Every time that a physician has a patient before him, whether in the consulting office or at the bedside, there are two problems he must solve, two different studies he has to undertake: to make a diagnosis and to select a remedy. And I say a remedy, diagnosis and to select a remedy. And I say a remedy, meaning internal medication, because it is the duty of the practitioner, in my opinion, to begin his treatment with a remedy even if his case falls within the field of a surgical procedure or any other physical aid. For surgery, as well as any form or method of physiotherapy, should be nothing else but auxiliary measures to the fundamental treatment which is the internal medication.
In making the diagnosis of his case the physician comes to a point when he has to draw his final conclusions from a differential study of the conditions which bear similarity to his case, unless it is to simple as to be diagnosed at first glance.
In studying his case for the selection of the remedy he also has to make a a differential study of remedies in order to find the similimum. It is very seldom that the picture of the case is so clear that none other but the indicated remedy comes to mind.
The success of the prescriber depends on his ability to rapidly establish the differences between the remedies that come to his mind while studying his case, in order to determine which is the one that covers the greatest number of symptoms. And while considering the symptoms it is not only a matter of numbers, but he must also be able to properly distinguish their importance and classify them accordingly.
Thence the study of the materia medica should be by means of comparisons between remedies, that is, a study of a Differential Materia Medica.
Complying with the wishes of our Chairman we must endeavor ourselves to study here the Differential Materia Medica of Nitric Acid.
To make a differential study of a remedy is to bring out its characteristic nature or conditions among all other remedies that may resemble its mode of action. There are two different kinds of remedy relationship: the natural relationship and the clinical relationship. The latter may be complementary, antidotal, inimical, compatible, before and after the given remedy, or incompatible.
We find the natural relationships of Nitric acid among the acids, and especially among the mineral acids.
All acids, cause great debility, but it is greater when producer by mineral acids which also originate a scorbutic state of the system, with manifest tendency to ulcers and low forms of disease: typhoid diseases. Vegetable acids show more of a tendency to produce membrane exudations in the throat.
Besides Nitric acid we have among the mineral acids: Muriatic, Sulphuric, Carbolic, Arsenious, Fluoric, Hydrocyanic, Benzoic, Phosphoric and Picric.
Muriatic or Hydrochloric acid affects mainly: the blood, the mucous membranes, the brain center which regulates the supply of hydrochloric acid to the gastric juice; the Peyers patches in the small intestine, the salivary glands, the skin.
Sulphuric acid acts mostly on the mucous membranes of both the alimentary canal and the respiratory tract.
Carbolic acid affects: the respiratory center in the brain and the peripheral nerve endings, the gastrointestinal mucous membranes, the blood and the skin.
Arsenious acid or Arsenicum album, one of our great polychrests, with a much wider sphere of action, acts – mainly on the nervous system, altering the function of the pneumogastric, the respiratory centers, the fifth nerve, the motor and sensory endings, the vasomotor centers and nerves, the motor tract of the spinal cord, the solar plexus, the ganglia of the heart and the emotional centers, also affecting the functions of the heart and the emotional centers, also affecting the functions of the heart, kidneys, lungs, digestive and generative organs. It also acts on the mucous and serous membranes and the blood.
Fluoric acid has an action principally on the bones, skin and lymphatic glands.
Hydrocyanic or Prussic acid affects the nervous system in its respiratory center; the origin of the pneumogastric, the motor centers including the vasomotor and nerves, the automatic nerve centers of the heart and the peripheric sensory nerves; it also has a disorganizing effect on the blood, destroying its fibrin element.
Benzoic acid acts mainly on the urinary organs producing a strong smelling urine, and on the small joints, heart and bowels.
Phosphoric acid manifests its effects on the nervous system, especially on the motor and emotional centers; on the bones and mucous membrane of the digestive tract and on the generative organs.
Picric acid is characteristic for its action on the central nervous system, mainly causing brain fag and neurasthenia, and for its action on the male sexual organs.
Nitric acid acts more on the mucous membranes, with a special affinity for the mucocutaneous outlets of the body, and the acid sections of the gastrointestinal canal: the stomach and the large intestine, the glandular system, mainly the lymphatic and salivary glands and the liver; the kidneys, the blood, the skin and the bones. So much for the nature relationships of Nitric acid.
The clinical relationships are the most important for the physician, and a good size volume could be written if we were to study all the remedies that by acting on the mucous membranes, the glands, the kidneys, the liver, the skin, the bones and the blood, produce similar conditions to those caused by Nitric acid. The limitations of a paper forbid such undertaking.
We aim only to mention those remedies which, by acting on the same organs or tissues that Nitric acid affects, often come to our mind when taking the case, those remedies from which we must distinguish Nitric acid.
Nitric acid is at once antipsoric, antisycotic and antisyphilitic, and here we think of Causticum; but Causticum, although better suited to dark haired people like Nitric, acid, acts mainly on the respiratory organs, motor nerves, muscles of the bladder and larynx even causing paralysis, and we already know that Nitric acid has a special affinity for the gastrointestinal mucous membranes, the glands, the skin, kidneys, live; and we are more apt to find its lesions on the margins of the outlets.
Mercury is another remedy related to Nitric acid, although it acts better on light haired people; but Nitric acid is more indicated after Mercury, and more so when the latter has been abused. Like Aurum metallicum it has a most brilliant action on syphilitic cases overdosed with Mercury; but Aurum met. mostly when the bones have been affected. Nitric acid has also the found useful in cases largely treated allopathically with potassium iodide. Hepar sulph. is another remedy which is as good an antidote for the abuse of mercury; but “when mercurialization is conjoined with syphilis, Nitric acid is the preferable remedy,” as Farrington says.
Both Mercury and Nitric acid have much pain during and after stool, but the pain of Nitric acid lasts for hours after. The stool in both remedies is slimy and greenish, but is more offensive and more excoriating in Nitric acid, which has besides “borborygmus as if a boiler were working in bowels”, and the patient is physically exhausted after the bowels,” and the patient is physically exhausted after the stool. Here Nux vomica comes to mind because although it may have a great deal of rectal pain before and during the stool, like the other two remedies, it is all gone after the movement.
One of the most outstanding peculiarities of Nitric acid, one that always, when found in a case, focuses our attention to the remedy, one that is always present, it – does not matter where localized, is its aggravation by a slight touch,m but the pain giving always a sensation as being produced by a splinter. Ulcers, which by the way are offensive, granulating, bleeding easily, are characteristically irregular in outline, tending to dip deeply in Nitric acid-and here again, another difference from Mercury which produces flat superficial ulcers-are always painful when touched, giving the sensation of a sharp point sticking into the tissues.
Three remedies have been mentioned as complementary to Nitric acid: Arum triphyllum, Caladium and Arsenicum album, and it is interesting to note that the latter has already been mentioned as one of Nitric acids natural relationships; but the other two bear a mutual natural relationship between themselves; they are plants that belong to the order of the Aracea.
Studying the first of these three remedies, we find that both Nitric acid and Arum triphyllum are very useful in low typhoid forms of diseases with a high degree of toxicity. They are champions in the treatment of malignant types of scarlet fever and diphtheria. Both have very offensive and excoriating discharges from nose and throat; the nostrils and upper lip are raw and painful, but more so when touched in Nitric acid with the splinter-like sensation, while Arum gives us a peculiar symptom which facilitates the differentiation: the child is constantly picking at and boring his finger into his nose.
Two years ago I had the opportunity of saving the life of a child, guided mainly by this symptom. It was a very serious case of laryngeal and nasal diphtheria; the child, a little girl three years old, twice collapsed with asphyxia and I had to resort on both occasions to laryngeal intubation. After succeeding the second time in restoring the childs restoration I noticed that she was picking at her nose, boring her finger inside. I asked the parents if she had been doing that before and the answer was, “Yes, Doctor, she does that all the time.” I recalled then that only two other remedies have a similar symptom, Lycopodium and Cina, but neither has the offensive and excoriating discharge that we find in Arum.
Arum 200 in half a glass of boiled water was prepared and teaspoonfuls given as often as necessary. That prevented the repetition of the attacks of asphyxia and effected the complete cure of the child.
Caladium seguinum resembles Nitric acid by being another antidote to Mercury. It also has sensation of stitches like needles in various parts of the body, but not necessarily when touched; yet the abdomen is sore and pimples on the scalp are sensitive when touched. It also has an intensely irritating effects on mucous membranes. Some authors consider Caladium as the only complementary remedy to Nitric acid.
Arsenicum album is another remedy of which we think in low types of diseases. Like Nitric acid it has an irritating effect on mucous membranes producing excoriating discharges; but the peculiar symptoms of Arsenic are so characteristics and so well known that really there is no need of mentioning them here, for seldom will we have trouble in recognizing its characteristics.
Arsenic may have a strongly acid urine which produces a burning pain in the urethra when voided; but so is the case in Nitric acid and in this remedy the urine and stools may be so irritating that the skin of the whole perineum and even the skin of the inner surface of the thighs may show extensive excoriations, the urine having a very strong ammoniacal door, like the urine of horses. And this symptom reminds us of another good remedy, another acid-Benzoic acid, which has an even stronger smelling urine, although not quite so irritating. Haematuria is another indication for Nitric, acid, especially when there is a passage of pure blood distinctly separated from the urine.
In case of phthisis, Nitric acid has a wide field of action, and follows well two other great antipsorics, Calc. carb. and Kali carb. The suffocating action of its fumes clearly shows the electivity of Nitric acid for the respiratory organs.
Now, since we could not go on with the study of all remedies which are in some way related to Nitric acid, here is a list of those most important.
You will please excuse the repetition of those already mentioned, but the list will not be complete without them.
COMPLEMENTARY REMEDIES : Calad., Arum triph. and Arsenicum alb.
REMEDIES IT IS ANTIDOTED BY : Calc. carb., Hepar sulph. calc., Merc., Mez., Sulph.
REMEDIES IT ANTIDOTES: Calc. carb., Dig., Merc.
REMEDIES THAT ARE COMPATIBLE, IF GIVEN BEFORE : Calc. carb., Kali carb. (phthisis), Puls., Sulph., Arnica, Kreos., Secale.
REMEDIES THAT ARE A COMPATIBLE WHEN GIVEN AFTER: Calc. carb., Kali carb. (phthisis), Puls., Sulph., Arnica, Kreos., Secale.
REMEDIES THAT ARE COMPATIBLE WHEN GIVEN AFTER: Calc. carb., Aurum met., Carbo an., Hepar sulph., Natrum carb., Puls., Sulph., Thuja.
INCOMPATIBLE OR INIMICAL: Lachesis is the only one.
REMEDIES THAT MAY ALSO BE COMPARED: Med., Sulph., Psor., Mur. ac., Nit. mur. ac., Iod. and Caust. in dark haired people; Graph. in amelioration by riding in a carriage (although Graph. is not a sensitive remedy while Nit. ac. is); Arnica, Rhus, Hyper. and Calc. in spinal injuries; Ledum in punctured wounds; Lach., Nat. mur. and Sulph., because they also < when awaking; Carbo veg., Calc. phos. and Nat. carb. for the < by pressure of that; Magnetis polus australis in ingrowing toenail; Kali bi. in stringy leucorrhoea; Bell. and Lyc. because toenail; Kali bi. in stringy leucorrhoea; Bell. and Lyc. because of pains that appear and disappear suddenly; Acon., Cham. and Hepar for violent pains;
Hepar compares for its sensitiveness; Nat. mur. and Nit. sp. dulc. in dyspepsia from effects of salt; Benzoic acid for the strong odor of urine; Petroleum for brownish scattered spots in dark haired people; Arg. nit., Hepar and Sulph. for splinter-like pains; Merc., Sulph., Cham., Ars., Puls., Syph., China and Nux vom. for sore excoriated anus; Sil. and Calc. carb. for ulcers threatening to perforate in cornea; Thuja for condylomata, enlarged tonsils (syphilitic or sycotic), fissures, greenish leucorrhoea; Anac. for the disposition to swear; Arum triph. for diphtheria, sore mouth and scarlatina.
Let us finish by summing up a clinical picture of Nitric acid.
It acts mainly on the mucous membranes, especially at the seat of the mucocutaneous junctions, and on the glands and bones, producing irritation, destructive ulcerations, going on even to gangrene.
The two great characteristics are: offensive, excoriating discharges, and splinter-like pains.
There is, for instance, an offensive, excoriating discharge from the nose, accompanied by nosebleed and offensive, odor, hard plugs which, when detached, leaves a raw surface. And in the throat Nitric acid gives us the sensation of a splinter, fishbone or piece of glass and produces ulcers with offensive discharge and odor. Ulcers anywhere are irregular, deep and filled with grandulations, bleed on slightest touch, have sticking pains in them and burn violently.
The stools, which are passed only with a great deal of straining, are offensive and greenish, causing soreness about the anus where fissures and ulcerations may develop.
The irritating urine that smells as strong as that of a horse causes tenesmus and burnings along the urethra when voided, with voided, with a sensation as if needles were sticking through the tissues. It antidotes, the restlessness, mental anxiety, periosteal pains, the ophthalmia, ptyalism, ulceration of the mouth and throat and even the caries of bones produced by Mercury.
The cough of Nitric acid is a dry tickling cough, with night aggravation, often starting at a localized spot in the larynx.
Its indications in pulmonary tuberculosis are: difficult, green, purulent expectoration; night sweats; soreness of chest; haemorrhages; dyspnoea and hoarseness < at night.
A very good remedy in typhoid fever, when the stools are greenish, offensive and slimy; there are intestinal haemorrhages; fainting from least motion; threatened paralysis of the lungs, with rattling breathing and intermittent pulse.
MONTERREY, N.L., MEXICO.
DR. BRYANT: I should like to call your attention to one cure I made with Nitric acid.
Maybe I was too lazy to study the differential diagnosis of these remedies. Dr.Trevino has saved me all that trouble. This individual came to me in a very discouraged state, telling me he had been with the regular school of medicine for two or three years for an old syphilitic necrosis of the nose, particularly the septum. I asked him what he been taking, and Dr. Trevino brought out very nicely that these Nitric acid indications following a long treatment of mercury and potassium iodide-I prescribed the 10M. The odor from his nose was something terrible. In facts, when he reached the reception room the girls reported to me there was a terrible stench in the reception room, and asked me what to do about it. I told them to take the stomach around the back and bring him in the rear.
I was in a hurry, and I prescribed Nitric acid on what superficial symptoms I saw. Two weeks after that he came back odor free. That one prescription did the work. This man was in financial distress. I had charged him three dollars for the prescription. He disappeared and I never saw him again, but I had letters from him after that nearly every two months over a period of period of several years and, much to my surprise, the letter said almost the same thing each time: “I cannot fathom my recovery. I am enclosing a check for twenty dollars.” I think I collected 200 before I got through.
DR. GRIMMER: I want to say I can confirm the observations Dr. Trevino made in several such cases, where the ulcerations are extensive and the destruction of tissue goes on.
One man had the whole antrum eaten out. Part of his whole face, his nose and antrum, was falling in. Nitric acid in a series of doses has healed that over. Of course, some of the lost tissue will never be recovered, but he is well.
Another man, who had undergone extensive treatment of the arsenicals by injection, was constantly getting worse until he got Nitric acid, when the ulcerated processes of the throat and nose ceased and he got well.
DR. KLINETOP : Before I graduated, I was sent to see case in Chicago in the out-clinic. A girl of about ten years old had a very severe use of tonsillitis. I looked her over, and prescribed of course. I have her a CM. of Nitric acid. She did so well that finally the father said, “I want to give you something. If you will tell me where you are going to locate, I will send you a shingle, painted.” He was a painter by trade. He sent me my shingle afterward, for that prescription.
DR. MOORE: I will give you just one very short case. You might strike this some time. Nitric acid worked after two other remedies failed. This man, without any inflammation in his throat, could not swallow water. He was given a remedy, but on the next day the could not swallow water, and on the third day he couldnt swallow water, solids, or anything. There was no inflammation of that throat, and Nitric acid cured it like that.
DR. FARRINGTON: I once cured a case of Vincents angina with Nitric acid on the classical symptoms that are contained in Dr. Trevinos excellent paper. The paper was well written and contains a number of very interesting things, and points a few lessons. For instance, he calls attention to the sequences in those remedies which are related, often following Nitric acid, something which at times when we are busy we are apt to overlook.
There was one statement in the paper in which I particularly interested. You will remember he said the inhalation of fumes of nitric acid was irritating, and this established the fact of Nitric acid as a remedy in irritation or inflammation of membranes. A number of times I have thought of this, and I want to see if others of you have had any ideas on the same line. There seems line. There seems to be a remarkable similarity between the chemical or local effects of drugs and their dynamic effects.
Actual nitric acid fumes will cause conditions in the respiratory tract. That has been found in provers, and also in cases where their use is indicated. Arsenicum acid cause a superficial serpiginous, burning ulcer when applied to the membranes. The potencies will cure a similar condition. Kali bichromicum is apt to produce round holes like punched-out ulcers, and we all know how quickly it will heal the ulcers when indicated by the symptoms. Argyrol applied to mucous membrane will cause very superficial ulceration. When treating nasal and other conditions, we know this remedy in potency is best suited to a similar pathological state. I could go on and give some more remedies along those lines.
Dr. Trevino did not mention Ignatia in pain, lasting long after the stool has passed. Otherwise, the two remedies have very little in common. I once cured a man of haemorrhoids with Ignatia, and he had this among other symptoms. He came only once, and got one dose of the 10,000th. Several weeks passed. I remembered the case and thought to myself. “Like all the rest, he thought the condition was surgical and isnt coming back again.”.
He called me up the same day and said, “Doc, I want to thank you for giving me that little bottle of pills. It cured those haemorrhoids in short order. In fact, I took only two or three doses out of the bottle, and then lost it. I hope some poor devil found it who needed it as much as I did.”.
DR. RICE: At one time, in my city practice I made considerable in treating gonorrhoea. I expected to get enough cases of that kind to pay my office expenses at least, because every case I got I got I explained to the man why I could not use injections. By the time I got through with him, he felt so well, the treatment having eliminated all the other poisons in his system at the same time, that he sent me another case. It paid well, and pain my conscience, because I felt surely I was rendering a service to him and to the public.