Muriatic Acid

Cyanogen.

Carbo veg.

f Debility, typhoid fever.

Diphtheria.

Muriatic acid. < „

Scarlatina.

(^ Muscular weakness from Opium.

f Rhus tox., Bry., Phos., Phos. ac.

^r . . . , Apis, Rhus tox., Arsenicum. ( Camphor.

Muriatic acid. < ~: ' ^ J _ .

Opium. > < Bryonia.

[_ Nitr. ac. ( Alkalies.

Now that we have obtained an idea of the acids in general, we will find Muriatic acid a very easy drug to study. The continued use of Muriatic acid must give us pathological effects. Now this acid, when abused, produces pathogenetic effects, which present two series of symp- toms for study. We find its mental and nervous disturbances under

522 A CLINICAL MATERIA MEDICA.

two stages or classes. Under the first effects of the drug there is con- siderable excitement. The patient is irritable and peevish, and the senses are all too acute. Thus light hurts his eyes, distant noises cause buzzing or roaring in the ears, or aggravating headache.

Both smell and taste are abnormally acute. The patient is restless and changes his position frequently. His mind is actively engaged in visions in reference to the past and present and even to the future. The cheeks are quite bright red, the tongue and mouth are apt to be dry, and the heart-beat is quick and irritable but lacking in energy and force.

If he is at all delirious, it is only slightly so. He is sleepy but unable to sleep, or he tosses about, dreamy and restless, all through the night. Now these are the transient symptoms of excitement or erethism which may occur under the influence of Muriatic acid. You are able to trace beneath these symptoms, from beginning to end, a certain amount of weakness.

There is an appearance of over-strength, but it is in a weakened constitution. You know that it is not a true ' ' hyperaction, ' ' but only an irritability, that comes under the head of irritable weak- ness.

The next stage, or that of exhaustion, has several grades, of course. Beginning with the mental S3'mptoms, we find that the patient is apt to be sad, and is absorded in self, taciturn, introspective, sad and brooding. If you question him you will learn that he is anxious about something real or imaginary. Headache may now appear, he feels as if the brain were being torn or bruised, or there is heaviness as if the occiput were made of lead.

The patient becomes unconscious, with muttering delirium, sighs and groans during sleep, the tongue grows more dry and seems to have actually shrunken and become narrow and pointed; so dry is it that when he attempts to talk, it rattles like a piece of wash leather in his mouth. Still later, the tongue becomes paralyzed, so that he can scarcely move it at all. The heart-beats are regular and feeble. The pulse intermits characteristically at every third beat.

He now becomes so weak that the muscles refuse their office. He has diarrhoea, which is watery and is accompanied by prolapsus of the rectum. Stool is involuntary when straining to urinate. He slides down in bed.

He actually 'has not sufficient strength to keep his head upon the pillow. Paralysis of the brain is now threatening. This is indicated by vacant, staring eyes, dropping of the lower jaw, coldness of the extremities, and this, if not checked, is followed by death. Now these are the symptoms that call for Miuiatic acid, particularly in typhoid fever.

THE ACIDS. 523

The concordant remedies of Muriatic acid here are Rhus, Bryonia, Apis, Phosphoric acid, ATitric acid and Arsenicum.

Bryonia resembles it in the early stages of typhoid fever. Both have that nausea when sitting up in bed, both have dry tongue and soreness through the body, but there are quite a number of other symptoms which will enable you to distinguish, and which have been mentioned in the lecture on Bryonia.

Rhus tox. , like Muriatic acid, has this restlessness in the beginning. The patient is continually moving and tossing about the bed. He can- not sleep at night. There is slight delirium, with muttering. All these symptoms are under both Rhus and Muriatic acid. Rhus has not so much debility as the latter, hence it is followed rather than preceded by the Muriatic acid.

Phosphoric acid resembles Muriatic acid, but resembles it in this re- spect: Phosphoric acid has apathy and indifference; a complete "don't care condition;" indifferent to what may happen to himself, or to others. That is not the condition calling for Muriatic acid, for taci- turn^ is not indifference. Then again, Phosphoric acid does not cause the same prostration that we find under Muriatic acid. The character- istic stupor of Phosphoric acid is this: the patient is easily aroused from stupor, and is perfect^ rational when aroused, no matter how soon he may drop off again to sleep.

Apis resembles Muriatic acid. Both remedies have this dry and shrunken tongue, both have sliding down to the foot of the bed, im- pending paralysis of the brain, etc. The Apis tongue is very charac- teristic, and differs from that of Muriatic acid. It is covered with little blisters, especially along the border. The patient cannot put the tongue out; it seems to catch on the teeth, or, if he does get it out, it trembles.

Arsejiicum you can readily distinguish by the symptoms, which I will give you next week when I lecture on that drug.

You should also remember in this connection Baptisia, which has, in common with Miiriatic acid, this great weakness. Baptisia, however, has a besotted look to the face; the teeth are covered with black sordes, and the tongue is red on the edges and yellowish-brown down the centre.

Now, a word of caution. Do not mistake the symptoms of Muriatic acid for those of Belladonna. The novice is apt to do it. For instance, you notice the flushed face, the over-excitement of the senses, desire

524 A CLINICAL MATERIA MEDICA.

to sleep but cannot; these are all symptoms of Belladonna. But try to find the meaning of the Belladonna symptoms and then of those of Muriatic acid, and you will find that they are by no means the same. The Belladomia symptoms apply to hyperemia, and to the beginning of the disease, and not to overwhelming of the system by disease, as in Muriatic acid.

Next I wish to refer to Muriatic acid in scarlatina. The body is in- tensely red. There is rush of blood to the head, with bright red face and great drowsiness. Now the rash comes out very sparingly, and is scattered irregularly over the surface of the body, and interspersed with petechise, with bluish or purplish spots.

The child is very rest- less, throws off the clothes, and will not be covered, As the symptoms progress, the skin becomes purplish and the feet decidedly blue. Catarrhal or even diphtheritic symptoms, the diphtheritic symptoms already referred to, may complicate the case. A thin, excoriating dis- charge escapes from the nose, making the upper lip sore. And so irritating are the discharges from the mouth that the mucous membrane becomes intensely red, and even denuded of its epithelium.

By and by, yellowish-gray deposit forms in the mouth, and particularly in the fauces, and on the tonsils, uvula, and posterior wall of the pharynx. One of the provers had symptoms that made it difficult to decide be- tween those of diphtheria and those produced by Muriatic acid. The breath becomes very foetid, and the uvula, cedematous. Sometimes the latter hangs down as thick as your thumb, and lies on the tongue, causing the child to gag and choke.

These are the diphtheritic and catarrhal symptoms, and they may occur with or without scarlatina.

Belladonna is apparently, not truly, a concordant remedy here. These symptoms may cause you to give Belladonna, and incorrectly, too. The drowsiness and disturbed sleep, etc. , of this remedy are caused by congestion of the brain, which is not the case under Muriatic acid.

More closely allied are Apis and Sulphur, which both produce red- ness of the skin to a marked degree.

Kali permanganicum resembles Muriatic acid in the throat symptoms, especially in the cedematous uvula, but is marked by excessive fcetor. Other remedies having this symptom are Apis, Natrum arsenicosum, Mercurius cyanatus, Capsicum, Kalibichr., Arsenicum and Hydrocyanic acid. This last remedy resembles Muriatic acid in its throat symptoms, and in the blueness of the surface, and in the presence of petechiae in the rash.

THE ACIDS. 525

Sulphuric acid resembles Muriatic acid in scarlatina in that both remedies have these bluish spots, great weakness and diphtheritic membrane. Sulphuric acid does not have relief from uncovering. Then again, there are appearances on the skin like suggillations. Spots ap- pear that look as though the parts had been bruised.

I have also found Muriatic acid useful in the last stages of dropsy from cirrhosed liver. Of course it may be used in any other serious disease of the liver in which the symptoms indicate it. The dropsy progresses as it does ordinarily in cirrhosed liver. The patient finally develops a typhoid condition, and becomes drowsy.

Now these are the symptoms for which I have selected Muriatic acid. It does not cure; it will only relieve. The patient is drows}^ and becomes very much emaciated. The mouth is dry or it is aphthous.

The stools are often watery and involuntary. The stomach is so weak and irritable that no food can be retained.

Nitro-muriatic acid is also to be remembered in these cases of weak digestion. Its symptoms you will find recorded in Allen, and are very similar to those of Muriatic acid.

The antidotes to Muriatic acid are Camphor and Bryo?iia for the dy- namic effects of the drug, and alkalies for its acute poisonous effects.

Mtiriatic acid may also be used for the muscular debility following the prolonged use of Opium.

LECTURE L.

PHOSPHORIC AND SULPHURIC ACIDS.

{Debility — Aphthae — Typhoid. Haemorrhages. Diarrhoea.