Nitricum acidum

Volume I — Main text

ACIDUM NITRICUM.

Nitric acid, NO^. — Result of distillation of natural nitrate of *soda or potash (hence old name Nitri acidum) with sulphuric a^cid,

L Provings. — I, H A HK EM AN N% CArWf /)fVtfj^'^ Part iv of original, vol, of English translation. Contains 1424 symptoms, of which about 1200 are his own, 200 from fellow-observers, and 30 from authors,

2 In Sept., 1793, I began to take nitric acid. On the iith^took at different times about 3J of strong acid diluted with water. Soon after taking it felt sense of warmth in stomach and chest, but no disagreeable sensation or other material effect* On 2nd d.,took considerable quantity of diluted acid, as much as could easily be drunk in forenoon^ and continued so to do for 4 d* more. On 3rd d. felt gums affected ; they were somewhat red and enlarged between teeth. Slept ill, but could lie for length of time on 1. side, which, from some affection of liver, had not been the case for many months before. Pain at back of head resembling that which I have commonly felt when taking mercury. On 4th d,, gums a little tender. Pain still in head, and also about jaws. On 5th d,, slight salivation. On 6th d., yet more, and mouth sore. On 7th d., mouth so troublesome that I shall take no more acid. On omitting it, mouth gradually got well. (Scott, Duncan's AnnaU^ i^ 379.)

1. 11.30 a.m. Health normal, pulse 78, regular; took 10 drops of fuming acid in half glass of water (Jij). Soon pressure and heaviness in forehead, with darting pains in ears and vertigo. Can walk straight only by an effort. These symptoms attended by chilliness and nausea. 12. Nausea increased to vomiting, with pain in mouth, throat, and stomach. Vision obscured. Eyes feel hot and excoriated. Feeling of intoxication continues : vomited once only, but repeated and constant retching followed. 12.15. Burning pain in bladder and

call to urinate; urine scalding. 12.30. Urinated again, scant and hot. During aft. repeated urination, odour strong. Towards e. drawing pains in back and loins. Pulse 68, weak. 5.30. Desire for stool, no relief. 7. Difficult stool with straining and burning in rectum. 2nd d. — Sleep was restless and uneasy; waked with pain in head and cervical region. Chilliness and shuddering even when near hot stove (temp, and pulse not taken). 7 a.m. Passive epistaxis, dark blood. Desire for stool, no relief; urinary symptoms continue. 1 1. Rheumatic pains and drawing from knee to groin, with soreness of testes. 12. Indisposed to read or study. 3rd d. — Pulse slow and irregular ; feel very languid with continued chilliness : two diarrhceic stools during morning, with tenesmus ; occasional loose cough. 4th d. — Dark red papular eruption in clusters on various parts of trunk and neck, with soreness and itching : this continued for nearly a week. Otherwise well. (W. H. Willson, M.D., communicated,)

1. 10 a.m. Health good, pulse 76 ; took 18 drops of ix in water. 10.15. Fulness of head with dull headache. 10.30. Increased pressure in head with inabih'ty to apply mind ; face pale ; veins turgid and swollen. 10.35. Respirations laboured and impeded ; surface of body cold to touch. II. Drowsy, with neuralgic pains in r. supra-orbital region and car. 11.15. Passed normal urine (unusual hour); hands and feet cold and sweaty (no cause). 11.30. Urinated again, scant and strong odour. 12. Pressure in head and neuralgic pains continue, with wavering of objects before the eves. Mouth and lips dry ; tonj^ue feels scalded, tip and edges very red. 12.30. Fulness and oppression of chest and epigastrium is somewhat relieved ; normal warmth has returned. 2nd d. — Restless and sleepless at night : waked with full pressing headache involving eyes. Desire to urinate was frequent, and flow irritating for 2 d. following. Otherwise seemed welL (R. H. Curtis, M.D., communicated.)

2. Mrs. took one m. a few drops of the dilute nitric acid

of the B. P. In afternoon, slight aching in both feet and leg^ up to hips ; felt as if she had taken cold in them. Woke early next m. with deep-seated bitter coldness of same parts and deep-seated feeling as if dogs were gnawing flesh and bones, and as if sinews were being pulled up. All these sensations worse in feet and thighs. Kept her awake rest of night ; not relieved by position or movement^ relieved for time by hard rubbing. After breakfast they suddenly disappeared, leaving parts tender to touch, and as if clothes were too heavy for them. With the coldness there was chattering of teeth for I h. Towards m., also, there was violent pain like throbbing or hammering on 1. side of head, coming on gradually. It began near vertex, descending to region of I. ear; then went gradually over vertex to r. side of head, but ^till worse on 1. ; not relieved by warmth of flannel. She felt as if she^ could beat the head to pieces. It gradually diminished, and about breakfast left her entirely. After rising, but before breakfast, great naulsea in stomach as if going to retch, but without retching or vomiting, lasting till she fell asleep. After breakfast, for about 1 h. (other pain having ceased), feeling as if head were in a vice from ear to ear, over yertex, arising and departing gradually.

Afterwards felt as if she had no head ; it felt light on her shoulders, numb, or as if made of putty. For about i h. painless lumps in calves about size of half a walnut. Again fell asleep; on waking felt hungry and thirsty, and took second breakfast, after which she was c|uite well. (Berridge, N, Am. Journ^ of Horn ,xxi, loi.)

1. In small quantities, the diluted acid excites the appetite, increases the secretion of a light*coloured urine, causes a whitish coating on the tongue and dryness of the mouth ; about the fifth day after commencing the use of the acid, the teeth begin to become loose, the gums bleed, in some cases ptyalism sets in. The continued use of the acid is followed by digestive derangements, colic, foetid breath, headache, languor, constipation or diarrhoea. (Wibmer, IVirk, der Arz.^^ sub voce,)

7, A small pustular eruption sometimes appears upon the skin. Bateman, who gave the acid in a diluted form for hepatic derangement, found that it produced salivation, but neither foetor of the breath nor ulceration of the gums. But all these symptoms existed in several of the cases (syphilitic) reported by Prioleau, This salivation would appear not to depend upon the local action of the acid, if we may accept the statement of Richter, who found the same effect produced by nitric acid baths. (Stillk, op, cit,^ sub voce.)

IL Poisonings, — i. A girl, aet. 17, in good health, took about 3j — 5SS of strong nitric acid. Burning pains set in in mouth, throat, and epigastrium, then vomiting, going on for several days and expelling bloody masses. On 2nd d. dysenteric symptoms appeared ; frequent evacuations, sanguinolent, with pains and tenesmus. From this lime urine remained suppressed. On 3rd d., admitted to hospital. Usual signs of corrosive action of acid on mouth and throat were present ; abdomen soft and not distended ; in epigastric and both iliac regions pains increased by pressure. Resp, 16, pulse 96, temp. 30 R. (=; 99^ Fahr.). On next two days motions more frequent and now semi* membranous, bladder empty, pulse 84 — 1 00; resp. 20 — ^24.; temp. 29-2° — 28'6^. Patient became paler ; now calm and apathetic, now anxious j quite sensible, but occasionally complaining of headache. On 8th d. stomach seemed full of fluid, and vomitings occurred, with anxiety and finally delirium. Temperature fell to 278^ (under 95** Fahr.) on 7th d., and on 8th she died. At p. m. usual local lesions were found as far as stomach, but small intestines were free. Large intestines throughout exhibited the appearances of intense dysenteric inflammation, and kidneys those of acutest form of Bright^s disease. fWuNDERLiCH, De Act, quihusdam Addi Nitrici caustici in corpus humanum intromissi. LipsirC, 1876.)

2, A man drank freely of a weak solution of nitric acid in mistake for water. Within a few m. a deadly and intolerable nausea came on, which, within i h., ended in vomiting. After this he felt better for some time, when pain, griping and flatus succeeded ; and about 15 h. after taking dose, tenesmus and bloody stools occurred, succeeded by headache and f^ver. These dysenteric symptoms lasted 2 d., and

• Wunderlich in his conclusions calls attention to the claims made by homceopathic physicians as to the usefulness of nitric acid in dysentery^ and to the repute it enjoys m B right's disease in ordinary practice.

cradually went ofF, no medicine having been taken* (Waiters, Mtd% Kepmtory, ii, 337.)

3, As nitric acid gas begins to be developed, there is a prickling^ tickling sensation in nose, with frequent sneezing ; as gas increases la ]uantity^ lips feel as if covered, and give very sour taste when touched

'^with tongue. On being inhaled, it causes a constant and violent cough, with whistling inspiration, redness and sweat of face and body; the paroxysm of cough increases so much by continued inhalation of the gas, that it causes a taste of blood, nausea, and actual vomiting of mucus and ftx^d* Longer exposure to gas causes oppression of breathing and anxiecy, so that it becomes necessary to leave the room in order to breathe freely and silence the cough. There remains behind, for A h. to 2 h., great rawness, soreness, and weariness of chest, with pains in head* (Lederer, jfllg, horn. Zett.^ li, 148.)

1. a. From exposure to n. ac. fumes (which proved fatal in another case) a young man suddenly felt exhausted and pressed for breath ; fell, and began spitting green slimy matter, having at same time pains as if prodded with some sharp instrument in head, face, and body. Going borne drank freely of cold milk, and next day went to business. Was

'^^soon seized with violent vomiting, with pricking pains in head, face, lips and gums, and sharp aching in jaws. Returned home and went to bed \ had sense of horrible constriction across lower chest, with dyspnoea and incessant cough, bringing up greenish, slimy sputa \ great nausea, with unquenchable thirst, drinking causing increase of pricking paint in stomach, and vomiting ; sensitive to slight noises, which cause shocks in head j swelling of lips with burning pain ; dull pain in bones of head ; painful, raised papilla! on tongue ; aching in limbs ; deh'rium, fancying himself suddenly rich, &c. ; ugly raving. On 3rd d., patient was beside himself with fancies \ angry at attendants -, slightly delirious \ there was constant spitting of green mucus, and about every 15 m. vomiting of same, followed by neuralgic pains in gums, teeth and jaws, and throat ; throat raw, with smarting sensation down oesophagus ; burning in chest, and sense of severe constriction ; catching of breath at every attempt at a full inspiration ; muscular soreness through intercostal spaces i severe pain in hypochondria in m., passing up walls of thorax, coming together at upper thjrd of sternum, causing a terrible fit of coughing after about 20 m., lasting some 10 m., with bursting headache, and pricking pains in face and temples, &c. ^ sharp cutting pains all through abdomen, centring at siomach-pit; about once an h. terrible cramps in abdomen, not relieved by stools of black fluid, which occurred about every 15 m,

b. I was called to the patient on the evening of this, the 3rd d., and finding the vomiting and purging to be accompanied by feeble and irregular pulse, cold, moist surface, and symptoms of cedema of the lungs, I gave verairum viride Ix in water, a teaspoonful every \ h., except when sleeping, throughout night, Sept. 19th, which was the 4th d. after the accident, I found diarrhoea controlled when I called in m., and by noon vomiting had ceased, he continuing the veratrum viride as before. At this time he presented several objective symptoms of interest ; lips swollen to twice their natural si^e j blisters and swollen

papillae on the dry, brownish-hued tongue ; pallid^ bluish-coloured face, which was pinched ; eyes wild and staring, with dilated pupils ; great restlessness, patient tossing and rolling about in the bed, and frequently getting out of bed to sit or walk the floor i gait weak and staggering. There was ringing in ears, with stopped- up feeling, and for a few moments, after trying to sing, marked deafness ; after cessation of vomiting belching of great quantities of gas, accompanied by aggravation of sharp, pricking pains in stomach ; constant sour taste in mouth j violent pains in face, pricking on lying down, better on rising ; drawing pains under both scapulae, with constriction of chest as by a rope drawn tightly around lower part of it ; coughing violent, spasmodic, ineffectual, ending in gagging j great weakness and languor j first appearance of pain in the lumbar region ; urine like brandy, but not strong in odour ; later, and after several days more, it became somewhat more abundant than normal, and straw coloured, with only occasionally an hippuric odour, scarcely noticeable ; sp. gr not taken ; ravenous hunger, dissatisfied with milk and gruels j horrible thirst. 5th d. — Unconquerable drowsiness all day, waking with canine hunger ; thinks he is going to die j frightened feeling ; hps somewhat swollen still \ some cpistaxis ; eyes smart i severe lachrymation j small ccchymoses and papulae appear here and there and disappear again ; crawling sensation all over the body, with sticking pains. 6th d, — ^Symptoms of convulsions, such as subsultus, twitching of facial muscles, with distortion of visage ; slight wandering of mind ; tossing about in bed ; insatiable thirst j bursting headache, with soreness of scalp, as from ulceration ; relief of head symptoms by tying head up tightly; constipation, with pricking, cutting pains at anus during stool, which was hard and dry. On this and the two preceding days the patient received bryonia jx in water every h. 7th d,^ General improvement in all symptoms except those of lungs. Great distress for breath, and some dulness on percussion over lower parts of chest, back and front, with dulness of respiratory murmur ; considerable raising of frothy mucus, with rawness of chest on coughing. 8th d, — Raised about an ounce of bright blood this afternoon while coughing, after which he breathed with more ease. Thirst nearly gone ; appetite more normal \ flatulence gone ; less pain about the head and body. 9th d. — ^No especial change, except a gradual subsidence of symptoms on bryonia 3X. nth d. — ^Patient rapidly improving; went out to walk this afternoon ; raised about an ounce of blood while coughing ; soreness of chest declining, and cough loose and easier. 15th d. — The patient called at the office, and, seeming to feel relieved in all respects, he was discharged from treatment, with bryonia for a few more days and general advice as to exposure, &c,

c. There was at no time any icterus. But his employer, Mr. Codman, who died in a few hours after exposure to the fumes of the acid, grew yellow in less than 3 h. He complained of general malaise, oppression of the chest, drowsiness, and, after eating a little fruit for his noon lunch, gradually sank, and died with his lungs filled with frothy mucus, as shown by the necropsy, (Hcb£R SmitHj M £ngh Med. Gw2., Sept., 1884,)

ACIDUM NITRO-MURIATICUM.

Volume I — Appendix

Aoidum nitxdcmn. — After I, 3, insert 'A lady, making experiments with a galvanic battery, vs^as exposed tor some time to the fumes of N. ac. At once she is taken w4th a peculiar anguish, runs to her physician, but, as he is not at home, hires a carriage to drive to the house where she experts to find him During her ride all the anguish is gone. Arrived at home, she feels as bad as ever j and feels herself thus forced to drive about the whole d., till ail the effects of the acid have passed oflF. (Hendricks, Jm, Jourtt, of Horn. Mat. Med., iii, lao.)"