Fluoricum acidum

THE ACIDS.

Acids: Fluoric acid; Muriatic acid; Nitric acid; Sulphuric acid; Oxalic acid; Citric acid; Phosphoric acid; Hydrocyanic acid; Picric acid; Lactic acid; Malic acid; Silicic acid; Arsenious acid.

Then we have derived from organic chemistry Hydrocyanic acid, sometimes called Prussic acid. That, we shall find, exists in a great variety of plants. Then here is Oxalic acid. That you are somewhat familiar with. Many of you who have tasted the " sorrel grass " know how sour the leaves are. It is Oxalic acid which gives them their acidity. It exists also in the rhubarb. Rhubarb, either the medicinal or the edible variety, may or may not be poisonous. When raised on new ground it is very apt to contain an undue amount of Oxalic acid, and thus may make some persons very sick. Malic and Citric acid are derived from the vegetable kingdom. Malic acid is found more particularly in apples and pears and also in raspberries. Citric acid is found chiefly in oranges and lemons. Acetic acid is an organic acid, and is the principal ingredient of vinegar. Lactic acid is derived from sour milk.

In the first place we may say a few words about the acids in general and tell what characterizes them as a class. It has been determined by careful experimentation with the acids as a class that they decrease the acid secretions of the body and increase the alkaline. If, for instance, a quantity of acid, such as Citric acid, is taken into the stomach, it will diminish the secretion of the gastric juice. On the other hand, it will increase the secretion of the saliva. The practical value of this hint is hygienic rather than therapeutic, and yet in that degree it is of great use. For instance, we know how intolerable, at times, thirst is in fevers. Now this thirst may be due, at least in part, to lack of secretion from the salivary glands. The mouth is parched and dry; the tongue cleaves to the roof of the mouth. In such cases as this, acidulated drinks, by acting reflexly, increase the flow of saliva, and will give your patient great relief. For instance, you may give lemonade, providing, of course, it is not antagonistic to your indicated remedy, for there are some medicines which Citric acid will antidote and some which will disagree with it. Again, if you are giving Belladonna, you would not think of using vinegar, as vinegar retards the action of that drug. But when giving Belladonna you may use lemonade, as that aids the action of the remedy. Antimonium crudum will not tolerate acids, but you may use tamarind water. Now if you find the mouth or throat sore in fever, the " edge " must be taken off the acid by the admixture of some mucilaginous substance to the drink. You might use gum Arabic, but that interferes with digestion somewhat. Irish moss, Iceland moss and slippery-elm are too medicinal. They all act powerfully on the lungs, and you might induce medicinal symptoms if you employ them. Flaxseed has some medicinal effect, but not sufficient to make its use inappropriate. Another substance which may be used is gelatin, that is, if you know that it is made properly. Some of it is made from the refuse of the tanner; some from fish-bones, and that is quite palatable; but best of all is that made from calves' feet. This last may be used in water to relieve this sharpness.

We find that the acids may be useful in dyspepsia, not as remedies (their therapeutic uses we shall see presently), for we are now speaking of their hygienic applications. You may give them, for instance, in sour stomach. You then administer the acid before eating. Allow the patient to drink lemonade before meals and you will often find that the usual heartburn and sour risings after eating are thus diminished. Pepsin, which is often used as an adjuvant in the treatment of dyspepsia, is perfectly allowable, as it does not interfere with the action of any medicine and is not itself a medicine, and is often aided in its action by some kind of acid, particularly in the digestion of nitrogenous articles of food.

Vinegar has been used as an antidote for intoxication.

There is a property of the Lactic acid which is well worth noticing. This is a very corrosive acid. It will eat into every tissue of the body. In fact, it will dissolve the enamel of the teeth, so that great care must be used in its administration. When prescribed in material doses, it is usually administered through a tube, which prevents it from touching the teeth. Dr. Hering was in the habit of recommending that the teeth be washed occasionally with cream that had become sour by keeping twenty-four hours.

Muriatic and Lactic acids favor digestion. Some persons are greatly relieved by drinking sour milk.

Sulphuric acid must be avoided in any form whatever, because it tends to make the food insoluble by combining with its albuminous constituents. Sulphuric acid is not used in dietetics, except by children in the "sour-balls," which are acidulated almost exclusively with this acid.

Hydrocyanic acid certainly aids digestion. There are some persons who have been cured of dyspepsia by eating peach-kernels, which contain this acid.

There is a distinction between the mineral acids on one side and the organic acids on the other. The mineral acids, as a class, all produce an irritability of fibre together with weakness and prostration. I am now speaking of their medicinal effects. You will find them to produce an irritable weakness — the pulse is weak and irritable — whereas the vegetable acids produce weakness without irritability. The acids, too, as a class, check haemorrhages. This is a quality that belongs to nearly all of them. We all know that Acetic acid is useful in checking hemorrhage. When I have a patient who is subject to haemorrhage, I am in the habit of instructing the nurse, in case haemorrhage sets in before I can be called, to dip a cloth in vinegar and place it over the pubes. In many cases, this will be successful. We all know, too, that Citric acid will produce and cure haemorrhage. A child, after eating too freely of lemons, had haemorrhages from every orifice of the body, even from the conjunctiva. We shall see that Phosphoric, Sulphuric and Arsenious acids all produce and all check haemorrhages. It is said that they all do this by reason of their astringency. But how can this be so when they act favorably even in the two-hundredth potency?

Another quality of the acids is their tendency to produce pseudomembranes. Thus we find some of them indicated in diphtheria; Muriatic, Phosphoric, Sulphuric and Nitric acids, for instance. Here, again, caution is necessary. As these acids, particularly the vegetable acids, may cause croupous deposits, do not permit a child convalescing from croup to partake of acid fruits. When the child is susceptible, any one of these acids may tend to produce this disease again.

We find that all the acids cause a peculiar debility. This is not a simple functional weakness, such as might result from a rather exhausting diarrhoea, such as you find under Cinchona, or such a functional weakness of the nerves as will be curable by Zinc, but it is a debility which arises from defective nutrition, particularly from blood disease. Thus we find them called for in very low types of disease, disease in which blood poisoning is a prominent feature, in typhoid states and in scarlatina, particularly when of a low type, in conditions of exhaustion from abuse of various organs of the body. Thus drunkards, who have long been indulging in liquors to excess, may be relieved by Sulphuric, Phosphoric and Arsenious acids.

We find them indicated, too, in diabetes mellitus. The principal acids for this condition are Phosphoric and Lactic acids.

We find, too, that many of the acids are useful in scurvy, particularly when it has arisen from a diet of salty food with deprivation of vegetables. So much for our general review of the acids. We will now begin to speak of the acids in order, and first of all, of Fluoric acid.

Fluoric Acid.

Fluoric acid: Silicea, Calcarea ostr., Calcarea fluor.; Kali carb.; Arsenicum, Phosphoric acid; Mercurius; Rhus tox.

This is a highly excoriating acid, eating, as you know, even into glass. It is to be particularly remembered from its action on the bones and on the skin. It acts especially upon the lower tissues of the body. We find it indicated in caries of the bones, particularly when the long bones, as the femur, humerus and radius are affected. The discharges from the affected parts are thin and excoriating. The symptoms are frequently relieved by cold applications. Fluoric acid is frequently useful for caries of the temporal bones, and especially of the mastoid process, and that, too, whether it be the result of syphilis, or of scrofulous catarrh of the middle ear.

We also find it indicated in dental fistulae. The discharge is bloody, and has a saltish, disagreeable taste, rendering the mouth foul, and gradually undermining the whole constitution. Fluoric acid will here relieve. There is another remedy which has not been thoroughly proven, but which seems to act better here than the Fluoric acid, and that is the Fluoride of Calcium or Calcarea fluorica.

Calcarea fluorica is especially useful for osseous tumors and for enlargement of bones with or without caries. This summer a lady came to my office with what the dentist had pronounced to be necrosis of the lower jaw on the left side. The teeth had been removed by him, but the patient, instead of getting better, grew worse, and there was a continual discharge from the cavity. The molar just back of the one taken out had been filled with gold, and that I found on examination to be rough at its root; and when she would press her jaws together tightly, there would ooze, apparently from its fangs, a fluid which was offensive, dark and bloody, and mixed with fine pieces of decayed bone. The gum around the bone was purple and offensive in itself. The dentist had said that a surgical operation was necessary. The first remedy given was Silicea, which seemed to have some effect. This was followed by Fluoric acid. These two remedies are complementary, and you will frequently find in bone disease that you will have to give one after the other. Fluoric acid is especially indicated when Silicea has been abused. It is also indicated when Silicea apparently does some good but fails to complete the cure. Now, in the case I have just related, Fluoric acid also helped for awhile, but improvement again came to a stand-still, and now I noticed a swelling of the bone on the outer surface. This led me to think that Calcarea fluorica would act better, and I gave it in the sixth trituration. That she has been taking since the first of August. A week ago* the discharge had entirely ceased. The tooth, which had been filled with gold, was no longer painful. Pink granulations were springing up all over the gums. The probe can no longer detect bone which is diseased.

You will remember, as a distinction between Fluoric acid and Silicea in bone affections and ulcers, that Fluoric acid has relief from cold, whereas Silicea cannot bear anything cold. The slightest draught is intolerable.

We next have to speak of the action of Fluoric acid on the skin. It seems to produce a decided roughness and harshness of the skin, developing cutaneous eruptions of various kinds. There is itching. I do not know of any remedy that causes such general and persistent itching as does Fluoric acid. There is itching in small spots here and there over the body. This is worse from warmth and better from a cool place. You will find, under Fluoric acid, that old cicatrices will become redder than natural and itch. By and by, little vesicles will form on or near the cicatrix, thus showing you the affinity of Fluoric acid for this kind of tissue. Then little red blotches appear on the body, and you have well-marked tendency to desquamation. No remedy has this more marked than Fluoric acid. You will find that Fluoric acid also attacks the nails, causing them to grow rapidly. Thuja has the effect of making the nails grow soft.

We may use Fluoric acid in felons, particularly in bone felons. Here, as in case of other diseases of the bones, the discharge is offensive. Here, also, we may make the same point of distinction between it and other remedies, relief from cold applications.

Fluoric acid also acts upon the muscles. Here its effects are rather novel. It causes an increase in muscular endurance. Under its influence a person is able to withstand more muscular exercise than that to which he is accustomed. More than this, he seems to be better able to withstand the heat of summer and the cold of winter. Thus the drug has a general invigorating or tonic effect.

• The lecturer was speaking on October 17th.

This same effect we find under other drugs. We know how Rhus tox. will enable persons to withstand muscular fatigue. The same is also true of Arsenicum. But the remedy that has this property, more than any other I know of, is Coca. This interesting plant is used by the people of South America, particularly by those who climb the Andes. It prevents all the symptoms arising from the fatigue of the journey and from the disproportion between the external and the internal atmospheric pressures. We may make use of this in persons who are weak, particularly for old people who get out of breath easily when and particularly if they cannot stand a rarefied atmosphere. In that condition Coca relieves.

Under the influence of Fluoric acid, a short sleep seems to refresh. This effect may also be produced by low potencies of Mephitis putorius.

We find that Fluoric acid has produced, and therefore ought to cure, varicose veins. Little blue collections of veins in small spots were caused in two or three provers by Fluoric acid. It may also be of use in naevus.

Other remedies here are Hamamelis, especially in acute cases. It is often used externally and internally in the treatment of enlarged veins.