothesis. From the symptoms of the proving, a series of symptoms referred to the muscles and joints, in particular synovial crepitation, exists; clicking in the joints is often reported; but it has not been confirmed that a gouty-rheumatic trend of natrium phosphoricum has more definite clinical significance than the other alkaline salts.
How the clinical reports of oxaluria and jaundice have come into the clinical picture of natr. phos. is not apparent. Natrium sulfuricum has more claim to consideration for a liver action in any case. The origin of the recommendation in morphinism (H. Schulz) is likewise unclear. The administration in large doses in Basedow’s disease by Kocher has been mentioned above.
Thus for the present only the acid burning remains as a sure clinical indication for natrium phosphoricum. Whether the report of Schussler about the yellow creamy secretions will be confirmed must be left undecided at present. The general actions in common with acidum phosphoricum or natrium carbonicum are not expressed so characteristically that one should give preference to natrium phosphoricum over these remedies in definite cases.
DOSE : The most commonly employed dose is the D 6.
The acid monopotassium phosphate, KH2PO4 is the preparation meant. In kali phos. both constituents unite in their actions to form the picture of muscular and nervous exhaustion as it arises partly from over work and partly from phsychic causes. The mental state consists of marked anxiety, depression, bad memory and downcast nature particularly from acidum phosphoricum. To this potassium adds a note of nervous irritability because we know besides the anxiety and fearfulness also the “critical”, irritable, restless disposition from potassium. Kali phos. has proven valuable in brain fatigue from excessive study. Generally the early morning aggravation, as well as from cold, is traced back to the potassium influence; aggravation after coitus is common to both components. The association with sexual weakness exists here as with acidum phosphoricum. Sticking pains, sensation of numbness, motor weakness up to paretic states, weakness and sensation of cold in the back, trembling (especially in the calves) are signs of potassium; the same is true of the weakness of the bladder sphincter and enuresis.
The diarrhoea of kali. phos. is present in the early morning on arising, is worse after eating and shows its vegetative character by a dependence upon nervous factors. Colitis mucosa is an indication given by Schussler. A decomposed odor to the stool is cited as a peculiarity.
Generally still another special trend to decompostition processes is ascribed to kali phos., this apparently originating from the report of Schussler since he has recommended the remedy in septic states with fever and hemorrhage, carbuncles, typhoid and typhoid-like fevers, scurvy, noma, phagedenic chancre, gangrenous states, etc. We need not attribute much significance to this side of the kali phos picture. It is entirely clear that for the trend of Schussler with its minimal materia medica of 12 or rather 11 remedies, a breadth of clinical indications are attributed to a single remedy which can be scarcely justified. If one will refer to phosphorus, for example, a greater part of its indications have been taken over for the phosphate; entirely apart from this, we possess a large series of much more active remedies in these septic and adynamic states. It is similar for the clinical indication of albuminuric retinitis and gastric ulcer where we prefer phosphorus and in alopecia areata where we may use acidum phosphoricum. Kali phos., just as acidum phosphoricum, is much better when selected as a remedy in convalescence after severe septic and especially typhoidal diseases.
A further report from the proving of H.C. Allen that all secretions, stools, urine, sputum, and nasal secretion should have an orange-yellow color requires considerable confirmation.
Generally kali phos. will be selected when the muscular and nervous exhaustion is combined with neurasthenic-depressive states showing definite relation to the kali component, particularly in the modalities.
DOSE : The most commonly used is the 6th decimal.
Arsenic is a “chalkophilic” element, that is, its characteristic site of deposit is in the sulphur-oxygen shell of the earth. Thus it appears in the lithosphere only in traces in the sulphide compounds (orpiment and realgar), moreover, compactly in crystalline pieces and in combination with heavy metals and their sulphides. In the lithosphere it does not have the possibility of stabilization by precipitation with calcium as does phosphorus. As a rare element with an uneven ordinal number, it finds no special conditions for enrichment in the lithosphere; it also remains “foreign” to the organism, that is, it is not enriched by natural selection and combination.
Arsenic appears in a number of springs and is used therapeutically in this way.
For example the Durkheimer Maxquelle contains 19.6 mg. As2O3 in a liter and most of the other springs are iron-arsenic waters, Levico, 6 mg, Val sinstra 3.7 mg, Roncegno 42.6 mg. Guberquelle 6 mg. As2O3 per liter.
There are two allotropic modifications of the element, exactly as with phosphorus. The yellow arsenic corresponds to the yellow or colorless phosphorus and is a typical non-metal (molecular size As2). It is volatile even at low temperatures and has a garlic- like odor. Like yellow phosphorus it acts strongly, reducing even more rapidly than yellow phosphorus it is transformed by light (especially by short waves) or by warming into the metallic modification, which corresponds to red phosphorus. Metallic arsenic which conducts electricity is grey, black or brown and is stabile at ordinary temperatures.
From arsenic-containing soils arsenic passes into plants and for this reason it is not surprising that the animal body, likewise the human, contains light traces. Gautier in particular has found it regularly in the thyroid moreover in the thymus, the brain and in traces in the skin and hair and he ascribed a physiologic role to it. It is said to leave the body in men through the hair and in women with the menstrual blood and milk, It remains longest in the hair. Bertrand goes so far as to give all cells an arsenic content. But later investigations have shown that the occurrence of arsenic in the body is not so regular. In any case it is not proven that arsenic is a physiologically necessary constituent of the organism. It is conceivable that the ingestion of traces of arsenic in the food varies according to geologic conditions. Moreover the arsenic containing smoke or coal comes into consideration as a source. The hair of men who live in the English manufacturing cities regularly contains arsenic in traces while the hair of people in regions where peat is burned is always free from arsenic.
Even if arsenic is not a physiologically necessary constituent of the body, still frequently traces are found in the normal and it is remarkable that the thyroid seems to be the depot while the skin and accessory structures are excretory sites with definite affinity.
When we speak pharmacologically of arsenic we always mean arsenious acid or its anhydride As2O3, (H3AsO3)2 – 3 H2O arsenic trioxide. It appears in an amorphous or crystalline form. The arsenites correspond to the phosphites and they stand in the same relation to arsenates as phosphites to phosphates. Qualitatively the arsenates, also the AsO4 anion, have the same action as the arsenites but the toxic manifestations with the arsenates appear much more slowly, a property which closely recalls the behavior of the oxidation steps of phosphorus.
The toxic action of arsenic acid is much less than that of arsenious acid. It has even been assumed that the arsenates can only unfold a toxic action by reduction to arsenites. If arsenic acid is introduced into the body then it is reduced to arsenious acid. H. Schulz and Binz proved that this reduction does not occur outside the body, that is, not with chicken protein by itself. If arsenic acid is injected subcutaneously then it is reduced to arsenious acid and the 66 Percent or more is excreted through the kidneys. The toxicity of arsenious acid to arsenic acid should be in a ratio of 10:6. Apart from the small intestine, the liver is said to particularly participate in this reduction. One has made the easily split out hydrogen of the SH group responsible for the reduction. In any case the danger in arsenites is that they will not be oxidized to arsenates in the body, while phosphites will be transformed to phosphates.
In the body the arsenic is probably combined to the nucleins. At least arsenic combines with the liver nucleins in a very stabile compound which is easily split by acids or through alkalies. In the blood arsenic is bound by absorption to the blood corpuscles for the most part.
It has been assumed that arsenic can appear in place of phosphorus in its physiologic compounds, especially in calcium phosphate of the bones, in the phosphatides, and the phosphorus- containing nucleins and in this way can be deposited and unfold its toxic action upon the cells. As yet the substitution has not been proven. But in any case the chemical similarity of phosphorus and arsenic stands so close even in their pathologic effects that one can consider arsenic as a dangerous double of the physiologic phosphates. Its toxic actions are remarkably similar to those of imperfectly oxidized phosphorus; as a protoplasmic and capillary poison especially in the acute actions, as nerve and bone poison in the more chronic poisonings. The conjecture seems likely that arsenic unfolds its destructive action just as unoxidized or incompletely oxidized phosphorus along the track of the physiological phosphates.
In arsenic poisoning the liver and kidneys contain the most arsenic; then follow muscles, bones, brain. In acute poisoning it remains longest in the bones, in chronic most in the liver although it will be found even longer in the skin and its appendages; the spleen likewise takes up relatively large amounts, the heart muscle more than skeletal muscle.
The excretion of arsenic occurs through the kidneys, the gastro- intestinal mucous membrane (also after parenteral administration) the bile, the milk glands, the sweat glands, the skin and epidermoidal structures (hair, nails).
The local actions of arsenic on the mucous membrane must be considered as inflammation and slow necrosis. Because arsenious acid lacks the chemical properties for a characteristic corrosive action, that is protein precipitation. The necrotizing cell actions are used for the destruction of dental pulp. The epithelial mucous membrane alterations by arsenic (protoplasmic atrophy, vesicular turbidity of the cell nucleus; finally the entire cell becomes a homogeneous transparent mass, leucocytic infiltration and serous imbibition) appear only gradually after some hours. The turbidity of epithelium has also a capillary, inflammatory cause which leads to cell death from saturated solutions of arsenic.
By subcutaneous injection one can effect suppuration and tissue necrosis with dilute solutions. Repeated application to the external skin can provoke an eczema.
Arsenic can destroy any cell of the human organism which it reaches in sufficient concentration. But only the acute or chronic introduction practiced in the favored manner makes the series of results and the intensity of the disturbing actions comprehensible.
The action in an acute poisoning is greatly dependent upon the form of the arsenic introduced. Thus it is observed that horses die in a definite time after the ingestion of 2 grams of the dissolved and only after 64 grams of the solid form of arsenious acid. First it arts a marked local irritating action on the part of the mucous membrane with which it comes in contact. If the poison is taken into the empty stomach in an easily absorbed form then stormy manifestations soon appear. Dryness, severe burning in the mouth, in some a metallic taste are noted. “The poisoned are overcome by a cold paroxysm, an intolerable anxiety, vomiting, oppression in the chest, a cold agonizing sweat on the forehead and a general trembling of the extremities alternating with one another. The most severe pains are felt throughout the entire digestive tract, salivation, soon vomiting which is at first colored green due to the admixture of bile, but later may contain some streaks of blood and diarrhoea. The liquid stools are bloody or like rice water, marked tenesmus is added. The abdomen is at first retracted then distended. Severe thirst with great dryness of the mouth, esophageal spasms may appear; the uvula swells and aphthous ulcerations are observed on the tongue and oral mucous membrane. The face becomes cyanotic, the eyes encircled with dark rings, puffy, the skin, in particular the hands, feet and tip of the nose, become cold. In the calves and hands severe spasms occur. The pulse is accelerated, small, and thready. There is precordial anxiety. “The unspeakable anxiety and the burning, tearing overwhelming pain at the pit of the stomach torments with increasing severity”. Respiration is labored, the patient collapses and the sweat may smell like arseniuretted hydrogen. If the course is longer owing to slower absorption or smaller doses then the vomiting is repeated every day or two, esophageal complaints, boring gastric pain, unquenchable thirst, petechial hemorrhages and mucous membrane aphthae appear. Erythema, eczema, urticaria-like skin eruptions are observed after internal administration. They usually involve the face but may occur on the entire body. It may result in extensive desquamation and loss of hair. Icterus is also observed. Finally there is jactation, delirium, loss of consciousness. The urine is scanty, bloody and contains albumin; death occurs with convulsions and trismus. With very large doses a severe even fatal collapse may occur within 12 hours after the administration or even sooner, or the cholera- like picture of asphyxia arsenicalis may be seen. In other cases the cerebrospinal symptoms stand in the foreground: vertigo, stupefaction, head and body pains, anesthesia and paraesthesia partial paralysis.
The chronic poisoning may progress in various stages without the picture always being a complete one. Increased salivary secretion is often an early symptom; the bronchial secretion is also increased and tenacious. The patient emaciates, the facies often presents a greydun color, at times is somewhat icteric and more rarely bronze-like, or, particularly in brunettes darkly pigmented “spots”, “arsencial melanosis” are noted. Petechial hemorrhages appear. Angina is often encountered and with it a mild conjunctivitis even from the first doses. The gums are lividly discolored and bleed easily. The skin becomes dry, desquamates, erythema appears, the hair, nails and teeth may fall out. Vasomotor disturbances appear in the form of marked sweating of the hands, legs and feet and there is is light cyanosis of the upper and lower extremities. Trophic disturbances with gangrene are rare. The patient complains of vomiting, unpleasant taste in the mouth, headache, burning in the palms, yellow discoloration of the eyes, gastric pressure, constipation or at times bloody diarrhoea; they feel weak and prostrated. The appetite disappears entirely, mild febrile attacks occur paroxysmally or there is a feeling of fever without increased temperature, dull headache, a sensation of vertigo, pressing pains over the eyes, some nocturnal insomnia, and old rheumatic complaints may again become manifest. The patient is depressed without reason, cries easily and is easily irritated.