Semecarpus anacardium. Indian Marking Nut. N.O. Anacardiaceae.
A TINCTURE or trituration is made from cardol, the acrid juice between the shell and kernel of the nut; or from the whole nut. This juice, which dries black, is used in India for marking cotton fabrics. It has been used in medicine to a very limited extent as a vesicant.
The most striking effects of anacardium are on the skin, the mental and moral spheres, and on digestion. It is consequently chiefly in these spheres that it is used in homoeopathic medicine.
POISONINGS.-The poisonous effects are most noticeable on the skin when the nut has been suspended round the neck or attached to some other part of the body for a supposed therapeutic purpose, such as the relief of rheumatism or lumbago, &c. In preparing the tincture from the nut, the juice may come into contact with the skin and cause irritation.
(1) In the case of a woman the nut was attached to the thigh. It caused a bright scarlet-red eruption over the whole body, especially of the affected thigh and abdomen. The parts were swollen and the girth of the thigh reached 3 ft. The part “looked like a barrel.”
A second case suffered similarly; both were followed by desquamation.
(2) In another case where the nut was hung round the neck, there developed severe itching on the chest (which compelled scratching), made worse by warmth, exercise and scratching. Red, inflamed, raised wheals followed and the eruption spread to the abdomen and axillae. The itching increased, kept the victim awake, causing fever, anorexia and constipation. When seen by a doctor, the chest, axillae, arms, abdomen, scrotum and thighs were covered by these wheals and pustules, exuding viscid yellow fluid which dried and formed a crust. Some of the spots had a warty appearance from thickened epidermis.
(3) From the juice squirted into the face; there followed, in a few hours, burning of skin and chin, and a crop of small vesicles exuding a quantity of fluid. The left side of the face became swollen and covered with small, pock like pustules. The inflammation extended to the hands and the left eyelid, with burning in the evening; considerable weariness was felt the first day. The burning passed off and was followed by painful itching and shooting, the raw surfaces of the encrusted wheals were slow in healing, but the weariness soon passed off. Toothache on the left side was noticed.
(4) In still another case there were similar skin symptoms and the patient was depressed and irritable, possibly from loss of sleep. There was confusion of head and loss of memory, relieved by belladonna. In all these cases it should be noted the areas of dermatitis extended widely beyond the site of contact of the poison.
The mental and normal symptoms were chiefly brought out by the provings.
The mildest effects are a certain degree of mental excitement, the mind being filled with many projects, followed by dullness and depression. The prover cannot concentrate-the mind wanders-worse in the morning; he is easily angered and is peevish.
A further stage of lowering of mental power is shown by definite lack of confidence in himself-he fears he will not be able to do what is required of him; the memory is much weakened in the direction of forgetfulness of very recent events or subjects.
Further, anxious apprehension when meditating on present or future prospects is experienced.
Definite evidence of disturbed mental balance sets in- suspicions arise, the prover thinks he is being followed, and he experiences contrary moods-laughs at serious subjects, and is grave and sad in ludicrous circumstances. A delusion seizes him that a stranger is keeping him company, or that a good angel is on one side of him and a bad one on the other. He is kept in a state of indecision by a realization of two conflicting impulses or wills controlling him or giving him different orders. In alienist language,”obsessional and confusional states and anxiety neuroses” may require anacardium, and possibly some cases of early dementia praecox.
Sleep.-Those symptoms may be associated with vivid dreams which seem real even the next day; with dreams of old events, of fire, of dead bodies, or steep precipices. The sleep is disturbed, there is screaming during sleep, and tiredness and sleepiness in the morning. A general worn-out feeling, with exhaustion from a short walk, necessitating lying down, or causing a faint feeling on going upstairs, will persist after the drug has been stopped.
Digestive Sphere.-Sore throat, with “empty” eructations (of wind), or burning eructations, heartburn and nausea are present. An empty or sinking feeling in the epigastrium as from fasting is very characteristic. This and all the gastric symptoms are relieved while eating and for an hour or more after. Food and drink are swallowed hastily, which is liable to cause choking. Stitches in the hypochondria, sudden sharp pains in the abdomen, or dull pressure inwards at the umbilicus, rumbling in centre of abdomen, and fulness as from eating too much are noteworthy. Either constipation or diarrhoea may be present, but in either case there are desire for stool and straining, which go off when the attempt is made to get relief, but soon return again. The diarrhoea is worse at night.
The rectum seems powerless, or as if closed by a plug; there is pruritus ani post coitum.
Head.-With the indigestion there is often headache, which is worse during motion and from bending the head back, but is relieved by food.
There are various kinds of headache recorded: heat and throbbing, pressure on the right side, constricted feeling, or sensation of a tight band from the nape to the ears. A dull pain over the right orbit and temple is relieved by strong pressure.
On the left side of vertex (or in other parts) the sensation o f a “plug” pressing in is conspicuous. This is a form of pain experienced in many parts of the body. The scalp may itch and small boils develop. Vertigo, with a tendency to fall to the left, is felt on walking.
Eyes.-The lids are swollen as part of the dermatitis described and a pressing pain from front to back is felt; also “rheumatic tearing” from left eye to temple. Photophobia, flickering of the light, a halo round the light and temporary myopic vision from ciliary spasm-any of these may occur.
Ears.-Pain when swallowing, when clenching teeth, and humming or roaring are observed.
Nose.-Sneezing, coryza in the evening, sore pustules on right side of septum and a bruised feeling outside on the left may be associated with loss of smell or with perversions of smell.
Genito-urinary Sphere.-A frequent or constant desire to pass water may be present in the early morning, with a cloudy clay-like deposit in the urine. With the straining at stool prostatic fluid may be forced out; increase of sexual desire in the mornings has been noticed and also voluptuous itching of the scrotum.
Respiratory Sphere.-A cough from talking occurs any time in the day or at night, or after food-probably from throat irritation. A tendency to vomit with it and pains in the head are produced.
A dull pressure (like “a plug”) or stitches in chest and over heart, or in the left mamma or pectoral muscles when raising the arms are described as being worse from breathing and walking, relieved by rest but returning at once on walking again.
Back and Limbs.-A variety of pains, or stiffness, worse on walking or on slightest movement, are felt-also cramps and twitchings.
Restlessness, especially of legs, may be relieved by walking but a weak feeling of knees makes this difficult.
“Fever.”-heat at night with violent thirst, and chilliness and shivering even in warm room-icy cold creepings and night sweats, mostly associated with the dermatitis, may be present.
Mind.-ANACARDIUM is so rich in mental symptoms that it gives promise extremely valuable in cases of great mental depression in which the mind shows evidence of lessened resistance or borders on definite disturbance of mental balance. Some of the symptoms recorded in literature are doubtless of clinical origin, but they are none the less valuable as indications for the use of the drug. It is not necessary to repeat the symptoms of the mind already recorded. They are given in an increasing order of severity. They have been applied clinically where the patient’s condition appeared to have been due to excessive study, prolonged mental exertion with anxiety sexual excesses or sudden shock (followed by loss of memory) especially in old people. Sedentary occupations favour the development of such conditions. The marked loss of confidence in one’s own powers found in the pathogenesis has been utilized for persons having to face some ordeal such as examinations or a court of law. For “examination funk” it was found very useful at Cambridge. In early stages of such weakness an effort of will or actual contact with the dreaded circumstances will dissipate the fear. a similar state is found in the silica pathogenesis. Fear of the future, and a presentiment of evil is similarly an indication for anacardium. Loss of emotional control shown by exaggerated language in those not accustomed to cursing has been a useful clinical guide, though the symptom “inclined to course and swear” copied in text books does not appear in the provings or poisonings.
Another phase of depression may be that in which the patient dwells on religious matters and despairs of salvation. This occurs even in earnest Christian people after much mental strain (in whom it is probably temporary), or in elderly people with lessening mental powers or where degenerative changes are going on after cerebral thrombosis or slight haemorrhage. In the prematurely old progressive loss of memory may end in dementia; a favorable environment with anacardium as a remedy may do much to retard the downward trend.
Kent, in his valuable Materia Medica, describes the cases of patients with double personality, or being controlled by conflicting wills, or those with illusions progressing to hallucinations and delusions and suspicions. Moral cowardice and loss of moral feeling, sullenness and sulkiness and mental states due to or aggravated by excitement, fright or mortification, he regards as calling for anacardium.
The drug certainly deserves more extensive employment in mental cases and neuroses.
Digestive disturbances with the modalities mentioned especially relief from eating and pain or gastric distress when the stomach is empty-are met by this remedy. Cases of hyperchlorhydria and duodenal ulcer or irritation may require it. The features recorded on p. 139 concerning the abdominal symptoms should be re-read. Some of these may act as a contributing physical basis for mental conditions, and if present would form a strong confirmatory indication for anacardium.
Head-Headache, too, may be associated with either the mental or digestive symptoms. Heat of the head and unilateral pain, especially right-sided, occurring chiefly in the mornings and worse during motion and bending the head back are characteristic; also pain in the right temple and over the eye, relieved by strong pressure. Giddiness on stooping or when walking is also complained of.
The skin lesions resemble erysipelas-redness, burning, swelling and itching are strikingly produced. Later, a condition somewhat like impetigo arises. Various concomitants of such a condition-sleeplessness, various neuralgic pains, indigestion, disturbance of the bowels-may be reproduced in the drug. Its use has been extended even to leprosy, with apparently some useful palliative results. It is an antidote to rhus poisoning.
Sleep.-Some specific disturbances of sleep, quite independent of skin irritation, have been recorded; reference is made to these on p. 139. The dream picture is striking.
Fever.-Chilliness and feverishness seem to be mainly associated with skin lesions.
Genito-urinary conditions include frequent or constant desire to micturate symptoms of the drug accord well with those due to over-stimulation of the generative organs, natural or artificial; nocturnal emissions occur, and escape of prostatic fluid on straining at stool.
Other symptoms which may call for the drug are: coryza, ocular symptoms such as photophobia or a halo round the light; toothache.
(1) The mental symptoms, including sudden loss of memory, especially for recent events.
(2) Dermatitis, resembling that produced by rhus and primula obconica.
(3) Duodenal “dyspepsia” with conspicuous relief from food.
(4) Headaches, especially with a similar modality, and worse from movement.
(5) a symptom noticed in many parts of the body is that of a constricting band, or a pressure inwards as by a blunt instrument or “plug.”
(6) Pains in limbs when sitting, worse on rising and slightest movement or setting the foot on the ground.
(7) Restlessness in legs when sitting, relieved by walking.
(8) sensitiveness to cold and draughts.
Morning (mental, head and urinary symptoms), bending head backwards (headache), walking (headache and limbs).
Eating (stomach, cough and head symptoms), warmth, walking (restlessness).