Pure Phenol. (C6H5OH). Dilutions made with Water and Spirit.
CARBOLIC ACID is acknowledged even by Cushny to afford an example of arndt’s law, for he states that very dilute solutions stimulate the activity of protoplasm, while large doses retard or paralyse it.
It precipitates proteins, with which it enters into loose combination, and can penetrate more deeply into the tissues than do metallic poisons which firmly coagulate the proteins and form an insoluble protecting layer on the surface.
Locally applied to skin or mucous surfaces carbolic acid produces heat, tingling and numbness, or pain and local anaesthesia, followed by dry gangrene (in the case of skin) or inflammation and sloughing (in that of mucous membranes)- according to the strength used.
The usual evidences of shock and collapse will follow the use of a strength sufficient to cause corrosive (necrotic) action on any considerable area.
The drug may be absorbed from skin or wound surface, producing, inflammation of the alimentary canal and fatty degeneration of liver and kidneys. In small doses the central nervous system is stimulated and, later, depression follows.
Tremors like shivering, local twitchings and convulsions occasionally occur.
The action on the heart and respiration is through the nerve centres, first accelerating then slowing them, followed by a fall in blood-pressure, collapse, coma and death if large doses be imbibed or absorbed.
Perspiration, salivation and lachrymation occur either through direct stimulation of the secretory apparatus or as part of the nausea and vomiting complex. The temperature is lowered pari passu with the advance of collapse.
Some haemolysis occurs, haemoglobin appearing in urine. The well-known dark greenish-brown colour of the urine (approaching black) is not, however, due to haemoglobinuria but to oxidation of the absorbed acid and the formation of dioxybenzole. Albuminuria and even haematuria may occur from irritation by the excreted acid.
The gross symptoms due to the corrosive action of the strong acid are much the same as those of other corrosive poisons-damage or destruction of parts attacked, pain, vomiting, diarrhoea or “dysentery,” tenesmus, tympanites, with varying degrees of shock and collapse. They are not of much value as therapeutic indications.
One case of absorption from a dressing is quoted in “Cyclopaedia,” vol. I, sub voice, giving picture of the effects of a small dose in a sensitive subject. The attack began with a sudden shivering fit, the pulse rose to 100 and 120, with a weak and fluttering beat, the tongue became foul, the skin became cold and clammy, and uncontrollable vomiting set in. The face became pinched and anxious, and the spirits greatly depressed. There were no wandering, sweet breath or jaundice, which might have suggested pyaemia from the wound, which, however, was quite healthy. The symptoms cleared up when the carbolic dressings were left off, but repeatedly returned and with increased severity when they were resumed. The patient seemed to be sinking from the exhaustion of extreme retching, the pulse reached 130 to 140, and was very thready, the tongue had a thick, brown coat, and the urine was scanty and loaded with urates. The mind remained clear. The patient ultimately recovered after final discontinuance of the dressings.
In the case of a child, aged 3 1/2 years, bronchitis occurred; in other (fatal) cases pneumonia was observed; in a non-fatal case it was at the right base. At one autopsy the kidney were found much congested, with cortical and subcapsular haemorrhages, albuminuria, and fatty degeneration of the tubular epithelium as in phosphorus poisoning. The liver was congested and blackish. Acute nephritis with suppression of urine, anasarca, uraemia and death is reported. ].
These bring out a few conditions repeated sufficiently often or so definite as to be obviously genuine and specific effects of carbolic acid apart from those due to the direct corrosive action of the poison.
Mind.-Disinclination for study and mental effort of any kind, even reading; confusion and laziness were frequently produced. The mind in one prover (a medical man) “teemed with delightful ideas.” Nervous irritability, great depression, restlessness, delirium or unconsciousness and absence of reflex responses-these varied with the temperament of the patient and the dose of the poison. Absent-mindedness with starting and trembling when spoken to.
Head.- A frontal headache with feeling of constriction, “as if an elastic band were drawn tightly across forehead from temple to temple,” is the most frequent. Pain over one eye, dull or described as “neuralgia” is common-most often perhaps on the right side but not confined to it. Noise, light and mental exertion sometimes aggravate the headache. Fulness of the head is noticed, in one case the head felt “inflated,” and as if ten times its normal size – relieved by lying down : heat of the head relieved by fresh air. The scalp may be tender to touch, and jarring in a carriage very distressing.
Digestive System.- Total loss of appetite is common. Soreness of the throat (with pricking pains in it) on empty swallowing occurred from the 3c dilution – too small a dose to have local direct effects. The right hypochondrium is painful, abdomen distended with wind which cannot be passed, and there are eructations not giving relief. Acute dyspepsia resulted in one case with head pain of a dull character combined with sharp darting neuralgic pains. Ineffectual and frequent desire for stool with or without diarrhoea is produced. Nausea and vomiting may be accompanied with deadly faintness, the vomitus being very offensive.
Sleep.- Yawning, drowsiness and unrefreshing sleep, disturbed by sexual dreams and emissions were experienced.
Skin.- Tingling, burning, pricking and itching occur in different areas, relieved by rubbing. Vesicles, &c.
Rheumatic and neuralgic pain occur in different parts, in large and small joints; soreness under patellae.
These pains occur suddenly, last only a short time and disappear suddenly, recalling the pains of belladonna. Dull, tired aching in the lumbar region has been caused and relieved by carbolic acid; and tenderness and pressure at the level of seventh cervical spine. The back pains were increased by jolting and straightening the back.
Special Senses.-Sensitiveness to light and sound has been noticed, and the sense of smell is more enhanced, making the sufferer ready to faint.
Urinary Organs.-Acute nephritis is the most serious condition in this department; it may be so acute as to cause suppression of urine, anasarca and death. Burning in the urethra, pyknuria, tenesmus, scanty albuminous urine occur, and the urine may be profuse, scanty or suppressed. The dark colour of the urine may be profuse, scanty or suppressed. The dark colour of the urine has been referred to.
Eyes.-Neuralgia over eyes-especially the right; dimness, burning, disturbance of accommodation and contracted pupils are the chief ocular effects.
Unilateral symptoms are oftenest on the right, but pains in the left lower limbs and left ovary are recorded.
Not much use has has been made of this powerful drug, possibly because its indications are not very clear. It has been recommended for various conditions, called putrid in ancient parlance-septic we should call them to-day-e.g, bronchitis, pneumonia, diphtheria, malignant scarlatina, and enteric. Whether the results, justify the recommendation, and whether the indications are really homoeopathic or the action frankly antiseptic it is not easy to decide. It has also been recommended for offensive discharges from ulcers, smallpox, epitheliomata breaking down, and may have a value not explained by its pathogenesis.
Headaches of the well-defined varieties recorded under the provings would certainly be amenable to the drug.
For the vesical and renal conditions the provings and poisonings produce, other drugs are better indicated.
Vomiting.-Obstinate vomiting in exhausted conditions with deadly nausea, vomiting of pregnancy and of drunkards may require the use of the drug, and it has been successful in substantial doses.
Rheumatic and neuralgic pain in hip, knees, ankles feet (tendo Achillis), shoulders, forearm or fingers are benefited when they are sudden in onset and departure (like those of belladonna) and short in duration. The pains change from one place to another and back again. Jolting and straightening the back increase pain in that region.
The cutaneous affections for which it may be required are papules, with itching relieved by rubbing; acne spots; eruption of fine vesicles; rubbing is followed by burning. It is also praised in psoriasis.
Ovaritis has been attributed to the drug, and if that condition is associated with other carbolic acid symptoms, such as lumbo-sacral pain and offensive leucorrhoea, it should be considered; it is usually left-sided.
Sleep, heavy and Unrefreshing, disturbed by dreams at night, may be associated with drowsiness and yawning by day, and this combination with headaches, &c, would call for carbolic acid.
Diarrhoea is so common a disease symptom that for a drug to be successful it should be well indicated. Large doses of carbolic cause it in most cases, due to local irritation; for it to be of clinical value, it should be associated with leading indications elsewhere, or of its own modality. nausea, chilliness, cold sweat, cyanosis are concomitants, and involuntary, unconscious stools during sleep should recall ac. carbol. to mind.
(1) There are few general indications : rapid prostration with cold surface, bathed in sweat, leading to collapse is one.
(2) Severity of (rheumatic or) neuralgic pains, coming and going suddenly and of short duration is another.
(3) Mental depression, disinclination for mental or physical effort, absent-mindedness, with starting and trembling when spoken to are also “general” symptoms, though not very “leading.”
(4) Offensive nature of discharges from nose, mouth, rectum or vagina.
(5) Great foetor of breath, especially in vomiting of drunkards or form cancer of the stomach.
(6) Headache, constrictive, frontal from temple to temple.
(7) Various septic conditions.
(8) Dysentery, tenesmus, mucus, exfoliated fragments of mucous membrane and black, offensive stools.
(9) Pneumonia at the base of the lungs.
(10) Malignant types of exanthemata. Influenza.
jolting, extending (back pains), strong odours, right side.
lying (headache), rubbing (itching of skin).