Wild Ind., U.S.A. N.O. Leguminosae.
THIS baptisia is an inferior indigo dye, the plant growing wild in North America. A tincture is prepared from the root, and dilutions are made with spirit.
Few records of laboratory experiments with the drug are available-those extent show its chief influence to be on the alimentary tract, naso-pharynx and muscular tissue.
The provings only faintly foreshadow the therapeutic uses of the drug. The account of its action which follows therefore mainly clinical.
FEVER.- In a word its effects very closely resemble a mild case of typhus fever. For patients with a typhus like (“typhoid”) condition baptisia is the first remedy to be thought of. In such cases the temperature is always raised-from 100 degree to103 degree F. (less or more). The patient’s aspect is the most striking feature. The face is suffused with a dull, darkish flush, the eyes are heavy and reddened, perhaps having a little sticky mucus in the corners. He lies on the side or back, taking little notice, and his ,mental condition corresponds with his appearance-it is dull and sluggish and an effort is required if he has to think. He may at first answer correctly or he may wander; in any case he settles down again into a somnolent condition. The “wandering”, in bad cases, is liable to degenerate into a muttering delirium-it is seldom violent. If violence develops other remedies should be considered. If the patient becomes worse these symptoms increase in severity, a lies on his back, with the eyes and mouth partly open; the lips and tongue are dry and the latter from having a yellowish-brown streak down the centre, with red, shiny edges, may become dried up, cracked or ulcerated, dark brown or blackish. The lips are coated with sordes. While the patient is still conscious he is likely to complain of severe headache. There is soreness of the scalp on brushing the hair or felt on the part touching the bed; the eyeballs are also sore, worse on moving them; photophobia is usually present. The locality of the pain in the head is not fixed or characteristic; it may be in the middle of the forehead, going down the nose or in the occiput extending to the neck; numbness and tingling of head and face are common.
If the patient has no localizing symptoms the case may be due to typhus fever or subtertian malaria. In the first, baptisia would be the most likely remedy; it should be compared with arsenic, ailanthus, and the serpent poisons. In the second, if quinine hypodermically has failed to give relief or if not available, or where the diagnosis is uncertain, baptisia would be a wise prescription.
Localizing symptoms may be present in the alimentary tract. The mouth condition, in more or less pronounced degree, will probably exist in all these cases. If to the above features there is added soreness of the abdomen, with tenderness in the right side of it (iliac and lumbar regions) and looseness of the bowels, the diagnosis of enteric may suggest itself. If given early, and especially if the evacuations are darker than the usual pea-soup type and more foetid, baptisia may be counted upon to do good.
It has been believed to have the power of aborting enteric fever. More extensive observation, checked by the Widal reaction, should be carried out. American experiments carefully made appear to show that in the healthy subject this drug, given in considerable doses, has the power to evoke a reaction capable of producing an agglutinating substance in the blood resembling that of enteric fever. As Wheeler points out, it is understandable that a much smaller dose may effect the same result when the organism is already struggling to produce the “antibody” in response to the enteric poison.
The feature of the stools already alluded to, namely, foetor, is a characteristic found in other bodily secretions- sweat, pus and urine (less marked); also the breath.
Another focal area affected by the drug and by certain diseases is the pharynx. Symptoms such as the following, in combination with some of the foregoing or associated with some of the mental symptoms presently to be mentioned, call for baptisia. These are : throat, dark red and swollen, not necessarily painful, with offensive secretion; inability to swallow solid food, which causes retching or a choking feeling if attempted; frequent difficult and painful efforts to swallow. These symptoms have caused the drug to be used in a few cases of diphtheria and cases of spasmodic stricture of the oesophagus. Probably cyanide of mercury or diphtheria antitoxin will have been given already, and it is the general toxic condition which would call for our drug rather than the local condition-though that would undoubtedly emphasize the call.
Priority has been given to this typhus-like state (calling for baptisia) because it is very characteristic of drug and disease, and because there is substantial evidence of the value of the remedy in practice.
There are, however, conditions in which the foregoing features, while possibly present in a mild degree, yield in importance to certain mental symptoms which have been much emphasized. These have considerable value because the diseases in which they present themselves are more common in this country than are the severer diseases already alluded to. One of the most conspicuous in influenza, and some states with little or no fever. The besotted appearance is much less marked, but the patient nevertheless has a heavy look, is somewhat apathetic, and has a persistent confused impression described by Wheeler as a “divided personality.” It is not the Jekyll-Hyde dual personality, but a feeling that his limbs do not belong to him, that they are scattered about that that he is trying to “collect the pieces”; that the patient is someone else; that he is two or three people. Wheeler (loc. cit., p. 98) quotes the strange instance of R. L. Stevenson, who realized during a febrile attack that he had a fever personality and a normal one. When the former predominated he felt that “his sufferings were caused by the failure to join the ends of a certain piece of string.” The writer has experienced a very similar state of mental perplexity during a slight febrile attack; and the attack was speedily dissipated by baptisia.
General bodily restlessness is a baptisia symptom, chiefly due to soreness and aching of any part lain upon, worse after 2 a.m. Weakness, trembling of limbs, semi-paralysed feeling, heavy feeling of the feet, head feels swollen and aches-any or all of these may go to complete the baptisia picture.
The abdominal symptoms of enteric calling for this drug have been dwelt upon; apart from them there may be nausea, vomiting, retching and abdominal tenderness (felt chiefly on using the abdominal muscles). Offensive morning diarrhoea with bloody, mucous stools, and pain in the hepatic region have been indications for the drug in infantile diarrhoea and in dysentery, probably of the amoebic variety. On the other hand, constipation may occur associated with deficient peristalsis and abdominal distention. Baptisia should, however, never be prescribed for this particular symptom dissociated from the mental condition described.
Sleep is disturbed by restlessness, and the patient feels generally worse and more confused on first waking (as with lachesis).
Other conditions in which baptisia has been useful are:-
Headaches (see earlier); also soreness of head inside and out, worse on stooping. The skins of the forehead feels tight as if drawn back towards the occiput.
Hepatic Region.-Pain in region of liver and gall bladder, with colic round navel; much worse from walking.
Respiratory.-The chest feels tight and compressed-breathing is difficult, and the patient craves fresh air. There are cases of septic pneumonia or even pneumonic plague where it seems as if this drug ought to be useful, but the authors have no experience of it. If useful it would be where the “typhoid” state is much in evidence.
Limbs and Back.-Aching and soreness of parts lain on cause constant desire to seek a more comfortable position-the bed feels hard and lumpy, bedsores form readily. There is numbness, especially of left arm and foot.
Skin.-With the fever there is great burning of the surface; dusky spots like the measles rash may arise; or spots like urticaria; livid spots may come out all over, especially on the trunk-any of these would be confirmatory of the choice of baptisia.
THE TYPHOID STATE.-The present may be a favourable point at which to offer a word of explanation as to the recommendation of baptisia in diseases so varied as typhus, the typhoids, malaria, diphtheria, septic conditions, “malignant” exanthems, influenza, “ship fever,” &c. The reader should remember that baptisia is not brought forward as a specific for them all of for all cases of any one of these diseases, but for a certain state and stage called, for convenience, the typhoid state-using the word in its original significance of a state resembling typhus. This state is known to occur with more or less definiteness in most of the diseases mentioned. When the protective body mechanism becomes exhausted and resistance fails, “widely different bacteria may produce very similar clinical pictures,”…”the strange point about the specificity of these poisons which we call endotoxins is that when profound poisoning occur, instead of the poison becoming more it becomes less characteristic and clinically the patient is seen to be in the typhoid state.” It is therefore understandable why, specificity having become, as it were, blotted out, and a blurred fogged picture only being left, one remedy having properties calculated to meet this blurred non- specific condition should be useful in at least some of the cases. We have just remarked that baptisia is not suited to all instances of the typhoid state, for though it has enough similar features to classify the cases under the one title for nosological purposes, yet each patient’s identity is maintained by certain distinctive symptoms or signs. In this way, though bacterial specificity may have been lost, each patient’s therapeutic individuality will remain. Not only must a remedy be chosen which will combat the typhoid state, but be suited for the individual patient in that state, with his personal peculiarities and minute differences which mark him, for therapeutic purposes, as a unit. So that, though baptisia may be useful for a patient in such a state, in whichever of the diseases it originated, on the other hand in a group of patients in that state, though originating in the same malady, each may require a different drug as his remedy. The drugs most commonly required for this purpose are baptisia, arnica, arsenic, ailanthus, lachesis and crotalus, bryonia, rhus, muriatic acid and arum triphyllum.
1) A heavy drowsy state with flushed dusky face and tendency to wandering of mind in febrile conditions.
2) Soreness of parts lain on, interpreted as a hard, lumpy bed.
3) Consequent restlessness, necessitating movement, though movement is painful.
4) Foetor of all secretions and excretions.
5) Mental confusion, of double personality, &c. (see text) before unconsciousness develops.
6) Parts feel enlarged-head or hands.
7) The typhoid state, in specific or septic fevers; low, continued fevers.
8) Chilliness in daytime; heat, restlessness and sleeplessness at night.
9) Difficulty of breathing and craving for fresh air.
10) On first waking confusion more marked.
11) Livid spots on skin.
12) Involuntary discharge of urine and faeces, or retention of urine.
13) The state of the tongue varies with the stage of the disease: as first it feels swollen, trembles and is coated in the middle, later in becomes brown and dry or raw, finally hard, dry, almost black, and shrivelled, or it may be ulcerated. Intense foetor of breath and oozing of blood from the mucosa. Any of these states indicate baptisia.
14) Dysphagia from sore throat and spasm of oesophagus, worse from solids.
THE MODALITIES of baptisia are not well marked; its selection as a remedy must be determined by the grouping of symptoms just narrated.
From drinking beer (gastric symptoms); walking or moving affected parts (some abdominal and muscular pains); cold winds; from thinking of the pains.