Nitricum Acidum

[citric acid.]

Also designated as salt of lemons. Pure citric acid is a semi-trans- parent, slightly deliquescent body, and should therefore be kept in closely-stoppered vessels. Its taste is intensely sour and even some- what caustic.

It is soluble in three-fourths of its weight in cold water, one-half of its weight in boiling water and in alcohol ; it is not soluble in ether.

SCURVY. — Citric acid has been used for years past as a preventa- tive against and as a remedy for scurvy ; instead of using the acid, the pure juice of the lemon is preferred by most physicians. The mucilage, which is a normal constituent of the lemon-juice, is no longer found in the chemically-prepared acid.

ACIDITY OF THE STOMACH Prof. Thomas D. Mitchell, of Jefferson College, recommends citric acid for acidity of the stomach; he writes in his Materia Medica and Therapeutics: "I name another use of citric acid or lemon juice, which may seem paradoxical to some persons, viz., for the cure of acidity of the stomach.

I have proved its efficacy in my own person, and also in the cases of others. After having tried all kinds of antacids in vain,. I have found strong lemon acid to give prompt relief. The explan- ation is thus : a depraved state of the mucous membrane lining the stomach, dependent on loss of tone, is one of the sources of acidity.

The atony must be subdued and overcome by an appropriate tonic. This is often found in the lemon acid or juice.

" Since the preceeding remarks were written, I have met with a similar statement from the pen of Dr. Tracy, of Ohio, in the Am. Jour, of Med. Sciences. Like myself, he was long troubled with

ACIDUM FLUORICUM. 65

gastric acidity, and after vainly trying all ordinary means, was cured by lemon juice. I stated the practice in my lectures several years ago, and noticed the fact, also, that persons with stomach and bowel derangements, depending on excess of acid, were sometimes accidentaly cured by draughts of sour buttermilk."

The Professor's mode of explaining the curative action of lemon juice in acidity of the stomach, is the argument of a pettifogging therapeutist. Why will not quinine or iron fulfil the office of tonics in this disease? Why does the Professor persist in ignoring the law of homoeopathic affinity which underlies the curative action of lemon juice in gastric acidity?

In the October number of the London Lancet (American reprint) we are informed that hospital gangrene has been successfully treated by lemon juice and chlorine. The writer states that "in the hospitals of Paris, hospital gangrene was formerly very frequent, particularly in the Hotel Dieu, but now it very rarely occurs except in the Hospital St. Louis, where, under the influence of the miasmatic emanations of Montfaucon, it occasionally appears. Mr.

Jobert (de Lamballe) was the first to find the juice of lemon salutary. An instance of this disease has recently occurred in the Hotel Dieu. Mr. Eoux ordered lemon juice to be dropped into the wound, and the latter to be covered afterward with lint, steeped in a solution of chlorine.

Some days afterward the wound was cleansed and found covered with healthy granulations."

ACIDUM FLTJOEIOUM.

[fluoric acid.]

This acid was first procured in a pure state by Gay-Luscac and Thenard in the year 1810.

It has been supposed that fluoric acid is contained in the gastric juice of birds. This hypothesis has been weakened, if not over- thrown, by Tiedeman and Gmelin as well as by Lehmann. They caused the gastric juice and chyle of recently-killed animals to act upon glass, without being able to discover the least trace of corrosion on this substance. It is very possible, according to Lehmann, that Brungnatelli and Treviranus who were led to adopt the former view in consequence of having found pieces of agate and rock-crystal, which they had introduced into the stomach of common fowls and

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66 ACIDUM FLUORICUM.

turkey, apparently corroded, after having remained there for ten days, mistook a purely mechanical attrition of the fine granules of sand which are always found in the stomachs of these animals, for the corrosive effects of fluoric acid.

This acid occurs in the animal organism in combination with cal- cium, although in small quantities. Lehmann says that "the fluoride of calcium forms so integral a part of the enamel of the teeth, that we are inclined to ascribe to its presence, at least in part, the polish and the extraordinary hardness of that substance." Leh- mann further remarks that the presence of fluoride of calcium has been determined with certainty in the bones of almost all animals. It is said to be found in larger quantities in the skeletons of fossil animals than in those of our time. According to Liebig, human bones found at Pompeii, contained more fluoride of calcium than recent human bones.

Lehmann thinks that the small quantities of fluoride of calcium which are found in the animal body, may be conveyed into the sys- tem with the food; "we need only to remember," says this great physiologist, " that many mineral waters contain traces of fluorides, and that plants take up a little fluoride of calcium from micacious soils."

Fluoric acid is a powerful solvent, and destroys animal matter more readily than any other known acid. This property is illus- trated in the most marked manner by the following case of poison- ing which we find related in Frank's Magazine :

Francis Pschick, assistant in the Chemical Institute, had exposed his hand unprotected by a glove, for one minute to the fumes of fluoric acid whilst Jacquin was engaged in making some experiments before the class. An hour after, while he was washing some por- tions of the chemical apparatus in warm water, he experienced a troublesome prickling in the tips of Ms fingers which was speedily followed by acute pains, obliging him to discontinue his work. The pains being accompanied with a chilliness in the left arm, and soon after in the rest of the body, he mistook the attack for a violent cold.

It was not until evening that his suspicions became excited. He was seized with a violent chill, the pains became intolerable and the hand swelled very much. Early next morning, (December 24th,) all the fingers of the left hand, more particularly the thumb, were very much i7ijla7ned ; the tips of the fingers began to look discolored, the first phalanges were almost immovable, the remaining joints and even the hand itself could only be moved with aggravation of the pains which were of a drawing nature and extended up the arms as far as the shoulder; the tense swelling of the fingers gradually disappeared

ACIDUM FLUORICUM. q?

as it approached the wrist; the patient felt feverish. Dipping the hand in the white of eggs and poultices of raw potatoes afforded relief. Toward evening the pains again increased, became throbbing; the tips of the fingers swelled still more. On December 25th, the tips of all the fingers were white; the thumb seemed to be transformed into a white blister upon which the nail seemed to rest ; the throb- bing pains continued.

Every blister discharged a thick, brown, fetid fluid, having a very acid reaction. Beneath the detatched epidermis of the four fingers, the corion was found uninjured. Upon opening the blister on the thumb, the suppurative process was found to have penetrated through the whole of the integumentary tissues. The pains subsided very speedily after the blisters had been opened.

In four weeks, the parts were entirely restored.

WHITLOW. — It is evident, from this case of poisoning, that

fluoric acid is capable of inducing a most acute suppurative process.

I would recommend a trial of this agent in whitlow, using it both

internally and externally ; internally from the sixth to the eighteenth

attenuation, and externally a solution of one-eighth of a grain in an

ounce of water, with which compresses, to be ajDplied to the sore

finger, may be moistened.

Dr. Kreiner has made some experiments with fluoric acid upon his own person. Thirty drops of a mixture of one drachm of the acid prepared according to Thenard's method, in two ounces of water, caused violent burning and constriction in the fauces, rum- bling in the abdomen, pressure at the stomach, eructations, retching, and, in four minutes after taking the drug, several attacks of vomit- ing of a clear fluid containing pieces of a white, coagulated substance. The whole day he was affected with nausea, eructations and lassitude.

Ten drops of this mixture occasioned the same symptoms, except the vomiting.

These symptoms may be the result of a purely chemical action of the acid upon the mucous membrane of the oesophagus and stomach. To some extent they delineate the physiological action of the acid upon the organism, and may indicate its use in

CHRONIC GASTRITIS, where similar symptoms occur.

Fluoric acid is claimed to have acted curatively in bed-sores ; nsevi materni ; pimples ; ulcers with reel borders and vesicles ; vari- cose veins on the left leg (in an old man) ; small, bright red, round, elevated blood vesicles, resembling flesh-warts. All of these are usually characterized by burning ; it has been found useful in the itching of cicatrices of old ulcers (Halm. Monthly, August, 1875.)

The acid produces, and acts curatively in certain menstrual derange-

68 ACIDUM GALLICUM.

ments, such as too early and too copious menstruation, the discharge being thick and coagulated. It has also been used in chronic met- rorrhagia complicated with asthmatic complaints. It has been found of value in the treatment of leucorrhcea, when the discharge is yel- lowish, corrosive, irritating.

Its effects upon the mind are primarily stimulating, producing buoyancy, fearlessness and self-satisfaction.

The usual concomitant symptoms of the disordered conditions above-mentioned, are : weakness of memory ; increased ability to exercise without fatigue ; falling off of the hair ; rapid caries of the teeth ; excessive moisture of the hands and feet ; squamous eruptions on the body ; syphilitic erosions ; mucous tubercles ; exostosis and nightly bone-pains ; varicose veins. {Am. Jour. Horn, Mat. Med., July, 1874.)

The fluoride of calcium may prove useful in organic affections of the teeth, such as softening of the enamel and dentine.

[nitric acid, azotic acid.]

This acid was known to the Arabian physicians in the seventh century. It is a compound of nitrogen and oxygen. It makes a permanent yellow stain upon the skin which is distinguished from the yellow stain made by iodine and bromine in this, that the latter, if recent, can be readily removed by the application of strong alco- hol or caustic potash.

Wibmer sums up the poisonous effects of concentrated nitric acid in the following comprehensive statement :

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98 ACIDUM NITKICUM.

" Immediately after swallowing the acid, an intense burning pain is experienced in the parts having come in direct contact with the acid (mouth, fauces, oesophagus, stomach) ; there follows a develop- ment of gas ; eructations ; frequent vomiting of an acrid, burning substance; feeling of coldness externally; anxiety; shivering; a small contracted, hurried pulse ; restlessness ; sleeplessness ; inability to keep anything on the stomach ; symptoms of a fully developed gastritis ; difficulty of swallowing, costiveness.

The inner mouth, tongue, etc., look whitish, sometimes yellowish, furrowed ; if the patient does not soon die, this layer becomes detached, leaving for some time a raw surface. Even if the patient recovers, the stomach remains sensitive and even disorganized in consequence of which the patient will die sooner or later. After death, the border of the lips generally looks yellow, the inner mouth white and sometimes lemon- colored ; the teeth are loose, with yellow crowns ; the pharynx, oesophagus, stomach, and frequently the duodenum and ileum are inflamed, in most cases lined with a whitish-yellow, granular, fatty and frequently chalk-like layer of flocks, representing the disorgan- ized mucous membrane.

The other coats of these viscera are inflamed, injected, sometimes exhibiting gangrenous spots ; these coats are at times found thickened, and at other times much thinner than before the poisoning, they tear quite readily and are sometimes found perforated. The pylorus is generally contracted. The other organs are healthy, except if the stomach should have become perfo- rated, in which case the abdominal organs may become injured by the acid. Similar disorganizations take place in the rectum, if it should be toucked by the poison.

If applied externally, the concen- trated acid acts as a corrosive irritant, changing the animal tissue to a fatty, yellow-colored mass, followed by inflammation of the sur- rounding parts. In small quantities, the diluted acid excites the appetite, increases the secretion of *a lightly-colored urine, causes a whitish coating on the tongue, dryness of the mouth ; about the fifth day after commencing the use of the acid, the teeth begin to become loose, the gums bleed ; in some cases ptyalism sets in ; the continued use of the acid is followed by digestive derangements, colic, fetid breath, headache, languor, constipation or diarrhoea."

The N. A. Jour, of Horn., Novem ber, 1868, contains an un usually interesting case of poisoning by nitric acid, translated from the report of Dr. Wunderlich :

A girl, aged seventeen years, took, in order to kill herself, about a teas poonful of concentrated nitric acid. At the same moment she felt severe pains in the mouth, fauces and stomach. Vomiting set in, and bloody-colored masses were thrown up on the first and sec- ond day. She had frequent, painful, bloody, dysenteric stools during the second day. Urinary secretion suppressed. On the third day the patient entered the hospital. She showed a well-nourished

ACIDUM NITRICUM. 99

body ; slightly red cheeks ; around the mouth some yellow crusts (from the contact of the acid) ; the tongue was coated with two yel- low streaks and some red excoriations ; the fauces were red, with yellow crusts and irregular excoriations. The region of the os hyoides and jugulum painful. Severe singultus, sometimes with vomiting, discharging with difficulty a serous brownish fluid, inter- mixed with yellow and bloody flakes. No appetite, but immoderate thirst; swallowing difficult; abdomen soft, not bloated, but very sensitive in the epigastrium, in the ilio-coecal region and in the region of the Sigmoid flexure ; liver and spleen of normal size ; organs of respiration and circulation apparently normal.

Inspira- tion 16, pulse 90, temperature 30° R. For the following two days some bloody scabs were discharged by the mouth, swallowing became more difficult, and the abdomen began to bloat. She had during thirty-six hours fifteen very painful stools, with blood and pseudo- membranes. No urine, bladder empty.

Pulse between 84 and 100, respiration 20 to 40, temperature 29.2 to 28.6. Patient gets more and more pale, is apathetic and cfuiet, but clear in her mind, and complains of occasional headache.

Toward the evening of the sixth day, renewed vomiting of ten to twelve ounces, and after four hours, again, eight ounces of black, bloody fluid. Stomach distended ; restlessness and delirium. Tem- perature 29.2. On the morning of the seventh day, temperature 27.8; pulse 92 ; considerable paleness ; relaxation of all the muscles, fetid evacuations per anum ; no urine.

On the eighth day the pulse could hardly be felt ; respiratory movements interrupted ; cadaverous look ; deep apathy, broken only by mumbling ; renewed bloody vomit, and then death without agony.

On the sectio cadaveris the skin appeared resplendently pale, waxy ; yellowish in the face, hardly any death spots ; subcutaneous cellular tissue full of fat ; muscles very rigid and dry ; brain pale ; lungs, anteriorly, bloodless, but too full posteriorly. Heart healthy ; coagula in the auricles ; in the pulmonary veins thin, fluid, brown blood. Tongue and fauces full of ulcers and scabs ; epiglottis thickened, red, and with submucous infiltration in front, but covered with black crusts further back ; the mucous membrane of the pharynx and oesophagus gray, with many scabs and ulcers.

The mucus membrane of the stomach grayish black. In the coecum and the large curvature, black spots and ulcers with gray, shaggy surface. The stomach contained a large quantity of dirty, dark-red fluid. The duodenum, jejunum and ileum were full of the same fluid, but the mucous membrane was perfectly normal.

The whole tract of the large intestines, from the coecum to the anus, gives most perfectly the picture of the pathological alterations found in dysentery: strong vascular injection, infiltration, and reddish-gray and muddy-green coloring of the mucous membrane ; extensive pseudo membranes ; num- berless ulcers on many places of the submucous cellular tissue of the mucous membrane ; undermining suppurations ; on many places of

100 ACIDUM NITRICUM.

the serous membrane pseudo membranous layers. The liver pale, full of cherry-red, thin blood. Both kidneys considerably enlarged, the capside can hardly be taken off; surface yellowish white, covered with pale ecchymoses and showing vascular ramifications in the forms of stars; the cortical substance yellowish-white, anaemic and enlarged to double its size; very yellotv places along with white, injected and ecchymosed ones; in the expressed fluid not a particle of fat. Pyni- mids enlarged, filamentous and red on their base.

The epithelium of the urinary canals dull and finely granulated ; no fibrinous coagula in them ; urinary bladder empty.

Nitric acid will be found principally adapted to diseases depending upon the presence of some virulent taint, especially the scrofulous, syphilitic and mercurial. According to our usual classification, we obtain the following categories :

CEREBRO-SPINAL GROUP.

Nitric acid is useful in headaches arising from mercurial or syphi- litic poisoning ; it is likewise adapted to chronic headaches depending upon liver complaint ; the pains are thus indicated by our provings : pressure and heat in the head ; painful tension in the interior of the head ; the head feels as if it were surrounded by a tight bandage ; throbbing pains in the temples.

ORBITAL AND AURICULAR GROUPS.

OPHTHALMIA. — It is particularly in syphilitic and mercurial ophthalmia that nitric acid has been found useful. Purulent ophthalmia, when caused by the gonorrhoeal or syphilitic virus ; ulceration of the cornea, arising from similar causes or having a strumous origin ; opacity, and other degenerations of the cornea, have been cured by means of the middle or higher attenuations of nitric acid.

In certain diseases of the ear, acidum nitricum is a very important remedy. Its anti-scrofulous properties frequently call for its exhibition in various forms of

OTOKRHCEA, especially in scrofulous children, who are recovering from scarlet fever or measles. It is now taught, and seemingly with the best of reasons, that otorrhcea is frequently of the same path- ognomonic importance which attaches to leucorrhoea, chronic intes- tinal catarrh and other local expressions of a constitutional taint.

Nitric acid is fully in its place when the bony structure is more or less seriously involved, a feature frequently found in scrofulous per- sons and in subjects of a mercurial or sycotic taint.

ACIDUM NITRICUM. 101

Furthermore, it has been shown that this remedy is able to overcome a congested state of the inner ear, and of the tympanum.

NASAL GROUP.

SYPHILITIC OZCENA. — In syphilitic ozoena nitric acid is eminently serviceable.

CARIES OF THE ZYGOMATIC PROCESS has been arrested by means of this agent.

CHYLO-POIETIC GROUP.

ANGINA. — We use this acid with advantage in mercurial and syphilitic angina, with ulcerous disorganization of the mucous lining which has a whitish appearance as if the throat were lined with chalk or flour ; with intense burning and stinging pains, and, occas- ional bleeding ; foul odor from the mouth ; copious ptyalism.

From the report of the Pittsburgh Homoeopathic Hospital, (February 27, 1873,) I take the following case: James M., aged thirty-five years, was admitted Oct. 18th, suffering with ulcerated sore throat. He acknowledged having syphilis some four years ago in England. The tongue near the root was the seat of three large, deep ulcers, having bluish margins, with red centres ; tonsils nearly sloughed off. It caused him great pain to take the least nourishment; very foul odor from the mouth. * *■ -* Prescribed nitric acid6 Oct. 24th. — some improvement; throat not so sore ; ulcers not looking so malignant ; fetor diminished.

Nitric acid30, four times a day. Nov. 2d. — left hospital to-day nearly well.

ULCERS. — In diphtheritic ulceration of the throat, such as is frequently present in malignant scarlet fever, with foulness of breath, viscid ptyalism, suffocative and burning dryness and swelling of the throat, nitric acid has proved very useful.

SORE THROAT. — Common and obstinate sore throat of a scrof- ulous nature has been cured with it. It is likswise homoeopathic to

MERCURIAL PTYALISM, with ulceration and sloughing of the mucous membrane, spongy swelling and bleeding of the gums, looseness of the teeth, etc.

Nitric acid causes dull pains in the stomach, very much aggravated by pressure ; nausea and vomiting ; vomiting of a dark and glair v liquid ; vomiting of a lemon-colored liquid ; vomiting of dark blood ; burning pains in the stomach ; sour eructations.

In accordance with these indications we prescribe nitric acid for DYSPEPSIA, with pain and tenderness in the epigastric region, sour eructations, burning distress in the stomach, occasional retching and vomiting of yellow mucus. " Syphilitic and mercurial cachexia. Sensation of heaviness in the stomach soon after eating ; regursnta- tion and vomiting ; but it shows its curative action especially in in-

testinal dyspepsia. The constipation is painless and lasts several days. The stools are hard, preceded by great pressure and followed by mucus discharges. Lancinating pains in the rectum after stool, lasting for some time afterward and not dependent on the difficulty of defecation, for they follow also a soft stool. Painful haemorrhoids, prolapsing with every stool, with loss of blood." (Dr. A. Charge, Baku. Monthly, August, 1876.)

CHRONIC ILEMATEMESIS or vomiting of black, fluid blood and mucus, with pain and burning in the stomach.

PYKOSIS or heartburn, with sour eructations.

CARDIALGIA, with dull pains in the stomach, excessive sensi- tiveness to pressure, vomiting of yellow mucus and blood ; the attacks set in paroxysmally.

Hirschel in his prize essay on "The Pains in the Stomach, espec- ially the Gastrodynia," speaks as follows of nitric acid: "Valuable in nervous gastralgia, but a chief remedy in the vascular and organic gastrodynia, hyperaemia, with catarrhal swelling, hypertrophy, indu- rations, scirrhus — especially erosions and ulcers — are covered by this remedy. It suits persons suffering from haemorrhoids, hepatic troubles ; the melancholic temperament, parsons weakened by sex- ual excesses, syphilis and mercury ; also hysterical women, suffering from spinal irritation, plethora, arthritis and debauches.

The pains are burning, gnawing, clutching, contracting, pressing, stitching ; sensation of soreness or ulceration, of heat or cold in the stomach ; sensitiveness to pressure or motion. Acidity, loss of appetite, alter- nating with boulimia ; eating relieves, but soon again produces pain and feeling of satiety. Inclination to eat earth, chalk ; aversion to meat and milk. Cold drinks and external cold palliates for a while; heartburn ; sour, alleviating eructations ; vomiting, even of blood ; mucus, watery, bloody diarrhoea ;, great thirst.

Accompanying symptoms : tension around the umbilicus and distention of the abdo- men, preventing breathing ; apparently active congestions to the head and heart ; pulsations in different parts of the body ; sweating during meals; general debility ; sensitiveness of the dorsal vertebrae ; chronic catarrhs of the different mucous membranes ; colliquations, debility, emaciation, swoons, convulsions, trembling, cramps, pollutions."

Frank has extracted a case of poisoning by nitric acid, where the patient lived several months after the acid had been swallowed. The opening of the pylorus was found very much contracted, not exceeding one line in diameter ; the walls of the pylorus and upper

ACIDUM NITRICUM. 103

part of the duodenum were quite hard, and half an inch thicker than in their natural state ; upon cutting through this indurated and hvpertrophied portion of the duodenum, the surface presented a greyish-white and somewhat bluish appearance ; its tissue looked like lard and creaked under the knife. This disorganization pre- sented all the characteristics of scirrhus of the stomach, according to Andral's description of this disease.

Upon the strength of these post-mortem appearances, nitric acid is recommended by Dr. Peters " as the only known, absolute homoe- opathic remedy for hard cancer of the stomach, especially of the pylorus."

This recommendation is too hasty. Every member of the French Academy, before whom this case was read, rejected the conclusions of the reporter, Dr. Bouillaud, viz., that the cancerous disorganiza- tion was the result of chronic gastritis caused by an irritant poison. Delens and Velpeau suppose that the cancer existed previous to the poisoning.

Gualtier de Olaubry, who had some previous acquaint- anca with the patient, thought that the dietetic excesses and the abuse of spirits to which the patient was addicted, might have been the first cause of the disease. I make these statements in order to show how much caution is required in making post-mortem appear- ances the standard by which the homoeopathicity of drugs to given diseases should be determined.

In the present case, the patient, after having been relieved of the first effects of the irritant poison by means of magnesia, presented himself for admission in the hospital with the following symptoms : the inner cheeks, uvula, velum, fauces as far down the throat as one could see, were covered with ulcers exhibiting slightly yellowish-grey crusts ; the parts were swollen and painful, with fetor from the mouth ; roughness of voice, pain in the oesophagus when swallow- ing ; features somewhat sunken, pulse contracted, ninety-two to ninety-six. After some treatment, the patient only complained of a feeling of embarrassment at the lower and in the middle portion of the oesophagus, and left the hospital for some three weeks, when he returned.

The pains in the oesophagus and stomach, the nausea, vomiting colic and constipation had re-appeared. He was emaciated ; the features very much altered ; nausea, vomiting, fetid eructations, bloating of the epigastrium with constipation ; tongue pale, rather moist ; breath fetid, pulse sixty-six to sixty-eight ; temperature of the

104 AOIDUM NITRICUM.

skin almost natural ; swelling in the left hypochondrium. The patient sank very suddenly. In

CHRONIC GASTRITIS, where these symptoms occur, and which may lead us to suspect the gradual supervention of scirrhus, more particularly in the case of inveterate topers, nitric acid may do much good.

In a case of chronic poisoning by nitric acid which occurred in our practice, one of the most troublesome symptoms was diarrhoea, with soreness of the bowels. We may prescribe this agent success- fully in

CHRONIC DIARRHCEA, with soreness of the intestines, dis- charges of a serous liquid, loss of appetite, emaciation, symptoms of intestinal phthisis. Indeed in fully developed

INTESTINAL PHTHISIS, this agent may be of great use. Also in

CHOLERINE or cholera diarrhceica, diarrhoea remaining after an attack of Asiatic cholera. In chronic

DYSENTERY, or dysenteric diarrhoea, with tenesmus, discharges of blood, serum and disorganized mucus, nitric acid may afford relief.

CONSTIPATION may find its remedy in nitric acid, if the patient is of a bilious habit, laboring under tedious hepatic derange- ments, syphilitic affections or suffering from the effects of mercury The stools will be dry, difficult to expel, preceded by colicky pains, which often continue for some time after the expulsion of the stool and are followed by great prostration. Such a state of affairs is frequently found during convalescence from a protracted and severe fit of sickness. In

PROLAPSUS OE THE ANUS, Dr. Marcy has effected a cure with nitric acid30, given every night for six weeks.

TORPID HEMORRHOIDAL TUMORS of long standing, when the vascular tissue seems to have lost all elasticity or natural con- tractility, may be diminished by the external application of dilute nitric acid. In

CHRONIC HEPATITIS, with great enlargement of the gland, alternate watery diarrhoea and constipation, sallow complexion, nitric acid is useful.

FUNGOID DISORGANIZATION OE THE LIVER.— In the following case reported by Dr. Wilkinson, nitric acid likewise showed great curative powers in what was supposed to be a case of fungoid disorganization of the liver.

ACIDUM NITRICUM. 105

Thomas P., aged fifty-two, butler to Mrs. C, of Montague square, consulted me in the month of October, 1 840, about a large tumor in the throat. On making an examination, I found a large tumor, occupying the left side of the fauces, desending down the pharynx, but its extent in that direction could neither be seen nor felt. It ascended behind the bony palate, and continued its course along the roof of the mouth ; below, it pressed down the tongue, and pushed the velum palati diagonally forward as far as the teeth.

On one side it was connected to the pharynx by a base as broad as the tumor itself, whilst the other surface came nearly in contact with the opposite side of the throat. The tonsil on the diseased side seemed involved in the disease, but whether it commenced in that gland or lower down does not appear, as he never suspected the existence of such a companion till it had assumed the frightful size of a turkey's egg. The mucous membrane covering the tumor was tense, and somewhat glistening, of a dullish-red color.

It had not the least doughy feel, but wait semi-elastic in some parts, whilst other portions of the swelling had a firm, fleshy feel. His countenance was rather sallow, but from his general good health, I pro- posed the operation of removing it piecemeal by ligature, as it was evidently too vasCular and in too awkward a situation for the knife. His mistress had sent him to Mr. Lawrence, of Bartholomew's Hospital, who pronounced it malignant, and would not interfere with it.

I then proposed that Mr. Liston should see him, when it was agreed to pass a bistoury straight into the tumor, and evacuate any fluid that it might contain. A small quantity of straw-colored fluid was evacuated from a super- ficial puncture, but on the instrument being continued further downward, a rush of arterial blood took place, and he lost nearly a pint in less than two minutes. Cold vinegar and water and syncope fortunately put a stop to the haemorrhage, and I accompanied him home from the hospital in a coach.

In a day or two he had a great deal of irritative fever, the lips of the wound opened, and an excrescence, hav- ing a yellowish-white cauliflower appearance, protruded. This kept on increasing in size for six weeks, was hard to the touch, and now of a magnitude between a shilling and a half-crown. His appetite entirely failed him, and he could scarcely swallow fluids of the consistence of arrowroot. The debility of body was now much increased ; he had lost all his flesh, his countenance very sallow, and his features much attenuated.

The glands of his neck on the side of the tumor formed a chain along the sterno-mastoid muscle, as hard as marbles ; he was literally skin and bone. Mr. Liston and myself, who daily attended him, now thought that death would soon terminate his existence, and my friend took his final leave. Mr.

Aston Key, of Guy's Hospital, was now sent for, and I met him. He pronounced it at once a fungus, that in all probability he had another in his liver, and that the patient would not live four days. Though all hopes seemed now at an end, I observed that he would constantly call for the nitric-acid gargle which I had ordered him. I was, therefore, determined to give large doses of it internally, which I did every four hours, beginning with thirty drops, thrice a day, in a glass of water ; increasing five drops each dose per * diem.

In less than a week the excrescence sloughed and came out; the nitric acid was continued and he got rapidly well in six weeks. T. P. is still in his situation, in good health, and has been so ever since his recovery, four years and a half ago.

ENLARGEMENT OF THE LIVER, even to an enormous extent, is characteristic of the acid, and has been cured under its exhibition.

Willie L., aged twelve years, was brought to my office by his mother two months ago. The boy had had ague three years ago ; since then his abdomen had been very large, and was becoming more so from month to month, until she was ashamed to see him on the street. The boy was weak, his mucles flabby, his appetite abnormally voracious, and his color sickly. I prescribed nitric acid, six drops of the second decimal dilution, to be taken in an ounce of water immediately after each meal.

At the end of a month he was wonderfully improved. His mother affirmed that his abdomen was already reduced to almost its proper size, and a glance was sufficient to confirm her statement. At the same time the morbid appetite and the entire train of associated morbid symptoms had disappeared proportionally. I ordered the contin- uance of the medicine twice daily for a fortnight, at the end of which period I expect to find him cured.

(Dr. R. N. Foster, in U.

S. Med. Investigator, Feb. I, 1879.)

106 ACIDUM NITRICUM.

CHRONIC JAUNDICE. — In chronic jaundice, depending upon the enlargement and induration of the liver, with obstinate con- stipation, fetid, dark-colored urine, ulcerative pains in the epigas- trium, nitric acid has afforded much relief.

URINARY GROUP.

Nitric acid in small doses causes an increased flow of urine ; in larger doses it causes frequent and ineffectual attempts to urinate ; it also causes fetid urine.

Dr. Marcy states upon the authority of Reil, that " after taking nitric acid, pain in the lumbar region and kidneys is observed, and from there to the bladder, attended with great urging to pass urine, . followed by diminution, even suppression of the secretion of urine for some days, and enuresis. The urine -burns when passing the urethra, is very turbid, has a bad smell and is very dark, even brown in color, depositing fibrous nubecula, and much brown-red, greasy sediment. The mucous membrane of the urethra is likewise affected as in the first stage of blennorrhoea ; pains in the orifice of the urethra commence very soon after the use of the remedy, as in case of stone in the bladder.

It is not known whether albumen in the urine is produced by nitric acid."

ENURESIS. — In enuresis, with fetid urine, discharge of a purulent sediment, especially at night, this agent has proved very useful. Also for

ULCERS IN THE URETHRA, with stinging and burning, profuse suppuration, dry skin, loss of flesh.

DIABETES. — In diabetes, it may diminish the secretion of urine * and moderate the thirst and heat.

Wunderlich's case would seem to point to to the use of nitric acid in suppression of the urinary secretions, to which old people are sometimes liable. This agent may likewise seem indicated in uraemia provided the constitutional symptoms correspond.

ALBUMINURIA may require nitric acid. The following indica- tions for it are given by Dr. Walker, (Hahn. Monthly, March, 1876).

" In syphilitic cases, or after abuse of mercury ; dullness of the first sound of the heart ; worse at night. Heart intermits every third beat. Muddy and foul-smelling urine, like that of horse's. Dry, hot skin, fever, headache. (Edema pedum."

Your attention has been called to the fact that nitrie acid pro- duces a diminution, and even suppression of the urinary secretion,

ACIDUM N1TRICTM. 107

and the symptoms which usually attend such a condition have been given. The following case, related by Dr. E. H. Spooner in the Neio Eng. Med. Gazette of August, 1871, is of unusual interest, since it gives a condition of the urinary secretion, as to color, not frequently found in daily practice.

Miss H., aged about twenty-five years, has been troubled for a year past with urinary difficulties. The urine is scanty ; she does not generally pass it more fre- quently than every other day; never more than once a day, and sometimes only after an interval of seven days ; it is of offensive smell, and in color indigo-blue. This peculiar and extraordinary color has been observed for the past three weeks only. The concomitants are : menses scanty, and like muddy water ; many dyspeptic symptoms; rheumatic pains in the lower extremities; palpitation of the heart ; weak- ness of vision.

Prescribed nitric acid3. Improvement at once set in ; the urinary difficulty was cured in less than one week, and remains so now, more than a month ; the urine is secreted in the normal quantity, passes freely and is of the ordinary color. * * * At her next catamenial period, the menses were also restored to a normal quantity and color.

SEXUAL GROUP.

In syphilitic affections of the sexual organs, nitric acid is emi- nently useful. In

SYPHILITIC ULCERS of the breasts, it has effected a cure. We read in Huf eland's Journal that a nurse of thirty-two years was infected bv a baby. Ulcers with red and inflamed edo;es broke out

mf ml "•— >

on the breasts ; they discharged a thick, yellow pus ; shooting pains in the throat which was sometimes red and swollen, but without a trace of suppuration. Nitric acid was given in large doses. The patient Avas completely cured.

CHANCROL'S ULCERS on the labia, penis, nose, hairy scalp, etc., have likewise yielded to the internal and external use of the acid, after caustics and mercurials had failed.

Dr. H. N. Guernsey relates a very interesting case in the Hahn.

Monthly, Novem- ber, 1870: The patient had been discharged as incurable from a large Philadelphia hospital. Dr. Guernsey says : I found him in the following deplorable condition : Sloughing of the entire integument of the penis, and of the prepuce, leaving that organ entirely denuded. At one inch posterior to the corona glandis, on the left side of the corpus-spongiosum, was a fistulous ulcer extending into the urethra, so that in micturition a portion of the urine escaped through this orifice.

The integuments which cover the pubic region had likewise sloughed away, leaving the muscular structure bare, and ulceration was extending upward under the pubes. The entire diseased surface was in a very unhealthy, or phagedenic, ulcerated condition. The urine emited an intolerably strong odor on being voided, and gave rise to consider- able burning and smarting. Sleep at night was much disturbed ; appetite poor and there was considerable emaciation.

Frequent painful erections occurred in the latter part of the night. He had had chancres on the glans, and buboes were still in a con- dition of ulceration. I had the entire diseased surface dressed with sweet oil and raw cotton, and ordered nitric acid200 in water, to be taken night and morning. This resulted, in a comparatively short period, in a perfect cure, the fistulous opening into the urethra even being closed.

Of course, the true skin, prepuce and hair, which had been destroyed, were not reproduced.

108 ACIDUM NITRICUM.

CONDYLOMATA at the anus and on the sexual organs have disappeared by the internal and external use of nitric acid. In

LEUCORRHCEA, especially when syphilitic infection may be sus- pected, or in scrofulous leucorrhcea, with greenish or pinkish dis- charges, having a foul smell and corroding the parts, nitric acid is 'frequently eminently useful. There may be a discharge of mucus, which can be drawn out in long strings ; stitches in the vagina, shooting upward ; violent pruritus ; heavy bearing down, with pain running from the small of the back downward, through the groins ; swelling of the inguinal glands.

MENSTRUAL DERANGEMENTS occasionally require nitric acid. The menses are generally too early and too profuse ; they are preceded by a feeling of lameness and of being bruised ; accom- panying the flow we find distention of the bowels ; very severe bearing down, with pain in the back, hips and groins ; palpitation of the heart ; headache ; great prostration and the characteristic urinary derangements ; all of these are apt to be followed, at the disappearance of the flow, by a dirty-brownish, green leucorrhoeal discharge.

UTERINE HAEMORRHAGE, accompanied by severe ache in the back, very painful pressure downward, causing a sensation as if everything would be crowded out and issue from the vulva, calls for nitric acid. Persons of a dark, bilious complexion are more partic- ularly benefited by the exhibition of this remedy. I need hardly add, that the mental symptoms (distrust, expectation of death, etc.,) and other concomitants, indicative of the acid, must be present, to make the indication a specific one.

RESPIRATORY GROUP.

This acid causes hoarseness; dry, barking cough, with purulent and bloody expectoration, difficult respiration. It is therefore useful in

CHRONIC LARYNGITIS, when depending upon a scrofulous or syphilitic element ; also in

LARYNGEAL PHTHISIS, when similar causes prevail ; and in

PNEUMONIA of old, emaciated individuals, when the disease speedily threatens to terminate fatally by paralysis, with dry cough ; copious green, blood-streaked expectoration ; violent stitches, mostly on the left side, excessive difficulty of breathing, soft and intermit- tent pulse, profuse sweat, rapid failing of strength.

Nitric acid has been used with success in

ACIDUM NITRIC UM. 109

FEVER GROUP.

FEVER AND AGUE, and likewise in

TYPHUS ABDOMINALIS, last stage, with hemorrhage from the bowels, and hemorrhagic petechiae,

MERCURIAL and scorbutic fever, or hydrargyrosis when assum- ing the form of a scorbutic diathesis.

EXANTHEMATOUS GROUP.

Nitric acid is particularly adapted to

SYPHILITIC ERUPTIONS, rubeola, herpes, condylomata, ulcers, tubercles, etc.

Dr. Cooke has employed this acid successfully in desperate cases of

ELEPHANTIASIS or lepra leonina, the patients being emaciated and covered with sores, secreting a foul and offensive pus. The acid was given in doses of ten to sixty drops in six ounces of water, repeat- ing this quantity twice every day, and augmenting the dose every two or three days by six drops, and gradually decreasing again in the same ratio. Four patients were discharged cured in four weeks ; the other two had to be treated somewhat longer, on account of a syphilitic infection, but they too were ultimately cured.

In diseases of the skin, nitric acid covers a very large field. Rum- mel, Hofrichter, Tielitz, Jahr, Lilienthal, and others, speak of it highly in the various forms of cutaneous disorders, syphilitic, mer- curial and others not specific. Dr. Lilienthal gives under the head of "nitric acid" a long list of such complaints from which I select the following : Chillblains, especially on the big toes and hands.

Eczema at the edge of the hair, in the internal ear, and on the gen- itals. Small, flesh-colored excrescences on the glans penis, emitting a fetid humor and bleeding when touched. Miliary eruptions. Herpes on the whiskers, fingers and alse nasi.

Pimple on the inner surface of the prepuce, changing into a flat ulcer, yellow, as if cov- ered with pus and red all around it. Impetigo. Ecthyma, etc., etc. x\ll of these are characterized by : burning itching, especially so at night. Violent lancinations, as from splinters, all night.

Pricking in the face. Tensive pains. They are worse at night, in the open air ; during perspiration ; on change of weather. Ameliorated in the cold air ; on lying down.

I cannot forego the pleasure of giving you the following case of Dr. Gaillard, published in the Am. Jour, of Horn. Mat Med., Vol. iii, page 135, in which nitric acid cured a remarkable case of

110 ACIDUM NITRICUM.

WARTY EXCRESCENCES on the skin.

Mr. G., aged twenty, of good constitution, consulted me about numerous large warts, which disfigured the back of his hands. He had suffered, for four years, the most excruciating pains with them, and neither cauterization, ligatures, nor red-hot iron has ever done him any good. Since four or five months the disease is on the increase, and begins to tell more and more on his constitution.

The backs of his hands are covered with mammilated warty excrescences, hard and horny in places ; and so close together, that the least friction produces laceration of the skin. Deep rhagades, always bleeding, prevent him from any manual exertion ; especially as haemorrhages from them, which quite frequently set in, are stopped only with diffi- culty. He frequently suffers also from inflammatory affections of the lymphatics, and glands of the arms and axillae. Prescribed nitric acid30, six globules, to take a dose in the morning, fasting ; and to repeat it every four days, for twenty days.

Then nitric acid200, six globules, once a week. The patient soon began to feel great relief; the rhagades healed up, the larger warts disappeared, and the others looked softer and less irritable. The remedy was continued for two months and the patient was perfectly well when the case was reported, three years later.

MALIGNANT SCARLATINA.— In malignant scarlatina the acid has been employed by Durr, if the following group of symptoms developed itself at the onset : Small and hurried pulse, stupor and sopor ; occasional discharge of a fetid, glutinous, corrosive ichor, which at first looked whitish and afterward brownish ; delirium only at night ; they escape from the bed, and can only be brought back with great difficulty ; breathing short, tongue dry, and looking like smoked beef ; eyes violently inflamed and glassy. Glandular swel- lings, especially parotitis, were always present. Exhausting nocturnal emissions, itching of the scrotum and root of the penis, were like- wise of frequent occurrence among the precursory signs of scarlatina.

VARICOSE VEINS. — Nitric acid has been found an excellent means of arresting haemorrhage from varices, or of reducing and even removing varicose veins, by applying a mild form of the dilute acid.

VARICOSE ULCERS can likewise be made to disappear by this means.

COMMON ULCERS, painless, readily bleeding and emitting an ichorous pus, may likewise heal under the internal and external use of nitric acid.

WHITLOW. — Permit me, as I close this article, to state briefly that the concentrated nitric acid has been locally applied to whitlow, that painful and often tedious inflammation of the soft tissues of the finger, which at times involves the periosteum and extends to the hand itself, becoming a most formidable disease. It is claimed that the external application of nitric acid proves not only soothing, re- lieving the pain promptly, but curative in so far, that it causes the inflammation to subside very rapidly. This, of course, has reference

A.CIDUM NITRICUM. Ill

only to the milder forms of the disease. Dr. J. llirsch says: "We may positively promise a rapid and certain cure in the milder farm of whitlow, when there is severe pain, aggravated at night, greal sensitiveness to the touch, intense redness and swelling on one or both sides of the nail, and often a yellowish tinge on the margin of the skin close to the nail, indicating incipient suppuration. In such cases the acid is to be applied as follows : A bit of wood or a match, having been dipped into the acid, is to be rubbed gently over every part of the reddened and inflamed surface ; it being necessary to dip the match into the acid several times during the operation.

The most inflamed spots, and those where the acid does not seem to adhere well, must be moistened several times in succession. This process must be continued for two or three minutes, and will cause no pain. If the boundaries of the inflamed surface have been passed by the acid, the patient will complain of a sharp, itching or burning. This can be relieved at once by dipping the finger into a vessel of cold water.

"If the acid has been thoroughly applied, the skin of the affected part will, in a few minutes, assume a bright yellow color. If the skin is delicate, less time will be consumed by the operation than when it is tough and hard. Any point showing incipient ulceration beneath it should be thoroughly moistened with the acid. Avoid the introduction of the acid under the edge of the nail.

This will cause itching and burning, which, however, may be at once relieved by dipping the finger into cold water. When the operation is con- cluded, cover the finger lightly with a thin linen rag."

Dr. Hirsch adds a number of clinical cases, which I omit. Let me remind you that it is your duty to avail yourselves of all means which promise relief to your patient, and that the external use of medicinal agents, employed with discrimination, is no violation of your faith in our law of cure. In the present instance Hahnemann himself recorded under nitric acid symptoms which point clearly to a condition characteristic of whitlow, such as : painful swelling of the fingers; purulent collection at the end of the thumb.

ANTIDOTAL TEEATMENT.— In a case of poisoning we first administer an emetic of from twenty to forty grains of the sulphate of zinc, or even three grains of tartar emetic dissolved in tepid water, to be repeated in fifteen minutes, if necessary. After the emetic has operated we administer the chemical antidotes, viz., chalk, whiting, or magnesia suspended in water. In the absence of these, soap-suds,

112 ACIDUM OXALICUM.

an infusion of wood-ashes, weak solution of the alkaline norbonates, white of eggs, gelatine, milk, oil, or in fact any mild diluent, should be immediately given. External parts burnt with nitric acid should be washed with a solution of soap or simple water (Pereira).