Sulphide or Sesquisulphide of antimony (Sb2 S3).
THE best basis for a study of this drug is found in the records of slow poisoning experienced by workers in the antimony ores. Around these records are built up supplementary symptoms from the provings, and these again are added to from clinical sources. In antim crud. the last-named source is a large and important one. No laboratory work has been done with this drug.
(1) One of the earliest effects of the fumes or dust is headaches; they are more often frontal, but may be one sided.
(2) Next come Respiratory Symptoms.-Stitches in the chest, extending to the shoulders and back; these are accompanied or followed and back; these are accompanied or followed by a dry, painful cough, with difficult expectoration, and wheezing and rattling on inspiration.
(3) Genito-urinary effects are striking and important. The drug has a very depressing effect on the sexual functions and organs. Sexual desire and power are both lessened, and they may be abrogated. In workers of long standing there follow atrophy of testes and penis.
Micturition becomes painful and difficult; even strangury may be caused, accompanied with dark or reddish or bloody urine. At the same time urethritis with a urethral discharge may be present.
(4) abdominal or other digestive symptoms are less prominent in he workers than in provers; there are abdominal pains and tenderness, abdominal distension not passing off after stool; diarrhoea easily brought on by any indigestible food.
(5) Skin and Mucous Membranes.-Antim, crud. has effects on the skin and mucous membranes common to all the antimony salts. Pustules are very common to all the antimony salts. Pustules are very common and they occur chiefly on the scrotum and the face. Less frequently, papules or vesicles which do not suppurate occur and, very rarely, a more or less general erythema. The junctions of skin and mucous membranes become red and irritable. Itching of skin comes on, especially in areas that have had “spots” which have healed. Profuse perspiration occurs at night, after sleeping and after slight exertion. Hard, horny excrescences grow under the nails and are painful, the nails do not grow properly; warts appear.
(6) General debility and prostration are features running through the cases.
-These amplify the foregoing and they will be considered in the order of frequency and severity of the effects thus brought out, not in the order of poisonings, as given above.
(1) Headaches come early here also. They are often accompanied by a confused feeling and are often unilateral on either side. The pain may also occur on the vertex and be of a shooting or throbbing character. It is worse from movement, especially from jarring; from stooping or from lifting.
(2) Digestive phenomena are next in order of importance. Added to the worker’s records are a number of details not given by them-though some of them may have been present but not noticed.
Beginning with the mouth there is often salivation and a metallic or astringent taste (feeling); or the mouth tastes salty or bitter or sweetish. The tongue of some of the provers had a “slimy fur” and the teeth were covered with “yellow dusty stuff,” and in some the characteristic thick white coating developed. The mouth felt dry although much saliva was present.
Decided thirst with dryness of lips is noticeable. Eructations soon after eating, and tasting of food eaten, or bitter risings occur. Nausea comes on, but not early, and not so violent or prostrating as with antim. tart. Vomiting, when it develops, has the feature that it does not bring relief until it has gone on for some time. The patient (or prover) has the feeling that the stomach is over-full even if no food has been recently taken. If food is brought up it does not relieve the full feeling nor stop the vomiting. There are burning and tenderness on pressure or intense pain in the epigastric region, worse from the least movement. Appetite is usually spoiled, though it may be large. Lower down in the bowels there are pinching pain, tenderness and marked distension, not always relieved by passing wind; the flatus is odourless or smells like rotten eggs (H2S). Diarrhoea comes on, the call may be urgent; diarrhoea at night or in early morning; tenesmus may occur, but is not constant; if present it may cause protrusion of piles or rectal wall. Piles burn and protrude; there may be discharge of mucus from the anus. Smarting, pressure and throbbing-one or all these sensations may be present in the anus.
(3) Muscular and joint affections occur frequently in association with the indigestion referred to, and much more commonly in the provers than with the workmen. They are found in the lumbar region (especially the left), in the shoulders (1), arms, wrists and fingers; the joints may be enlarged and tender, especially the lower extremities, and the feet feel heavy, cold or numb. There may be tremor associated with the pains, or trembling and weakness apart from the pain. The joint pains are often worse in the morning and at night.
(4) The respiratory symptoms comes next in order. Beginning with the larynx and trachea, there are dryness and tickling which pass down into the chest. Viscid phlegm is present and is difficult to expel, and excites fits of coughing early in the morning. Loss of voice occurs when the patient gets fatigued with coughing or other exertion, and after a chill. Oppression and burning in the chest and stitches in the upper part and behind the sternum are produced. Sometimes deep breathing makes them worse. They are usually muscular and do not point to definite bronchitis or pneumonia as do antim. tart. respiratory symptoms. Where difficulty of breathing present it seems to be asthmatic.
The clinical indications for antim. crud. are to be found in the foregoing pictures, together with added details derived from experience in the treatment of similar cases by the drug.
Head.-To the head symptoms narrated should be added throbbing, with the sensation of the skull being lifted up at each throb. Experience has elicited that the headaches for which antim. crud. is called for are liable to come from depressing influences, such as taking cold, staying too long in the water while bathing; from suppressed eruptions and from indigestion- q.v.
The headache of this drug is not thing by itself, it is associated with digestive or respiratory disturbances, and in checked or if a chronic diarrhoea is suddenly suppressed by strong astringents or other cause. Here the general modality of antim. crud. will be found, viz., aggravation in a warm room and especially from the direct beat of the or sun, and from the strain of vomiting. Rest, lying down and quiet in the open air relieve all the symptoms.
Digestive System.-Clinically it is found that the most striking indication in this sphere for antim. crud. is a thickly coated very white tongue. A condition resembling acute gastritis with severe pain in the stomach and aggravation from slightest touch or movement, with the other symptoms of the drug may call for antim. crud.
Nausea, retching, and finally vomiting occur as stated above, After such food as may be in the stomach has been vomited, the patient continues to bring up thick mucus, but his feeling of repletion is not removed thereby. He may vomit until exhausted.
With all this, as would be expected, there is loss of appetite, more or less complete indeed the thought or smell of food may be loathsome. occasionally, however, this anorexia gives place to excessive appetite.
antim. crud. patients are likely to have an alternation of constipation and diarrhoea, or the loose motions may contain solid faecal lumps. tenesmus may be associated with the diarrhoea, and the desire for stool may at times be sudden and urgent. Piles, with oozing of mucus from the anus, are often or present, in old people especially, and they are often the subjects of a morning diarrhoea for which the drug may be suitable. Soreness, dryness and cracks at the angles of the mouth or at the anus, are often present, with or without piles. Smarting, pressing and throbbing in the rectum, may extend to the anus and perinaeum. Much flatus, tasteless or tasting of rotten eggs, passes up and down, but does not give relief.
The digestive disturbances of antim. crud. subjects are liable to be brought on by chills, after overheating or a cold bath; by sour wine or other acids, although they may have a craving for such drinks. The dyspepsia may result in a tendency to adiposity, and antim. crud. is frequently indicated for such constitutions.
Muscular and joint Affections-Closely associated with the digestive disturbances narrated above are rheumatic and gouty affections. Clinical experience confirms the usefulness of the drug in the conditions preferred to on p.146. Acute attacks may be brought on by over-eating or sour wind, or too prolonged cold bathing, and the pains are worse at night and in damp weather, and from radiated heat, though the direct application of heat to a painful part may be soothing. These rheumatic and “gouty” symptoms are only prominent in association with “indigestion,” especially chronic gastric catarrh.
Respiratory symptoms are not prominent in this drug. The cough it produces and relieves is liable to occur in paroxysms having the peculiarity that the first is severe and the subsequent attacks progressively diminish in violence. It has therefore been recommended in whooping cough. Here again it would only be indicated if associated with the characteristic gastric symptoms. Reference should be made to what has already been said on this sphere higher up.
Skin Symptoms.-Little more need be stated than that is recorded as experienced by workers in antimony (p.145). The curative virtues of this drug are not limited to pustules-pimples (papules) and vesicles occur and are commonly accompanied by itching. The itching of ant. crud. is followed by soreness after rubbing. Callosities on the soles of the feet are reported to be amenable to this drug, and the chief local indication for it is tenderness of the area involved when walking.
Genito-Urinary Effects.-Clinically but little use has been made of the drug in these spheres. The depressing and atrophic effects on the sexual organs felt by workers are preceded in provers by a stage of excitability, and this is more employed therapeutically. In old people for whose ailments this drug is indicated the atrophic features may be utilized.
In women there is a bearing-down feeling as if the internal organs would be forced out at the vaginal or anal orifices. If found in connection with diarrhoea, piles, or the gastric symptoms of antim. crud. it would confirm the use of the drug. Under similar circumstances irritability of the bladder, in either sex, might be relieved by it.
Mental Symptoms.-Antimonium crud. is specially suited for ailments found at the extremes of life and the mental state finds different expression at the different ages. Infants show some of the irritability and peevishness found also under antim. tart, they resent interference and do not like to be touched or looked at. Adults on the other hand are dull and sulky. After severe illness, before convalescence is established, there is sometimes found a lack of “will to live” which may really prejudice a patient’s chance of recovery. Weakness and a desire to die may help to bring about the fatal result. In two ways this may be effective, by some metabolic inhibition probably brought about by endocrinal disturbance and more directly by preventing the patient from following instructions or taking means to secure recovery. Antimonium crud. has been useful in stiffening the morale of such patients.
It is also reputed to be of use in mental depression following disappointment in love, and for ecstatic conditions in hysterical girls who become sentimental in moonlight.
Certain features are prominent in subjects requiring antim. crud. and run more or less through the cases. They are:-
(1) Sensitiveness to warm rooms and particularly to the direct rays of sun or fire (especially in headache and respiratory affections). Attention must be paid to the relief obtained by local warm applications to some of the pains-a “particular” contrasting with a “general” symptom.
(2) On the other hand depressing influences such as cold weather and cold bathing bring on a variety of ailments, digestive, “gouty,” &c.
(3) Dryness and cracks at angles of mouth and at anus are common.
(4) Children with a tendency to become too fat are subjects likely to develop antim. crud. symptoms in the digestive or respiratory sphere.
(5) Cessation of symptoms in one sphere is liable to be followed by the development of others elsewhere, the so-called metastases, e.g., of gout, &c., or alternation of weakness and depression with excitability and hysterical instability may exist.
(6) The left side is more frequently affected than the right.
(7) Absence of relief from vomiting, passing of stool or flatus.
(8) Drowsiness in the day time, especially after meals.
(9) Cough worse on entering a warm room (also bryonia).
Generally speaking antim. crud. patients are likely to be upset in different ways by acid drinks (especially wines) or food, by over-eating, by extreme of temperature, but especially wines) or food, by over-eating, by extremes of temperature, but especially by exertion in hot weather, and by direct heat rays; by movement (rheumatic pains and acute gastric attacks); worse at night, worse from damp, by looking at the fire (cough), cold bathing.
Relief from rest and lying still, from open- air; local warm applications.