Carbo Vegetabilis

Ars., China, Phos., Phos. ac. In collapse, Camph., Veratr. alb. Caust., Kalic, Sulph.

I Ant. tart., Amnion, c. <{ Baryt. c, Mosch., Nitr.

Paralysis of lunsrs

ac.

( Lauroc, Lach., Opium.

Bry., Nux v., Puis., etc.

As I have already intimated to you, Carbo veg. contains some car- bonate of potash. It is also a fact worthy of note that Kali carb. is complementary to Carbo veg. , especially in lung and throat affections and also in dyspepsia. Carbo veg. is also complementary to Phos- bhorus, here, too, in chest affections, in the throat more than anywhere else and, in excessive debility, particularly in the threatened paralysis of the whole system as a sequel to severe disease. The drug is anti- doted by Arsenicum and Camphor, and holds an inimical relation with Causticicm.

The inimical relation between Carbo veg. and Causticum is not so marked as that between the latter remedy and Phosphorus.

Carbo veg. is especially indicated in patients who are advanced in life, and, consequently, debilitated. It is called for in weak, delicate per- sons who are old dyspeptics, especially if they have abused their digestive organs by debauchery.

In analyzing the drug we will speak first of its effects on the blood. We find Carbo veg. indicated in affections in which the composition of the blood is decidedly changed. There is decided sepsis or blood poisoning in many of the diseases in which Carbo veg. is the remedy. We find the drug indicated in haemorrhages, haemorrhages, too, of a very low type.

Thus we give it in epistaxis or nose-bleed when the face is pale and sunken and almost hippocratic. The blood flows persistently for hours, perhaps for days. It is dark and rather fluid. It is apt to occur in old and rather debilitated persons and during the course of diphtheria.

You find nearly the same symptoms under Camphor and Mercurius cyanatus.

We also find Carbo veg. indicated in haemorrhages from the lungs, not only in haemoptysis but also in bronchorrhagia. In these cases 3i

482 A CLINICAL MATERIA MEDICA.

the patient suffers from great anxiety and yet without any particular restlessness. The anxiety is very evident in the face and in the efforts at breathing, but there is no particular restless tossing about. The patient complains of burning pain in the chest. Carbo veg. is to be used especially in well advanced cases of lung degeneration.

The pulse in these cases is apt to be intermittent and thready, the face is pale and often covered with cold sweat. The patient wants to be fanned, because fanning brings more air to the lungs.

These same symptoms indicate Carbo veg. in haemorrhages from the uterus, whether metrorrhagia or menorrhagia. Here, again, you find marked burning pains across the sacrum and lower portion of the spine. If the haemorrhage continues any length of time you will notice the same trouble in the chest, with the difficulty in breathing above mentioned.

Carbo veg. will here work hand in hand with Cinchona and Arseni- cum. Arsenicum is useful in these persistent haemorrhages of a low type, depending upon some degeneration in the organ affected. Both it and Carbo veg. have these violent burning pains. With the Arseni- cum, however, you have, as a distinction which applies in all con- ditions, irritability of fibre and mind, which is not the case with Carbo veg.

Carbo veg. is a torpid, sluggish remedy, while Arsenicum^ has irritability, with restless tossing about, anxiety, etc.

Ipecacuanha should also be remembered in haemorrhages, especially in haemorrhages from the lungs and uterus, when the patient takes long breaths, as if panting. Unless there is present coldness, amount- ing almost to collapse, you may prefer to begin with this drug rather than with Carbo veg. or Cinchona.

Next we find Carbo veg. useful in varicose veins which occur on either the arms or legs, or even on the female genital organs. These varicose veins tend to ulcerate. They are bluish or livid, looking as though the blood had long remained in them. In the resultant vari- cose ulcers you will find very similar symptoms to those in other ulcers in which Carbo veg. is the remedy; burning pains, and mottled appearance of the surrounding skin as though the smaller veins had become enlarged.

Bcchymoses are seen beneath the skin. The ulcers have a decidedly indolent appearance.

Carbo veg. is also useful in ulcers other than varicose when they are of a very low type. The}^ are flat, tending rather to spread on the surface than to dip deeply into the parenchyma. They discharge not

THE CARBON GROUP. 483

a laudable pus, but instead, that which is ichorous, corrosive, thin, burning and offensive in character. The burning is worse at night, depriving the patient of sleep and keeping him in torture the whole night. Even in cancerous ulcers, as in ulcerating scirrhus, you will find Carbo veg. useful.

It may also be administered in carbuncle, particularly when the af- fected parts are bluish or livid, and when the discharges are offensive and associated with burning pains. In these cases it is not only your duty to give it internally, but also to apply it externally as a plaster. It tends to prevent decomposition of fluids, sweetens the sore and so prevents poisoning of the system. The same is true for gangrene.

When carbuncles or boils become gangrenous, Carbo veg. may be indi- cated. In these cases it is distinguished from Arsenicum by the absence of this extreme restlessness.

In febrile conditions, Carbo veg. is useful for the typhoid and inter- mittent types of fever, for collapse during fever, and for yellow fever. It is a preventive of yellow fever just as Sulphur is of cholera. If all the ejecta of the patient are buried in charcoal, the spread of the disease will surely be prevented. When the disease is fully established, Carbo veg. is of no more use than Sulphur is during the course of cholera.

The intermittent type of fever in which you may employ Carbo veg. is of a low grade. The case is one of long standing, and has been abused by quinine. There is thirst during the chill. The feet are icy-cold up to the knee, a very characteristic symptom of Carbo veg.

When the heat comes, it is in burning flashes. The sweat is either sour or else exceedingly offensive from alterations in the discharges of the skin. During the apyrexia the patient is pale and weak. Memory is weak ; the mind seems to be befogged.

The patient is decidedly low-spirited and melancholy.

In the hectic type of fever, Carbo veg. is indicated by pretty much the same symptoms as those which I have already mentioned. It is particularly useful for hectic fever dependent upon long-lasting suppu- ration, whether due to abscess in the lungs, or in the hip-joint, or about the vertebrae. Menyanthes is the remedy in quartan fever when the legs below the knees are icy-cold.

You know that abscesses accompanying diseases of the spine may have to be opened. Sometimes surgeons are afraid to do this before they have prepared the system for it, because reaction is so slow that the patient may not survive. The danger from opening these abscesses

484 ; A CLINICAL MATERIA MEDICA.

may be greatly lessened by the use of Carbo veg. or Cinchona, accord- ing to the particular indications.

In collapse from various causes you may use Carbo veg. There is decided lack of animal heat. The nose, cheeks and extremities are cold. It is indicated in the late stages of typhoid fever; after pro- tracted loss of vital fluids, as after long-lasting haemorrhages; during cholera Asiatica; during pneumonia; and, in fact, in any form of dis- ease in which these symptoms appear.

The body may be icy-cold, especially about the extremities; the breath is cool; the pulse is thread-like, scarcely perceptible and intermittent. The lips may be bluish from cyanosis. Breathing is very weak and superficial; the patient may be either conscious or unconscious. Now, Carbo veg. in just such cases comes in as a savior, and rescues many a case that would otherwise die.

There are other remedies similar to Carbo veg. in collapse. Camphor ; especially, is similar to it in cholera Asiatica, but it is indicated rather in the beginning of cholera without any vomiting or diarrhoea; when the poison seems to have depressed or shocked the nervous system, so that the patient is icy-cold, dry or in a cold sweat; the tongue is cold. If he can speak it is in a squeaky or in a high-pitched voice, or else it is a husky, toneless voice. Camphor, in such cases, brings about reaction very quickly.

Carbo veg. would be indicated in the later stage, when the prostration is the result of the drain on the system by the alvine discharges.

Veratrum album is also similar to Carbo veg. in collapse. It has cramps in the calves of the legs, the thighs and the chest, and char- acteristically cold sweat on the forehead.

I wish next to say a word about the action of Carbo veg. on glands. The glands, especially the mammae, become indurated. There are burning pains in the swollen glands, with tendency to suppuration. When they do suppurate, the discharged pus is not of a laudable char- acter.

We find Carbo veg. indicated in catarrhal troubles which are pro- voked by warm moist atmosphere, such as we have in this latitude with southwest or southerly winds. The patient is worse in the even- ing or less characteristically in the morning. He has aphonia recurring regularly each evening, painless or associated with raw feeling down the larynx and trachea. There is dry tickling cough, at times quite spasmodic in character.

THE CARBON GROUP. 485

It is here analogous to Phosphorus, and is often preceded or followed by that remedy. The Phosphorus aphonia is associated with rawness of the larynx, and is worse in the evening.

In the morning aphonia, Carbo veg. is more closely allied to Sulphur, which has loss of voice, particularly in the morning.

Still another concordant remedy is Causticum, which is suited to laryngeal catarrh in singers with rough hoarse voice, associated with tracheo-bronchial catarrh, and rawness and burning under the sternum. This group is found under both remedies. The main difference is that Causticum has hoarseness worse in the morning, and Carbo veg. in the evening. Causticum has aggravation in dry, cold weather, and Carbo veg. in a damp warm atmosphere.

Another remedy is Eupatorium perfoliatum, which I use for hoarse- ness with soreness in the larynx, trachea and bronchial tubes. The hoarseness is worse in the morning, and is apt to be associated with aching all over the body.

Carbo veg. may also be used in asthma, particularly in the asthma of old people and of people who are very much debilitated. They look, during the asthmatic attack, as if they would die, so oppressed are they for breath. They are greatty relieved by belching wind. It is especially indicated in asthma which is reflex from accumulation of flatus in the abdomen.

It may also be used in threatening paralysis of the lungs in typhoid fever, after pneumonia, and in old people. The "paralytic catarrh " of old people calls for Ca?'bo veg. There are loose rattling rales when the patient coughs or breathes, a marked symptom of emphysema. The bronchial tubes are greatly dilated. In addition to this you will find coldness, symptoms of collapse, etc.

The nearest approach to Carbo veg. in emphysema is Ammonium carb., which, like Carbo veg., has blood poisoned by carbonic acid, giving you the coldness, blueness, etc., incident to that condition.

In threatened paralysis of the lungs, we have a great many reme- dies to consider, most of which I will reserve until we come to speak of Phosphorus, which stands very close to Carbo veg. Then, too, you should also remember Mochus and Antimouium tartaricum.

A?iti??io?iiu?7i tartaricum applies when there are loud rales heard in the chest. It seems as if there was an immense amount of mucus there, and yet the patient can scarcely raise any of it. The extremities are cold and blue from the cyanosis developed by the blood poisoning.

486 A CLINICAL MATERIA MEDICA.

The patient^soon becomes drowsy and passes into a stupor from which he can be aroused, but into which he readily relapses. You should also remember Antimonium tartaricum when, in the course of lung affections, whether there be bronchiectasia or catarrh on the chest in children (and here it is especially called for), the cough ceases or be- comes more rare and yet there is no diminution in the mucus-pro- duction itself. Your practiced ear placed on the chest detects just as copious an Jexudation, and just as much rattling of phlegm in the lungs, and yet the child does not cough so frequently. The mother thinks the child is better, but in reality it is worse, for the lungs are losing their power.

Carbo veg. is an excellent remedy for the terrible dyspnoea of chronic aortitis, especially when the patient has become very anaemic, drop- sical, etc. Here you should compare Arsenicum, Cuprum and Lachesis.

Still further, I want to speak of the action of Carbo veg. on the stomach and bowels. We find it here, rivalling other well-known remedies in dyspepsia or indigestion, and those of a rather low type, too. We find it indicated, too, for the bad effects of debauchery, for excessive indulgence in table luxuries, and for bad effects from wines and liquors and all kinds of dissipation. As a result of dissipation, we may have just such symptoms as call for Carbo veg.; headache, par- ticularly in the morning when the patient awakens from sleep, having spent the best part of the night carousing; dull headache referred to the back part of the head, with a great deal of confusion of mind.

There is humming or buzzing in the head as though a hornet's nest had taken its place there. The patient feels worse in the warm room. The pain also seems to go from the occiput through the head and into and over the eyes, with dull heavy aching in that region. There are nausea and usually a sort of burning distress and weakness referred to the epigastrium.

He is unable to take any fat food, whether meat, gravy or fried food. He cannot drink milk because it produces flatu- lence. After eating the stomach feels heavy, as if it were dragged down. The abdomen is distended with flatus and both belchings and borborygmi are offensive.

The wind belched has a rancid or putrid taste, and a decidedly offensive odor when passed from the bowels. He suffers from constipation with piles. The piles get worse every time he is on a spree; oozing of moisture from anus; perineum, sore,

THE CARBON GROUP. 4.87

itching.* Sometimes they protrude and are bluish, they are so dis- tended with blood. At other times, he has morning diarrhoea with stool which is very watery and thin and accompanied by a great deal of straining. We find Carbo veg. particularly indicated here after the failure of Nux vomica. The patient is peevish, easily angered.

Vertigo reflex from the gastric disturbance is present. It is especially worse after a debauch and excessive indulgence in high living. It is often associated with syncope, especially at meals or after eating.

The nearest concordant remedy here is Arsenicum. Both remedies have bluish protruding piles, both have burning in the epigastrium, both have anxiety, and both are suitable for the bad effects of ice- cream, and ice-water in hot weather. The difference may be expressed in these few words : Carbo veg. is torpid, Arsenicumis always irritable ; of the two remedies, Carbo veg. has the burning most marked espe- cially in internal parts, as in the stomach.

Nux vomica impinges on Carbo veg. in the bad effects of over-eating and high living. As I have already said, Carbo veg. comes in when Nux has ceased to act. The Nux toper is a thin, spare, yellow, wiry fellow. That of Carbo veg. is sluggish, stout and lazy.

Next we are to distinguish Carbo veg. from Cinchona. This is easily done, because the two drugs meet only in the flatulent dyspepsia and in debility. Cinchona is suited to a peculiar functional debility, when the system is devitalized by loss of animal fluids. Carbo veg. is the better remedy when the debility arises from organic causes, and we have a picture of collapse with hippocratic face and coldness of the body, particularly of the knees.

Both remedies produce great flatu- lence. Cinchona, however, does not have the rancid belching with burning. Belching temporarily relieves the symptoms in Carbo veg. In Cinchona they sometimes seem to be worse therefrom.

Lycopodium also typifies perfectly this state of tympanites. The abdomen is enormously distended. The distinction to be made is this : Carbo veg. produces more flatulence of the bowels, Lycopodium more of the stomach. Again, Carbo veg. produces rancid belching, or else passage of offensive flatus, with bitter taste in the mouth. Lycopodium has more of a sour taste with its belching.

* Perineum, moist, raw, oozing, etc.; Amnion, c, Alum, Natr. m., CARBO V., Carbo a., NITR. AC, Graph (and cracked), SuivPH., Rhus tox., Arsenic, Ant. cr. (mucous piles), THUJA (offensive oozing), SIIylCEA (moist), Sulphuric acid, Capsic, Petroleum (see also Fissures), Borax (slimy, purulent oozing), Sepia (oozing).

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Carbo veg. may be indicated in dysentery. Here it is called for in very severe cases. There are burning pains situated deep in the abdomen, usually in one or the other of the bends of the colon. The abdomen is greatly distended and tympanitic.

The pulse is weak and intermittent. The discharges from the bowels are horribly offensive and brown, watery and slimy in appearance. You see what a desper- ate case we have here, one that calls for great skill in prescribing. Here you must distinguish between two other remedies and Carbo veg., namely, Arsenicum and Cinchona.

Arsenicum helps when there is, as I have said, that irritability of fibre. The patient is just as sick and just as near death's door as is the Carbo veg. patient, but he is restless, and complains of burning thirst and yet exhibits an intolerance of water. The discharges from the bowels are about the same in character under the two remedies. Arsenic, however, has less tympanitic distension of the abdomen.

Cinchona and Carbo veg. are also similar in these cases. Both have these dark offensive fluid discharges, both have the distension of the abdomen, both have great weakness and hippocratic face. With Cin- chona, however, the movements from the bowels are provoked by every attempt to eat or drink. Belching gives but temporary relief . Again, the flatus is not so offensive as with Carbo veg. , nor are the burning pains so marked as under Carbo veg. or Arseyiicum.