Kali Hydroiodicum

The Iodide of Potassium, or Kali hydriodicum, does not, like the Bromide of Potassium, act on the higher tissues of the body. It seems to affect more the lowest tissues, as the fibrous, particularly the periosteum and the connective tissue wherever they may be found. It attacks the nervous tissues ultimately, probably by involving the neuroglia. The tendency of the drug is to produce infiltration, so that when it is thoroughly indicated you will almost always find an oedematous or infiltrated state of the part affected.

Some of the symp- toms produced by Iodide of Potassium are due directly to the iodine which it contains. For instance, what is known as iodine intoxication may be developed by the drug. The patient is very talkative; exhibits a great deal of anxiety about the heart; the face is flushed, the head is hot, in fact, he acts pretty much the same as one under the partial influence of liquor.

The headache which Kali hydriodicum causes is one of the external head, probably from the action of the drug on the aponeurosis of the occipito-frontalis muscle, because there appear sharp lumps like nodes on the scalp and these pain excessively. This may be a remote symp- tom of syphilis or of mercurialization, or it may appear in a patient with the rheumatic diathesis.

In affections of the eyes Kali hydriodicum is called for principally by the violence of the symptoms, especially in syphilitic iritis after the abuse of mecury. Now, if mercury has not been abused, I do not con- sider the Iodide of Potassium to be the best remedy. If there is any best remedy for iritis it is Mercurius corrosivus. We may also use Kali hydriodicum for inflammation involving both choroid and iris, the result

SALTS OF POTASH. . 717

of syphilis. More externally we find pustular keratitis, with chemosis, especially after the abuse of mercury.

Coming next to the nose, we have the following indications for the Iodide of Potassium : coryza or catarrh, occurring repeatedly in patients who have been mercurialized; every little cold or exposure, or every damp day causes the nose to become red and swollen; and acrid watery discharge flows from it, and the eyes smart and lachrymate, and be- come puffed. The patient is alternately chilly and hot, the urine is high colored (as the patient expresses it) and scanty, and there is usually some sore throat. Every exposure provokes a return of these symptoms.

Kali hydriodicum also cures this thin excoriating nasal discharge when it appears as an inheritance from syphilitic parents. The ozsena which it cures is either scrofulous, syphilitic or mercurial, or a combi- nation of all these. The discharge may be either thin and acrid, or else thick, green and offensive, and attended with burning sensation in the nose and even perforation of the nasal bones.

Next, the action of Iodide of Potassium on the lungs and heart. It is not a little singular that all the preparations of Mercurius produce sharp, stitching pains through the lungs (through either the right or left lung, and shooting in different directions), and that the very best antidote to mercury also produces stitching pains through the lungs, particularly through the sternum to the back; worse from any motion. Now, there are two very different conditions in which Iodide of Potas- sium is indicated by these symptoms.

One of these is in pneumonia, in which disease it is an excellent remedy when hepatization has com- menced, when the disease localizes itself, and infiltration begins. In such cases, in the absence of other symptoms calling distinctively for Bryonia, Phosphorus or Sulphur, I would advise you to select either Iodine or Iodide of Potassium. It is also called for when the hepatiza- tion is so extensive that we have cerebral congestion or even an effusion into the brain as the result of this congestion.

Now, the symptoms in these cases are as follows: first, they begin with very red face, the pupils are more or less dilated, and the patient is drowsy; in fact, showing a picture very much like that of Belladonna. If you are hasty, you may be led to give that remedy, but it does no good. The patient grows worse, the breathing becomes more heavy, and the pupils fail to react to light. You know then that you have a grave serous effusion affecting the brain, which must be speedily checked or

7l8 A CUNICAL MATERIA MEDIC A.

the patient will die. Why did not Belladonna cure ? Because all of the symptoms were not taken into account. The trouble did not start in the brain.

The cerebral symptoms are secondary to others. What, then, is the primary trouble ? You put your ear to the patient's chest and you find one or both lungs consolidated; hence the blood cannot circulate through the lungs as it should, and the different organs in the body become congested. Here then is a symptom, previously over- looked, which explains the failure of Belladonna.

Until you have proved that Belladomia has produced such a condition, you cannot ex- pect it to do any good.

Another condition in which we may use Iodide of Potassium is in pulmonary oedema, thus again showing the infiltration producible by the drug. This is almost always, as you know, a secondary trouble. The expectoration looks very much like soapsuds, but it is apt to be a little greenish.

We may also have Kali hydriodicum indicated in phthisis pulmo- nalis, particularly if there are present this same sort of frothy expecto- ration, night-sweats, and loose stools in the morning. The cough is of a violent racking, tearing character, and is worse in the morning, thus keeping up the tendency of the potash salts, to have aggravation of the chest symptoms from two to five o'clock in the morning. I may say that these symptoms of the lungs are often consecutive to Bright' s disease, in which disease Kali hydriodicum may be the remedy.

Yerba santa is used by eclectics for phthisis of catarrhal origin. It is used empirically. There is a gentleman who has a tendency to catarrhal asthma, with thickening of the bronchial tubes and constant oppression of breathing. I treated him for a year.

Sulphur seemed to be indicated, but was given with only partial relief. Finalty, I gave him Yerba santa in the tincture. It so far relieved him that every morning he coughed up a quantity of sputum, and there then followed a freedom of breathing he had not had for years.

The action of Kali hydriodicum on the heart is also characteristic. It produces a horrible smothering feeling about the heart, awakening the patient from sleep and compelling him to get out of bed. This symptom is also found under Lachesis, Kali bichromicumy Lactuca, Euphrasia, Graphites, and some others.

It is also useful for repeated attacks of endocarditis or pericarditis of rheumatic origin. There are sharp, darting pains in the heart, worse from any motion, and particularly bad from walking.

SALTS OF POTASH. 719

In disease of the spine you will find Kali Ziydnodieum indicated by these symptoms : feeling as if the small of the back were being squeezed in a vise ; bruised pain in the lumbar region and difficulty in walking: spinal meningitis with oedema or exudation, particularly when of syphilitic origin.

When gummatous tumors involve the nervous tissues Iodide of Potassium is your only hope.

It may also be of use when rheumatism involves the spine and para- plegia results. In these cases I think that it is the neuroglia that is attacked.

It may still further be used in rheumatism of the joints, particularly of the knee. This knee-joint is swollen and has a doughy feel ; here, again, you see the tendency of the remedy to produce infiltration of tissue. There is no fluctuation to be detected. The skin above the inflamed joint is apt to be spotted, and the pains are of a gnawing, boring character, and are worse at night.

In sciatica you may give Kali hydriodicum when the pains are worse at night, and from lying on the affected side, and when the trouble is of mercurial or syphilitic origin.

You will find that the Iodide of Potassium will sometimes help you in the treatment of the so-called contracted kidney, especially when of mercurial origin.

Iodide of Potassium, like all the potash preparations, produces an eruption of a papular or of a pustular character. Especially do these appear on the scalp and down the back ; when they heal they leave a cicatrix.

You may also remember Iodide of Potassium as a remedy for tertiary syphilis, particularly rupia.

The best antidote to Iodide of Potassium is Hepar.'

LECTURE LXXI.

KALI BICHROMICUM.

Today I shall lecture on Kali bichromicum, or the Bichromate of Potash. You would expect in a drug having the combination of this one, to obtain not only the results of potash, which forms the base of the salt, but also the modifying influence of the chromic acid. You will find, therefore, that while there are evident general resemblances to the other Kalis, there are decided differences arising from the acid combined with it. Chromic acid, as you probably well know, is a highly irritating acid.

It is a powerful escharotic, destroying animal tissue very rapidly, and penetrating quickly into the part, and so pro- ducing a deep ulcer or sore.

Kali bichromicum is a drug which acts generally, although not ex- clusively, on fat persons, and fat, chubby children more than on adults. We find that it possesses great virtues in inflammation of mucous surfaces, with tendency to plastic exudation and pseudo-mem- brane. It attacks mucous membranes, causing at first inflammation of these, violent in character and associated with a great deal of red- ness and swelling, and at first a production of an excessive amount of mucus, from over-action of the muciparous glands. This excessive mucous secretion is very rapidly turned into a fibrinous exudate ; hence there is a tendency to the formation of false membranes.

This character of the exudation on mucous surfaces gives us the well-known characteristic of the Bichromate of Potash, discharges are ropy and stringy. This S3miptom is true of the coryza, it is true of the discharges in pharyngitis and laryngitis, and it is true of the vomited matters in gastric catarrh. It also applies to the leucorrhcea and also to the gleety discharge from urethra, which may sometimes call for Kali bichromicum. Illustrations, then, of this general charac- teristic of the drug are not wanting in any part of the body.

We find this same quality of the mucous discharges even in scrofulous children, for whose diseases Kali bichromicum is often an excellent drug. For instance, it is indicated in inflammation of the middle ear, particularly when it affects the membrana tympani. There is ulceration not only of the membrana tympani, but also of the mucous surface of the middle

KALI BICHROMICUM. 721

ear. The distinction between Kali bichivmicum and other remedies in these cases is that the discharge is tenacious, stringy and purulent. With this there will be earache, with pains of a sharp stitching character which shoot up into the head and down into the neck. You will find the glands of the neck swollen and also the parotid gland on the affected side. This becomes large and indurated, and pains shoot from the ear down and into the swollen parotid.

In these stringy discharges compare Alumen, Senega, Kali carb., Asafcetida, Coccus cacti, etc.

In diseases of the mucous membrane of the throat we find this same character to the exudation. Thus, in diphtheria, we find Bichromate of Potash indicated under two or three contingencies. It may be a remedy when diphtheria assumes the croupous form. The membrane is quite thick, and is dicidedly yellow-looking, like wash-leather.

The tongue is coated yellow or is red, dry and glossy; pain in the throat extending to the neck or shoulder.; swollen cervical glands; well defined slough in the throat. The discharges, whether coming from the nose or throat, or both, are decidedly stringy. This has been, in nry mind, a sufficient distinction between Kali bichromicum and the Iodides of Mercury. When I am giving Iodide of Mercury in diphtheria, as soon as I find that the expectoration becomes stringy I change to Kali bichromicum because it suits that condition, and also because it may prevent the extension of the disease to the larynx.

Although, in general, Kali bichromicum is suited to rather sthenic types of inflam- mation, yet we have indications enough to prove that it may be suited to the adynamic cases also. So far as our knowledge of this drug goes it does not produce many neurotic symptoms or blood changes, but what few are recorded belong to weariness, sleepiness and prostra- tion, etc. , and at times, especially if there is gastro-enteric inflammation, there is cold sweat, lowered temperature, pale sunken face, showing that the drug may suit actual collapse and cases of asthenic type.

The Iodide of Mercury is to be thought of in diphtheria when the membranous deposit is more or less profuse, involving the tonsils and posterior nares. The glands in the neck are swollen. The tongue is coated dirty yellow. There is excessive production of mucous in the throat, causing a great deal of "hawking."

Carbolic acid and Kali per man ganicum are kindred remedies in diph- theria. Both have putridity well marked, the former associated with burning pains in the mouth to the stomach, or little or no pain, dusk}T

722 A ClvINICAL MATERIA MEDICA.

red face, pale about the mouth and nose, rapid sinking of vital forces; the latter with painful throat, soreness of the muscles of the neck.

We find Kali bichromicum indicated in forms of inflammation of the throat other than diphtheritic. Thus, it is called for in follicular pharyngitis. The follicles of the throat become hypertrophied and look like little tubercles on the pharyngeal walls. These discharge a white cheesy-like mass, which, when crushed between the fingers, gives forth a foetid, disagreeable odor.

These are attended by a feeling of roughness and dryness in the throat, and at times by an accumula- tion of tenacious mucus. You will find this disease a stubborn one to treat. In addition to Kali bichromicum, it will be well enough to remember Hepar, Kali chloricum (especially when there is a great deal of foetor of the breath) and /Esculus hippocastanum , or the horse- chestnut. sEsculus resembles Kali bichromicum very closely, but lacks the tenacious stringy mucus. There is dry, rough, burning feeling in the throat and pharynx and yet no swelling.

The face is sallow and digestion is slow. There is tendency to portal congestion, as shown by deep throbbing in the hypochondrium, and constipation and haemor- rhoids.

In other cases you will have Nux vomica indicated by well-known symptoms, which I need not here repeat.

Still other cases call for Secale cornutum, which has hawking up of these little follicular exudates; Sulphur, Hepar, Ignatia, Mercurius jod.t also Chimaphila maculata, which produces swollen tonsils, and tensive pain in the throat on swallowing.

We have Kali bichromicum indicated in yet another form of throat disease which is neither scrofulous nor croupous nor diphtheritic, but syphilitic. Ulcers form on the fauces and tend to perforate. The sur- rounding mucous surface is of a coppery-red color.

It is also indicated in nasal catarrh. It produces, at first, dryness of the nasal mucous membrane, with tickling in the nose and sneezing, these being especially marked in the open air. The secretion from the nose is ropy and stringy, and often collects in the posterior nares. It may or may not be offensive.

In catarrh of the post-nares compare Spigelia, Hydrastis, Natrum sulphuricum. The latter hawks up saltish mucus every morning.

At other times, as in ozsena, there are discharges from the nostrils or posterior nares consisting of plugs, or clinkers, as they are sometimes called. Lumps of hard green mucus are hawked from the posterior

KALI BICHROMICUM. 723

nares, particularly in the morning. At other times (often in syphilitic cases) you will find ulcers which carry out the perforating character of Chromic acid, and tend to perforate the parts on which they are located.

Kali bichromicum is indicated in true membranous croup. It suits best, although not exclusively, light-haired, fair-complexioned chil- dren who are rather fat and chubby. The cough has a decidedly metallic sound. It has more than the mere bark of catarrhal croup.

The fauces you will generally find quite red; the tonsils, perhaps, are somewhat red and a little swollen. The cough seems to descend; that is, the rattling goes down lower and lower until it apparently reaches the upper part of the epigastrium, or rather the lower third of the sternum, the irritation of the cough seeming to start from there. In this position, as well as in the throat, there seems to be a smothering, oppressive sensation; breathing becomes very labored. The child has smothering spells, arousing it from sleep, choking.

The whole chest heaves with the efforts at respiration. The membrane forms quite thickly in the larynx, narrowing its lumen. The expectoration is tough and stringy, and, perhaps, mucous, and contains pieces looking like boiled macaroni. The patient is worse in the morning from three to five o'clock.

Sometimes there is a tendency in these cases of croup to extend downwards and involve the trachea, and even the bronchi, giving rise to what has been termed croupous bronchitis. This is not a very common disease, but it is an exceedingly dangerous one. I remember treating a patient who, after taking Kali bichromicu?n, expectorated pieces looking like vermicelli and having numerous little branches, probably casts of the ramifications of the bronchial tubes.

One of the remedies following Kali bichromicum well in the throat and croupous diseases is Lachesis. It suits particularly when the spasmodic cough becomes so violent as to cause choking spells, and when the patient drops off to sleep, he awakens as if smothering. Kali bichromicum has modified the inflammation, but has not succeeded in preventing spasm of the throat. Then Lachesis comes in and relieves the remaining symptoms. Should the croupous symptoms increase, you ma3- return to Kali bichromicum.

There is also a resemblance between Mercurius cyanatus and Kali bichromicum in diphtheritic croup.

Kaolin is very useful for membranous croup when it extends down- wards, and when one of the characteristic symptoms is intense soreness along the trachea and upper part of the chest.

724 A CLINICAL MATERIA MEDICA.

The mucous membrane of the stomach, too, falls under the influence of Kali bichromicum . The drug is so irritating that it causes gastritis. Thus it produces gastric symptoms varying in severity all the way from those of simple indigestion to those of malignant disease of the stomach. In the milder forms of dyspepsia we find it indicated when there is headache, the pain usually being supra-orbital.

This may be periodical in its return, but is particularly excited by gastric irritation. Although it is neuralgic in its character, it is reflex from gastric irrita- tion. Another form of headache which is associated with these gastric symptoms is one of a peculiar kind. The patient is affected with blindness more or less marked, objects become obscured and less distinct, the headache then begins.

It is violent, and is attended by aversion to light and to noise, and the sight returns as the headache grows worse. I have met with that symptom in my practice four or five times. I have found the same symptoms precisely given under Gelsemium, but I have never used that drug under these circumstances, so I have not confirmed it. There are quite a number of remedies having blinding headache, but Kali bichromicum is the best of them.

We have Causticum sometimes indicated for blindness with the head- ache, but not diminishing as the headache increases. We also find it under Natrum mur., Iris versicolor, Psorinum and Silicea. In the latter remedy the blindness comes after the headache; in Psorinum before, the sight returning before the pain begins.

With this headache of Kali bich?romicum the face is apt to be blotched and bloated, and covered with pimples or acne. It is also sallow and yellowish, as if the patient were bilious. The whites of the eyes are yellow and a little puffed. The tongue is thick and broad and scalloped on its edges, as though it had taken the imprint of the teeth.

The stomach seems to swell up immediately after a full meal, just like Lycopodium. The bowels are constipated, or else there is early morning diarrhoea, as you find under Sulphur, Rzimex, Bryonia and Natrum sulph. The stools are watery, and are followed by tenesmus, which distinguishes this drug from Sulphur, Rumex, Bryonia and Natrum sulphuricum, all of which have morning diarrhoea. These are some of the gastric symptoms which will yield to Kali bichromicum.

They are particularly apt to occur after excessive beer drinking. Kali bichromicum is one of the best remedies for the chronic effects of ex- cessive indulgence in beer and ale.

KALI BICHROMICUM. 725

G?iaphalium is one of the little used remedies that has diarrhoea worse in the morning. The stools are watery and offensive, with nausea and vomiting. It is sometimes useful in the beginning of cholera infantum. Urine dark, scanty. Irritability of temper, con- tinuing even after the diarrhoea ceases.

We also find Kali bichromicum producing gastritis, herein very much resembling Arsenicum. The vomited matter is sour, and is mixed with clear mucus. You see how Kali bichromicum everywhere excites an over-production of mucus. The vomit may be bitter from admix- ture of bile.

It is renewed by every attempt at eating or drinking, and is associated with a great deal of distress and burning rawness about the stomach. With this kind of vomit you may give Kali bich- romicum in the vomiting of drunkards and in the round, perforating ulcer of the stomach.

In dysentery, Kali bichromicum is sometimes indicated. The disease occurs periodically in the spring or in the early part of the summer. The stools are brownish and watery, and mixed with blood and attended with great tenesmus. The distinctive symptom is the appear- ance of the tongue, which is dry, smooth, red and cracked.

In its action on the skin, Kali bichromicum causes, first of all, a rash which very much resembles that of measles. Kali bichromicum is par- ticularly indicated in measles after Pulsatilla. The latter remedy is suited for the milder symptoms, the former for the more severe. The inflammation of the eyes grows worse with the formation of vesicles or pustules on or about the cornea.

The meibomian glands or other structures of the lids ulcerate, so that the lids agglutinate, and there is more or less purulent discharge from the eyes. The ears, too, be- come involved, and there is a discharge from the ears of quite offen- sive pus. There are also violent, stitching pains which extend from the ear to the roof of the mouth and to the parotid gland on the affected side. The external auditory meatus is greatly swollen.

Kali bichromicum is one of the best remedies we have, when measles is asso- ciated with these ear symptoms and swelling of the glands, with sharp pains shooting from the ears into the glands. There is also diarrhoea which resembles that of Pulsatilla, but differs from the latter in the presence of slight tenesmus. The rash is the same as we find in nearly every case of measles. In a general way, we may say that it resembles Pulsatilla, only it is much worse.

It has the simple catarrh of Pulsatilla, watery or more commonly yellowish green secretions, made worse and even advancing to ulceration.

726 A CUNICAL MATERIA MEDICA.

We next find Kali bichromicum , like all the potash salts, producing papules. These papules are hard and tend to enlarge and develop into pustules. If the crude drug itself be applied to a slight abrasion in the skin its caustic action is severe enough to eat down to the bone. In extreme cases these pustules may even develop into deeply eating ulcers. L,upus, with severe burning pains, has been relieved and in some cases cured by this remedy.

We have also developed by Kali bichromicum symptoms resembling those of sycosis. This places the drug alongside of Thuja, Pulsatilla, and Sarsaparilla. We find scabs on the fingers, often about the nails, and also on the corona of the glans penis. There is a gleet3^ discharge from the urethra, which is very often stringy, thus keeping up the general action of Kali bichromicum on mucous membranes.

Ulcers looking like chancres, and tending to eat deeply rather than spread superficially, form about the glans penis and prepuce. In addition to these symptoms you must have the inflammation of the nose and throat of the character already described, wTith perforating ulcers affecting even the bones.

Kali bichromicum is also called for in inflammations of the eyes; this inflammation being rather indolent in character. There is lack of reactive power, so that ulcers form which progress slowly and show but little tendency to heal of their own accord. The same is true of the conjunctivitis, which may be of scrofulous or of sycotic origin. The lids are swollen and agglutinated, especially in the morning, with thick yellow matter, and, to keep up the indolent character of the remedy, you find very little photophobia.

Sometimes we find chemosis with these cases. It is very similar to Graphites and Calcarea ostr., in the indolent ophthalmia. Graphites has more cracking of the tarsi and photophobia especially in artificial light. Calcarea and Kali bichrom. meet in fat children, leukoma, etc., only Calcarea has the photophobia, the sweaty head and large abdomen.

You will find that iritis, whether syphilitic or not, may call for Kali bichromicmn . It is indicated, not in the beginning but late, when there has been exudation posteriorly between the iris and crys- talline lens, causing adhesions of these structures to each other. These exudations, if not too great, will be absorbed under the action of Kali bichromicum. Characteristic of this iritis is indolence.

There is little or no photophobia and not a very decided redness attending the inflammation. This is a general hint which will guide you to Kali

KALI BICHROMICUM. 727

bichromicum, and will save you the memorizing of less characteristic symptoms. Do not, therefore, forget the indolence of the ulceration, the absence or deficiency of inflammatory redness and the dispropor- tionate absence of photophobia.

We next come to the action of Kali bichromicum on the chest. It is indicated in bronchitis, particularly if the glands are involved. Pos- teriorly, on either side of the spinal column, you find dullness on per- cussion. The cough is of a hard, barking character, almost as in croup.

It seems to start from the epigastrium. The expectoration is generally of a stringy character. Sometimes it consists of bluish lumps, and is attended with a great deal of difficulty of breathing, arising mechanically from thickening of the lining membrane of the bronchial tubes. The cough is almost always made worse after eating, and is better when warmly wrapped up in bed.

There is a great deal of feeling of tightness in the epigastrium.

You must also remember Kali bichromicum as a remedy indicated in asthma dependent upon bronchiectasia. The bronchial tubes are filled up with this tough tenacious exudation. But we find Kali bichromi- cum indicated in another form of asthma, which is worse from three to four o'clock in the morning, and is especially liable to return in the winter weather or in summer time, when chilly. The patient is com- pelled to sit up in bed in order to breathe.

Relief comes when the patient raises stringy mucus. This kind of asthma calls for Kali bich- romicum, whether the patient be stout or thin. If you have this after midnight aggravation and relief from sitting up and bending forward, and from the expectoration of stringy mucus, you have a certain remedy in Kali bichromicum. Here is it a perfect complement to Arsenicum , which has nearly the same symptoms, but lacks the tena- cious sputum.

The low potencies have been most successful in the treatment of asthma. The high potencies have not failed, but in all of the literature that I have been able to see, the low potencies have seemed to be the most successful. Whether this is true or not, I do not know. I only give you the facts as I find them, that you may judge for yourselves.

Aralia racemosa is another remedy for asthma when the patient must sit up for relief. It seems as if he would suffocate if he did not. Dry, wheezing or loud musical whistling respiration. But the ex- pectoration, at first scanty, later increases, is warm and of a saltish taste.

728 A CLINICAL MATERIA MEDICA.

Lastly, I have to speak of the use of Kali bichromiaim in rheu- matism, particularly in rheumatism which occurs in spring or summer weather, when there are cool days or nights. The smaller joints seem to suffer. Thus we have pains about the fingers and wrists more than in any other part of the body. Pains wander about, suddenly jump- ing from one part of the body to another and relieved by moving the affected part.

Gastric and rheumatic symptoms alternate. I have had several instances in which I have been able to confirm this char- acteristic of the drug. It is somewhat like Artemisia abrotanum, in which remedy diarrhoea and piles alternate with rheumatism.

LECTURE LXXII.

CAUSTICUM.

Causticum is evidently a potash preparation, but its exact compo- sition I do not know. Hahnemann was not able to define it, and chemists since his time have not been able to tell of what it is com- posed. Nevertheless it is a unique remedy, and is one that we can- not do without in practice. The drug is conveniently studied under the heads placed on the board.

Carbo veg. Lachesis. Causticum. <{ Coloc.

Rhus, Dulc.