Picricum Acidum

[PICKIC ACID.]

Picric, carbazotic or nitrophrenesic acid is obtained by the action of nitric acid on indigo, carbolic acid, salycin, and various other organic substances. It exists in crystalline scales of a deep-yellow color. Its taste is exceedingly bitter. It is soluble in about 50 parts of alcohol and in about 700 parts of water. Either solution has a distinct yellow color and a decidedly bitter taste. Picric acid in union with various bases forms explosive compounds, of which the potassium-picrate is the most active.

Picric acid is emphatically a new remedy, and at present writing the positive knowledge of its modus operandi and of the probable place which it will take in the materia medica, is very limited.

Dr. Parisel published his thesis upon picric acid in 1864; it con- tained partial provings of the drug and reports of clinical cases ; Dr. Erbj (1865,) published a monograph in which he gave interest- ing experiments made by himself with the picrates of potash and of soda, and much information in regard to the acid and its salts, previously unknown. This publication increased the interest of the profession in the new remedy, and Prof. S. A. Jones, among others,

ACIDUM PICRICUM. 123

entered upon an enthusiastic study of the drug, experimenting with it and publishing from time to time the results of his investigations.

Dr. L. B. Couch has also contributed much valuable matter and has placed the profession under obligation for his inquiries into the physiological action of the acid.

The information which we are able to give, is mainly derived from the sources .ndicated. In the Homceopathic Times, April, 1878, Dr. Ooucn publishes a paper, in which he describes at some length the result of experiments made by himself Upon dogs with picric acid. These experiments, as recorded, seem to establish the fact that picric acid exerts a remark- able effect upon the spinal cord, and, probably, upon the medulla oblongata and cerebellum ; the cerebrum seems to remain compara- tively unimpaired.

The experimenter observed spasms, both tonic and clonic, which had "a striking resemblance to those produced by strychnine." "When thoroughly under the influence of the drug, the animal betrays great weakness and lassitude ; especially is this noticeable of the hind legs, they being scarcely able to support the already attenu- ated body which sways constantly from side to side ; the tail, too, is as limp as a wet rag, and cannot be made either to wag or curl. As more of the drug is absorbed, these symptoms become more and more prominent ; the animal falls over at the slightest push and seems unable to rise.

Its whole aspect is now one of the greatest terror; the fur on the neck is erect and bristling; the eyes are prominent and staring ; the head is turned quickly from side to side, as if fearing a deadly attack from some dreadful, unseen enemy ; the gait, too, is peculiar, resembling somewhat that of locomotor ataxia. This is due to sudden spasms of individual muscles during the act of walking. On being urged to run three or four feet, he seems as if suddenly pulled back upon his haunches by some unseen force.

The spasms now become general, involving all of the voluntary muscles ; the whole body becomes convulsed, respiration is stopped, opisthotonos sets in ; after one or two minutes the muscles relax and respiration is slowly established." " A slight rustling, a jar, or other noise is sufficient to produce a recurrence of the above phe- nomena. If rest and quiet are allowed, the animal may perfectly recover. If, however, too large a dose has been administered, the spasms recur more and more frequently, till death finally occurs from prolonged spasms of the muscles of respiration.

During the latter stages of the poisoning, clonic spasms of the jaws occur with

124 AOIDUM PICRICUM.

sufficient force to cause the sound of clashing teeth to be heard fifty feet or more. * * * Another very important and interesting symptom, anaesthesia of the posterior extremities existed to such an extent that pins could be passed into the joints, and even through the limbs themselves, without the animal betraying a consciousness of pain. These symptoms occur m both posterior extremities and in them alone. This fact would lead us to regard the lumbar portion of the cord as the seat of lesion."

The effect upon the brain is sufficiently striking to awake pro- found interest in the subject : It appears that actual symptoms of cerebral softening have occurred in animals poisoned by picric acid, clearly demonstrated by examination after death ; the softening- showing itself more particularly in the cerebellum, medulla oblongata and upper spmal cord. Not only did there exist in these cases muscular spasms, defective co-ordination, paralytic symptoms and other derangements, characteristic of such organic lesion of the brain, but provings upon the healthy have developed a train of symptoms which still further justifies the belief that the acid is able to produce cerebral softening.

Dr. H. V. Miller [Halm.

Monthly, November, 1877) says. "There were heavy throbbing and terrible pains in the cervical and occipital regions, extending down the spine and forward in the course of the supraorbital nerves, and into the eyes, with dilated pupils, conjunctivitis, lachrymation, blurred vision and myopia. There were also the following symptoms, which Hammond states are seldom wanting in cerebral softening : Dull, heavy, frontal headache, vertigo, fulness and sensation as if the brain were too large for the cranium, corresponding to a sensation of constriction around the head.

In these provings no mention is made of impaired memory, another characteristic of softening, especially when the defect is progressive. But the following charac- teristics were developed : Great indifference ; lack of will power to undertake anything ; disinclination for mental or physical labor ; great heaviness and weakness of the lower extremities ; heaviness of the legs, as if made of lead ; coldness of the extremities ; numbness of the legs ; lassitude and general debility."

Dr. Couch found no changes of any importance in the brains of dogs poisoned with picric acid, with the exception of a " beautiful " injection of the convolutions of the brain ; but he speaks particularly of the effects of the drug upon the eye. The eyes of animals, care- fully examined by means of the ophthalmoscope and found normal

AC1.DUM PICRICUM. 135

before the administration of the drug, showed well marked wnous congestion while under the influence. Dr. G. S.

Norton examined the eyes of one dog on two occasions, and stated the results of the examination, in substance, as follows: " Oct. 12th Refractire media clear, optic nerve apparently slightly hyperasmic, retinal vessels, especially the veins, enlarged ; thin streaks of reddish color in the choroid, probably physiological, and due to want of pigment ; above the optic nerve in particular, immense white patches of exudation are observed, with some hsemorrhagic spots. It is impos- sible to say whether they are in the retina or choroid, as there are several, points in favor of each.

Oct. 22d Optic nerve entrance much swollen and infiltrated ; masses of yellowish-white exudation are observed, extending from the nerve into the various portions of the retina; others are unconnected with the nerve entrance. In some cases these points have a white, glistening look, but generally partake of the appearance noted above. The whole retina appears as if infiltrated ; small extravasations are found on the optic nerve and in the retina.

The choroid was normal as far as examined.

The pneumogastric nerve also seemed sensibly affected by the acid* While the number of pulse beats in the minute remained the same,, the respirations became materially lessened in number. In dog No. 1, the respiration, numbering 25 in health, fell to 20 during the first twenty days of medication and to 9.4 during the last four days- In dog No. 3, they fell from 19 in health, until the number reached 8.9 during the last medication of the animal. Dog No. 4 showed a similar decrease, namely, a fall of from 18.6 to 11.1.

The primary action is an increase of number of respirations. So we have in dog No 2, an increase of from 23.4 while in health, to 31.4 when under the influence of the acid ; and in dog No. 3 an increase of six beats per minute while under the action of the first medication ; in dog No. 4, a similar, though slighter increase showed itself when a second and larger dose followed a first and smaller one.

The drug affected the appetite of the animals in a marked man- ner. Primarily it increased it ; but secondarily the appetite became seriously impaired, followed by wasting away of the tissue ; vomiting and loose, scanty, brownish stools followed soon after absorption of the acid into the system. Post-mortem examination revealed no serious lesion of the intestinal track. The bile and urine contained free admixtures of crysophanic acid.

The sexual symptoms, which have been produced upon provers,

were also present in the animals poisoned, they showing unmis- takeable signs of laboring under violent sexual excitement.

1 A somewhat animated discussion has been going on between Drs. Jones and Couch, in regard to the action of the acid upon the blood and upon the urine. The former gentleman claims (Am. Horn.

Observer, August, 1877,) "that picric acid is a drug which retards oxidation. This is effected through the blood, that composite tissue being its chief point of attack. The oldest living element of the blood, the red blood-corpuscle, succumbs to the deleterious influence of picric acid ; fatty degeneration of its contents ensues, its coloring matter is set free, and it is no longer capable of bearing oxygen to the tissues ; then the body temperature fails, and death from asthenia results. * * * Our studies of the action of the drug have led to the belief that picric acid destroys the oldest of the red corpuscles first, including the younger ones as the blood stream becomes saturated with the acid.

The result of this should be a more rapid disintegration of red blood-corpuscles." Its action upon the urine, according to the same authority, consists in an increase of uric acid and of the phosphates, and a decrease of the sulphates and of the chlorides.

Dr. Couch calls into question both of these statements ; and in regard to the particular effect of the acid upon the blood, he declares most emphatically that a large number of specimens of blood, taken from animals at all stages of poisoning with the acid, failed to show the least indication of the change so minutely described by Dr. Jones. He differs also with Dr. Jones in his views of the effects of the acid upon the urine. Time and close observation will eventually settle this question.

But it is well to remember that Dr. W. Erb speaks at length of the remarkable effects of picric acid upon the blood of animals experimented upon. He states that the blood of those animals was of a dirty-brown color, with distinct nuclei in the red blood-disks and floating free in the serum. The same authority insists that the change takes place during life and that it is accompanied by a large increase in the number of the white corpuscles.

The provings made upon the healthy are suggestive rather than conclusive. In Allen's Encyclopedia we have about four hundred and seventy symptoms under picric acid ; the following seem most noteworthy : Great indifference ; lack of will power to undertake

* ACIDUM PICRICUM. 1 '1 3

anything. Vertigo and nausea with intense pain in the frontal region and vertex ; could not sit up ; greatly aggravated by even raising the head. Headache, worse from motion, and greatly aggra- vated from going up-stairs ; headache relieved by pressure. Severe sharp, shooting pain in the center of the eye, extending back to the occipital region ; the pain seemed to follow the bourse of the optic nerve.

Sparks before the eyes. Sight dim and confused. Loss of appetite, aversion to food, great thirst. Nausea with faintness.

Disagreeable pressure as of a weight in the stomach ; desire to belch wind, with no result, seeming powerless to do so. Humbling in and fulness of the abdomen. Soft, diarrhoeic stools of light-gray or yellow color. Increased flow of pale urine.

Urine dark, high- colored. Terrible erections, with restless sleep. Erections followed by profuse seminal emissions. Violent erections all night.

Amorous excitement, impelling the mind to dwell on and revel in imaginary sexual pleasure. Great heaviness in the arms and legs, on exertion. Great weakness and heaviness of the lower limbs. Great weak- ness in the region of the hips.

Tired feeling, even on least exertion. Lame and tired all over the body General sense of (excessive) languor, great prostration. Drowsiness. Very sleepy.

Restless sleep. Extremities cold. Forehead hot. Heat in the lower dorsal and lumbar region.

The difference of opinion concerning the modus operandi of the drug makes itself also felt in the variety of pathological conditions which have been suggested as coming within the curative range of the remedy. The recommendation of picric acid as a remedy for jaundice is met with the claim, that the coloring of the skin and of the urine is wholly due to the absorption of the acid and cannot be considered a pathogenetic symptom ; the same objection is raised to its employment in Addison9 s disease. It has been asserted that idiopathic anmmia finds its very picture in the pathogenesis of the acid ; but the counter claim is made that the symptoms of anaemia produced upon animals during the exhibition of the drug, was simply the anaemia of starvation.

A few of the symptom-groups are so well defined and so complete that we can hope to find in the acid a reliable remedy in correspond- ing pathological conditions.

The effect of the drug upon the sexual organs of men is certainly remarkable and promises much for its use in

128 ACIDUM PICEICUM.

SATYKIASIS. — In fact Dr. Allen, of New York, reports a case of satyriasis of three years standing, which he cured with the third dilution of the acid. The following symptoms are characteristic of the remedy : Violent, strong and long-lasting erection, with fear that it would rupture the penis, followed by profuse seminal emissions.

Dr. Couch states that small doses of the acid produce intense sexual excitement, but that medium and large doses as effectually remove every particle of erectile power and amative desire. The writer has within the last six months prescribed for a case of com- plete impotence caused by long-continued sexual irregularities, namely, masturbation during boyhood and the habitual withdrawal of the male organ before the completion of the embrace during fifteen years of married life. After the use of the usual remedies picric acid, sixth decimal trituration, was given three times a day.

The utter and persistent weariness of the patient caused the selection of the remedy. The effect has been surprisingly satisfactory,, although sufficient time has not elapsed to say whether the cure will be permanent or not.

Dr. Jones reeommends the drug very highly in diseases which are characterized by an impoverished state of the blood or, to speak more specifically, by a diminution in the ratio of red blood- corpuscles. He makes especial mention of it in

PROGRESSIVE PERNICIOUS ANAEMIA.

Dr. White reports as follows {Horn. Times, June, 1878,):

John T. Magregor, aged sixty-two years, weight 140 lbs. July 26th Patient quite prostrate.

Ears transparent; face, neck, lips and hands are of a death-like whiteness. Were he dead he could not have appeared more pale. The whole action of the patient is of a " logy " character. He vomits from three to five times a day, the matter vomited being of a bright yellow color and very bitter.

Never vomits food lately eaten. Has not the faintest idea of what aggravates or brings on the attack.. They come on suddenly without any warning. Is easily prostrated; the slightest exertion obliges him to be quiet.

Often the prostration caused by some little out- door work in the morning compels him to keep his bed the remainder of the day. Sometimes he feels like dropping down where he is, as though he were unable to reach the house. Mouth badly ulcerated; tongue smooth, cracked, having the ap- pearance of an alligator's hide. Mouth very dry; the dry feeling commencing in the throat and working upward, causing him to drink oflen, but little at a time ; cannot double the tongue ; a feeling as though the tongue would crack were it not moistened ;. sensation as of a lump back of the thyroid cartilage, very troublesome when swallow- ing.

Appetite poor; no desire for any particular kind of food; eats what is set before him what he eats tastes good and seems to digest well. Retires about 10 p. M., almost always prostrate, but in a short time it passes away and he quickly goes to sleep. He awakens a number of times in the night to moisten his tongue, but readily goes to sleep again.

When he awakens in the morning he feels quite strong, but this soon passes away ; he dreads the day. Has been constipated during the last eight months ; has an evacuation once in four or five days ; the stool is hard as a rock, sometimes bloody ; great straining, with pain during or after stool, easing up after a little time. In complaining of his head he says, his head feels badly all'

ACIDUM PICRICUM. 129

through, but the pain is on the right side, extending from the forehead back, and in the top of the orbit of the eye. Feels better in a cool room, or when lying down; is inclined to be drowsy; he sometimes feels as though he could sleep all day; when walking up-stairs or up-hill he has a sensation as if the stairs or ground were coming up to meet him; vertigo on rising from the bed, chair or from a stooping position and immediately after work. Last April and May he was unable to retain his urine ; it was very hot, almost scalding, but soon passed off, leaving him very weak.

Has no erections, in fact there is decided atrophy of the sexual organs, especially of the penis. Prescribed acid picric 6x (trituration) every two hours. On examination of the urine I find a very distinct color for uroha:matin. The bottom of the chamber is covered with a deposit of free uric acid.

July 27th No vomiting since he took the first dose; no evacuation for two days. Picric acid6 every three hours. July 29th — No vomiting.

Had a passage yesterday and one to-day. No headache ; he feels stronger. Picric acid 6x, every four hours. Aug. 3d — A decided change.

The countenance has assumed a more healthy appearance. He awoke at 4 A. M. and worked in the garden till breakfast; walked clown street; went into the woods after berries ; and at 5 P. M.

I found him walking up and down the walk in front of his house, and when I asked the cause of all this, he replied that he was taking some exercise. Eats three times as much as he did a week ago. Continued picric acid 6x once a day. Sept. 1st

Bowels very regular, says he has hardly lost a day; splendid appetite, sleeps well, no prostration; can walk up and down hill without its affecting him ; can feel the strength he daily gains ; his countenance is becoming quite brown and healthy. Says now that nothing ails him. Works all day ; has not vomited, since he took the first dose ; is growing stronger daily. Discontinued the medicine.

He has been troubled to a certain extent in this way for three years. The prostration came on, lasting only a few days or a week or two. No vomiting or any other dis- turbance, save the prostration. During these times he has been constipated.

This year it came on unusually early, about the 5th of February, and he commenced going down, and had been gradually going down hill until I saw him. . When I took his case he said he never expected to get any better. Now he is as well and even better than many who predicted his death.

It is quite probable that picric acicl may prove a valuable remedy in

BliAIN-FAG or in utter exhaustion of the nervous system from a

long-continued strain upon it. The headaches, the indifference of

the patient, the complete prostration, which are characteristic of the

drug, point in that direction. The following is a case in hand ■

Miss , principal of a public school ; tall, dark hair and eyes ; consulted me in

November last for a severe and terrible headache, which so completely incapacitated her for labor, that she was compelled to relinquish the duties of her position. Her premonitory symptoms (which first began in March, 1878) were, complete exhaustion, caused by her daily duties She was so tired after her labors that she could scarcely reach home, although but a few blocks away. The headache began in the morning, on waking, increased as the day advanced and was always relieved by going to sleep at night.

It chiefly affected the frontal region, extending gradually toward the vertex and involving the entire cerebrum, accompanied with constant vertigo, aggravated by motion and mental exertion — particularly that connected with the duties of her school — greatly increased by going up-stairs ; sometimes intense and throbbing, at others dull and pressing; always better by keeping quiet. The pupils were not dilated, although she had some pain in the eye-balls, which was increased by moving the eyes, but not by reading.

The face was never hot or flushed. Accompanying the headache was a terrible sense of prostration ; " she was so tired." She felt better in the open air than in the house, but was too tired and exhausted to walk. She usually slept well, but sleep did not always refresh her.

No night sweats. Appetite good ; digestion and menstrual functions normal. Phosphorus30 relieved the head- ache somewhat; nux30 and 20° relieved the vertigo to some extent, but the feeling of utter exhaustion continued. Picric acid30 afforded promt relief and she resumed her duties again.

A slight return of the headache a month later was promptly relieved 1 y the 6th, and she now feels better than she has felt in two years. (Dr. H. C.

Allen in the Medical Counselor, August, 1879.) vol. 1.— 8.