Picricum acidum

Volume I — Appendix

Head.

Heavy, throbbing pains in the head, extending from behind the ears forward to the supraorbital notch, thence downward to the eye.

All head-pains relieved by bandaging tightly. Heavy pain iu occipital region, extending* down the neck and spine.

Heat and congestion of the head, with bleeding at the nose. Severe, sharp, intermitting pains in the left temple. Full, pressive sensation in the head, from within outward. Pains in the head, aggravated from motion.

Eyes.

Burning, throbbing pains, with dilated pupils, conjunctivitis, and lachrymation.

Everything seems blurred, as if looking through a fog or a thick veil.

Can read only with the book about five inches from the nose.

Great heaviness of the lids ; can't keep them open.

Eyeballs sore to the touch, with photophobia.

Severe, sharp shooting pains in centre of eye, extending back to

occipital region — seems to follow the course of the optic

nerve.

Lids sore, and slightly swollen.

Mouth, Throat, and Ears. Ears burn, look puffy, with sensation as of worms crawling on them.

Bitter taste in the mouth.

Throat feels raw, scraped, stiff, and hot, as if burnt. Collection of thick, white mucus on the tonsils. Great difficulty of swallowing ; sensation as if the throat would split open.

Dry cough, as from dust in the throat, followed by nausea.

Stomach.

Nausea, bitter eructations after breakfast ; sensation as of something in lower portion of oesophagus. No appetite ; bitter taste in mouth ; aversion to food.

Abdomen and Stool.

Stools light-colored, and passed with much burning and smarting

in the anus. Scanty, soft stools, with burning at the anus. Crawling, stinging pain in the abdomen.

Rectum and Anus.

Smarting, stinging burning of the anus after a passage from the bowels.

Urinary Organs.

Urine profuse, very hot when passed ; urethra feels as if burnt. Urine dark, high-colored, sp. gr. 10.25 to 10.28.

Generative Organs.

Great sexual desire, and painful erections, with emissions.

Lewd dreams, with emissions.

Very hard erections ; terrible erections.

Erections, with severe pain in the left testicle, as if bruised, extending up the cord as far as the external abdominal ring.

Chest.

Heavy, throbbing pain under tenth and eleventh ribs on left side.

Dull, stunning pain in the chest.

Back.

Heavy, throbbing pain in the region of the kidneys, extending

down the legs, especially the left. Small of the back sensitive to pressure.

Extremities.

Legs feel heavy, and very weak.

Legs below the knees feel very sore and tender to the touch. Severe pain in the anterior portion of legs when touched. Legs heavy, like lead. Great coldness of the feet.

Great heaviness in the arms and legs, especially on exertion. Shooting pain in the left arm, at elbow.

Skin.

Small, painful, reddish elevations, like furuncles, around the mouth and face ; when opened they exude a thin, clear serum, which soon dries into a transparent scab ; they then become pustular and very painful, and contain a thick, opaque pus.

Fever.

Great thirst for cold water; drank in large quantities, without relief.

Fever; great chilliness; can't get warm; followed by cold, clammy sweat ; chilliness predominates ; pulse 50, weak and small.

Sleep.

Sleep sound, but unrefreshing. Restlessness.

Generalities.

Throbbing and jerking of the muscles in the different parts of the body, with severe chills and great pain between the hips. Profuse cold, clammy sweats, with great chilliness. Very tired on going upstairs. General lassitude.

Rheumatic stitches in different parts of the body, with great muscular weakness.

Volume II — Special Therapeutics

reported by Dr. L. B. Couch, for which he was awarded the gold medal by Professor Allen, of the New York College, in the spring of 1874.

Picric acid, also called Carbazotic acid, Welter’s Bitter, Nitrophenisic acid, Nitrophenolic acid, is the product of the action of Nitric acid upon Coumarin, Indigo, Salicin, Carbolic acid, Oil of gaultheria, and several other substances, aided by heat. It forms in whitish-yellow prisms, with rectangular bases, which in thin layers are almost colorless. It reddens vegetable blues, and has an exceedingly bitter taste. It is fusible and volatile, and burns with a yellow flame, leaving a residue of charcoal. It is nearly insoluble in cold water, but soluble in hot water, Alcohol, or Ether.

Head.

Heavy, throbbing pains in the head, extending from behind the ears forward to the supraorbital notch, thence downward to the eye.

All head-pains relieved by bandaging tightly.

Heavy pain in occipital region, extending down the neck and spine.

Heat and congestion of the head, with bleeding at the nose.

Severe, sharp, intermitting pains in the left temple.

Full, pressive sensation in the head, from within outward.

Pains in the head, aggravated from motion.

Eyes.

Burning, throbbing pains, with dilated pupils, conjunctivitis, and lachrymation.

Everything seems blurred, as if looking through a fog, or a thick veil.

Can read only with the book about five inches from the nose.

Great heaviness of the lids ; can’t keep them open.

Eyeballs sore to the touch, with photophobia.

Severe, sharp shooting pains in centre of eye, extending back to occipital region — seems to follow the course of the optic nerve.

Lids sore, and slightly swollen.

Mouth, Throat, and Ears.

Ears burn, look puffy, with sensation as of worms crawling on them.

Bitter taste in the mouth.

Throat feels raw, scraped, stiff, and hot, as if burnt.

Collection of thick, white mucus on the tonsils.

Great difficulty of swallowing ; sensation as if the throat would split open.

Dry cough, as from dust in the throat, followed by nausea.

Stomach.

Nausea, bitter eructations after breakfast ; sensation as of something in lower portion of oesophagus.

No appetite; bitter taste in mouth; aversion to food.

Abdomen and Stool.

Stools light-colored, and passed with much burning and smarting in the anus.

Scanty, soft stools, with burning at the anus.

Crawling, stinging pain in the abdomen.

Rectum and Anus.

Smarting, stinging burning of the anus after a passage from the bowels.

Urinary Organs.

Urine profuse, very hot when passed ; urethra feels as if burnt. Urine dark, high-colored, sp. gr. 10.25 to 10.28.

Generative Organs.

Great sexual desire , and painful erections , with emissions.

Lewd dreams, with emissions.

Very hard erections ; terrible erections.

Erections , with severe pain in the left testicle, as if bruised, extending up the cord as far as the external abdominal ring.

Chest.

Heavy, throbbing pain under tenth and eleventh ribs on left side.

Dull, stunning pain in the chest.

Back.

Heavy, throbbing pain in the region of the kidneys, extending down the legs, especially the left.

Small of the back sensitive to pressure.

Extremities.

Legs fed heavy , and very weak.

Legs below the knees feel very sore and tender to the touch.

Severe pain in the anterior portion of legs when touched.

Legs heavy, like lead.

Great coldness of the feet.

Great heaviness in the arms and legs, especially on exertion.

Shooting pain in the left arm, at elbow.

Skin.

Small, painful, reddish elevations, like furuncles, around the mouth and face; when opened they exude a thin, clear serum, which soon dries into a transparent scab ; they then become pustular and very painful, and contain a thick, opaque pus.

Fever.

Great thirst for cold water ; drank in large quantities, without relief.

Fever; great chilliness; can’t get warm; followed by cold, clammy sweat; chilliness predominates; pulse 50, weak and small.

Sleep.

Sleep sound, but unrefreshing.

Restlessness.

Generalities.

Throbbing and jerking of the muscles in the different parts of the body, with severe chills and great pain between the hips.

Profuse cold, clammy sweats, with great chilliness.

Very tired on going upstairs.

General lassitude.

Rheumatic stitches in different parts of the body, with great muscular weakness.

Drs. Moffiit and Grace-Calvert mention the following properties and uses of Picric acid (in allopathic practice) :

It is tonic and astringent, the latter influence being effected by improving the general tone of the system. It has been efficaciously used in convalescence from acute diseases, cephalalgia, chronic diarrhoea, gastric irritability, dyspepsia, ana?mia, and intermittent fever, in which last disease it is considered a valuable substitute for Quinia. As the free acid is apt to occasion cramps in the stomach, the Carbazotate of ammonia and Iron have been found the best. The Carbazotate of 'ammonia and Gallic acid, one grain each, with one-sixth of a grain of Opium for a dose, and repeated three times a day, in obstinate diarrhoea. By the use of these agents the skin and conjunctiva become colored, so as closely to resemble jaundice, and would deceive the keenest observer. The acid has been detected in the urine, even when this has been kept several days. The dose of these is from half a grain to a grain, repeated three times a day.

Since the last edition of this work, I (Hale) have prescribed this acid a good deal, and while I have found it useful in some cerebro-spinal neuralgite, with evident brain-fag, I have been disappointed in its usefulness in the class of disorders mentioned in the following paper by Dr. Jones. Since his article appeared, it has been ascertained that he based much of his theoretical recommendations on data which have been proven by Dr. Couch to be false and illusory. I have found the Picrate of Ammonia to be much more efficient in all cases than the acid. I retain, however, a portion of Dr. Jones’s paper.

Grauvogl’s doctrine of the “constitutions” commends itself to the practitioner because it affords such a classification of a remedy, and is to some extent expressive of the pathological nature of its action. Guided by his data, I shall first endeavor to determine what “ constitution ” is induced by Picric acid.

Hasty observation will lead one to class this drug in the hydrogenoid group. At first I fell into this mistake; but a little “reading between the lines” will enable one to assign this remedy to its proper place.

Great chilliness, can't get warm, followed by cold, clammy sweat; chilliness ‘predominates, are certainly symptoms suggestive of the hydrogenoid constitution. Besides this, I have known the wet-weather pains of a patient with locomotot ataxy to be markedly relieved by Picric acid. And, farther, in a case wherein my friend Dr. Lilienthal gave this remedy, it induced a sensation of freezing cold ness ; each successive dose being complained of on this account. However, with our remedy, all these phenomena are pseudo-hydrogenoid.

In the animals poisoned with Picric acid, the blood was black and fluid; a condition which suggests a privation of oxygen.

In the symptoms of the human provers we find ample evidence of congestion;

a perversion of nutrition, wherein the balance between waste and repair is disturbed, and which tends toward incomplete oxidation of the blood.

Our “homoeopathic” habit of differentiating also assists in assigning Picric acid to its proper constitution group, for we find the remedy to be characterized by an aggravation from motion ; motion meaning tissue disintegration, accelerated histolysis, and blood still farther charged with effete material.

We observe, also, an amelioration from rest; the quietude reducing tissue change to a minimum, and thereby economizing the oxygen. And, still farther, we must note the amelioration from cold (air and water) ; the temperature aiding the embarrassed circulation by the tonic effect of cold upon the vasomotor system.

From such considerations I am led to regard Picric acid as belonging to the carbo-nitrogenoid group ; but that it may be only thus classified, I am not prepared to assert, remembering that, at least curatively, Nux vomica, 3d and 30th, is respectively a hydrogenoid and a carbo-nitrogenoid remedy.

I can but regard deranged innervation as the first link in the chain of the action of Picric acid, when I remember that the best of the several provings was made with the 30th potency — a proving in which the symptoms are well marked, the modalities clearly evinced, and the tout ensemble stamped as genuine by the parallelisms educed from other provers, with other potencies, even as low as the first.

When we survey the whole action of Picric acid, and take in its subtlety, observing how comparatively soon such insignificant doses undermine the organism and sap its strength, we cannot avoid the conclusion that the derangement of innervation occurs in a highly vital territory. In the proving to which we have just referred, the first symptom produced by the drug is : “ Ears began to burn and look puffy, with a sensation as if worms were crawling on them. These symptoms lasted, two hours.” Schroder V an der Kolk says redness of the ears indicates congestion of the posterior half of the base of the brain ; and you may depend upon it, if the prover had completed the record, “ redness of the ears ” would also have been noted; for pathology can supply a prover’ s omissions. Van der Kolk also gives redness of the nose as an indication of congestion of the anterior half of the base of the brain ; and the second prover, in three hours after the first dose, notes “ bleeding of the nose, with heat and congestion of the head.” Evidently the first act of this pathogenetic drama is cerebral congestion.

Where is its location, or rather, where is the congestion specializing itself by effect ? The “ sensation as if worms were crawling on the ears ” signifies something amiss in the pons varolii.

If still further evidence is needed that cerebral congestion is the pathological status, we find it in the sleep symptoms. In a brief proving on myself, an inability to fall asleep until long past my usual time was a disagreeable feature ; and from Durham and Hammond we learn that sleep requires cerebral anaemia ; that a certain degree of cerebral congestion gives insomnia; that an intense degree is coma.

As it is not my purpose, on this occasion, to specialize the symptomatology of this remedy, I turn at once to the post-mortem record of the poisoned animals.

In the cat were found the following conditions : “ Membranes of the brain gave no evidence of inflammation ; cerebrum slightly softened; the cerebellum, medulla oblongata, and upper part of the cord were soft, pulpy, and apparently completely disorganized ; in the lower portions of the cord no lesions were discovered.” In the dog, “ the cortical substance of the cerebrum, the whole of the cerebellum and of the medulla oblongata, and a portion of the cord were apparently completely disorganized.”

I regret to say that these “ apparently disorganized ” structures were not submitted to an unquestionable microscopical examination, and, as a result, we are embarrassed in the attempt to read the riddle of the physiological action of this agent.

By classifying Picric acid with the carbo-nitrogenoid group, we are placing it among the agents which most especially devitalize.

We do not find in its action any of that destructive energy, that true erethism, which characterizes the oxygenoids, and we need only exercise a little circumspection to avoid mistaking the indolence of the hydrogenoid for the languor of the carbo-nitrogenoid.

The condition of the blood also tends to confirm this classification. It is “black and fluid,” and we are aided in properly estimating this by the following symptom which was observed on the dog: “ Profuse frothy saliva hanging in long strings to the ground.” We are reminded of Kali bichromicum and its stringy mucus ; and when we recollect Babington’s experiments on the effects of alkalies on albuminous fluids, and know that Liquor potassse transforms laudable pus into a transparent, tenacious, and stringy plasm or mucus, we are led to regard this black and fluid blood as a blood in which some alkali is in excess ; as it is in the blood of enteric fever, of diphtheria, and of all (?) diseases characterized by adynamia.

With such a blood-condition we are prepared to appreciate the significance of the symptom, “pulse 50, weak and small.” When to this blood-condition we add the structural degeneration in the brain, medulla oblongata, and upper part of the cord, we easily perceive why it is that the pathogenetic genius of Picric acid — its prostrating power — is so readily discerned, and we can but be struck by the correspondence between its symptomatology and its pathological anatomy.

In a slow poisoning with Picric acid, the victim appears as smitten by a blight ab initio. A languor steals over the whole organism, gradually deepens into torpor, and makes it more and more difficult to arouse the waning energy, until, like an exhausted lamp, the last faint, flickering spark trembles and is gone. This torpor at first dulls, and finally extinguishes the intellect ; coetaneously the motor function is impaired — weariness, profound debility, complete inertia being the grade and order of its progress. In brief, a universal prostration, psychical and physical, is the distinguishing feature, and speedy exhaustion from slight exertion the grand characteristic of this remedy. One single word portrays the generic action of Picric acid : Asthenia.

The intense excitement of the genital apparatus, as evinced by violent and long-continued priapism and profuse seminal emissions, will not suggest the exuberance of lusty vigor to him who is aware that such evidences of quasi strength in that department of the economy are the best proof of weakness — of a specific debility, and of which, if the cause be not removed, the sequel is cardiac hypertrophy, consumption, or insanity, and the end premature death.

All drugs in their action induce disease, pervert function, and derange structure, but the feature of the action of Picric acid with which I am most impressed is that, beside bringing such discomfort as attends all drug-action, it initiates a profound derangement from the very beginning of its operation — it seems to be in deadly earnest from the very first.

The incompleteness of the pathogenesis which we now possess, will not enable such a differential study of this remedy as the proper exercise of our art demands. And indeed such a study, if we had the necessary material, is “ for other bands than mine.”

I trust, however, that I may presume to offer you a contrast by which the prime feature of this remedy will be fastened in the memory.

Both Picric acid and Silicia are signalized by a condition which is best expressed in the incisive vernacular of the street as “ played out.” A fragmentary citation from Marshall Hall will enable us by this “ played out ” feeling to fix the location of the action of these two remedies. This great physiologist says :

“ Another function of the cerebral system is the sense of fatigue . As the

true spinal system does not sleep, so it is incapable of fatigue.”*

In the Silicia patient this “played out” feeling is very marked, but he can become interested, and then he works with both mind and body as well as ever ; in fact he will outdo those who are working with him — the very continuance of effort which seems to exhaust them appearing as if it only reinforced him ; therefore, we may say of the Silicia patient that while at work he is not only unconscious of any inability, but by a seemingly awakened ardor irresistibly impelled into a paroxysm of overdoing.!

From a short proving of Picric acid on myself, I learned to recognize the difference between these remedies. While under the influence of the drug, I was copying from a volume before me, and when upon the fifth sheet of manuscript I found that after reading a line in the book I could not remember it long enough to write it down ; two words of three syllables seemed about all that my memory could carry, so that I was constantly obliged to be recurring to the printed page. I am so accustomed to transcribing, that I can ordinarily retain two or three lines of type; indeed, I did this when I began work on this very occasion. Now, I had previously observed, as an effect of Picric acid, that a w'alk, which ordinarily I would make no account of, produced a great weariness in the lower extremities, and I had jotted down, soon wearied by slight exertion, as a feature of the action of this drug. From this last experience, then, I learned that the same modality is as true of the mind as of the body. Then, the contrast is this : the prostration of Silicia comes only after the endeavor has been made ; that of Picric acid supervenes while the endeavor is being made. The Silicia patient resembles a thoroughbred who runs the race, wins it, and then dies in the stable. The Picric

• On the Diseases and Derangements of the Nervous System, p. 26. f Fora knowledge of this “inside history” of Silicia — a knowledge which I should never have obtained from the pathogenesis of this remedy — I am indebted to Dr. Carroll Dunham. I have so often shared in the fruits of his discriminating insight, that my many obligations would be burdensome did I not know’ that from his fulness he can enrich others without impoverishing himself.

acid patient is like a low-bred cob who falls and dies upon the track. These are by no means mere figures of rhetoric ; on the contrary, they recognize a pathological fact which is the essence of the difference between these remedies, namely, the action of Picric acid is to extinguish that quality which we call grit, while Silicia leaves it intact.

As we have employed figures to illustrate a contrast which may aid us in selecting either of these drugs as a remedy, nevertheless, as physicians, we must attempt to determine the physiological import of the idea which is clothed in those figures.

We may then ask, what is the physiological meaning of grit ? In the sense in which we employed that word it is matter obeying mind, or, if you will, volition compelling function. The will is a stimulus which excites the irritability of a neurine cell in thought, and of a muscular fibre cell in motion.

Now, can we say that Picric acid acts directly on the will, enfeebling it? If I did say this, Samuel Lilienthal, M.D., Professor of Psychological Medicine, would not let me share his office another hour.

When I was copying from the book before mentioned, I had a good will to have finished my task at one sitting ; but when I willed my memory to retain a line at a time of the printed page, the brain-cells had become so fagged that one or two words made a faint impress, and the rest faded. The stimulus of the will was of little avail, because the organs on which it sought to act had lost their irritability — they no longer responded, or only feebly responded to the stimulus.

Evidently, then, the ultimate pathological difference is that Picric acid exhausts the irritability. The profound sense of fatigue in Picric acid is genuine debility ; the sense of prostration in Silicia is a delusion.

Said Dr. Dunham to me once: “The Silicia patient feels as if he could not possibly do this or that, but when urged to the doing, he goes off in a spasm of overdoing.” Writer’s cramp affords a good instance of this Silicia condition, and in such overdoing, we see wasted strength — a prodigality of doing — rather than waning strength and inability to do.

Silicia exalts and intensifies the normal irritability ; Picric acid depresses and extinguishes it.

Because we have spoken of the action of Picric acid on nervous tissue especially, do not receive the impression that this is its only sphere. From its action on brain, medulla oblongata, and spinal cord, we must deem it capable of secondarily inducing universal havoc. The type of its secondary action will be that of deranged nutrition.

By its action on the encephalic mass, the inhibitory nerve of the heart is stimulated, so that a young man under the influence of this remedy records a pulse of only 50, weak and small ; but when we ascribe this to the cardiac inhibitory, how do we know that the general adynamia is not paralyzing the accelerator nerve, or the ganglia, whose ramifications envelop the auricles and ventricles ?

I cannot close without a word about the wasted muscles of the inferior extremities which were found in the poisoned dog.

Of the nature of the pathological change in them, we unfortunately know nothing ; but the significance of the naked fact must not be overlooked so long as nosology recognizes a progressive muscular atrophy.