Plumbago. Black lead. An allotropic modification of carbon. Trituration of prepared black lead from finest English drawing pencils.
GRAPHITES is not quite a pure substance as it contains from 0.4 to 0.6 per cent. of iron. Whether from the fact that it contains this amount of iron. or whether carbon in this different form gives origin to dissimilar pathological symptoms, or from both these causes, graphites has a place of its own on our pharmacopoeia quite independent of carbo vegetabilis, although there are points of similarity between them.
Graphites in its crude state is insoluble and inert, but when triturated and raised to the higher potencies becomes an important antipsoric and a valuable remedy in many chronic diseases. It acts chiefly on the skin and mucous membranes, but also has a deep-seated influence on the system. manifested by certain nervous phenomena. The large secreting and exerting organs seem not to be directly affected by it.
Skin-The predominating skin affections caused by graphites are herpetic and eczematous, and have the characteristic that their discharges are of a glutinous, honey-like nature, sticky and corroding, but dry eruptions, pimples and nodules also occur, and these may break down and ulcerate. Ulcers when present are indolent, callous and have an indurated base, they are inclined to show “proud flesh” and to be covered with foetid pus. The graphites eruptions may appear on any part of the body, but the seats of predilection are around the muco-cutaneous orifices and in the flexures, especially the parts about the genitals, such as the scrotum, the folds of the nates and the groin, the upper part of the thighs adjacent to the scrotum, the female pudenda, the prepuce and the glands penis. The backs of the ears, the scalp, the face and chin are also s4eats of election of graphites. The glutinous character of the discharge is conspicuous in all these positions. There is much irritation of the vulva, which is sore and moist with sticky secretion. Round about the anus are cracks and fissures, which itch and bleed and exude the characteristic viscid fluid. There are itching in the anus and stitching, smarting nd sore pain there after wiping the part. Other orifices are similarly affected; the meatus auditorius is sore and exudes the sticky discharge which smells like herring brine; sores and scabs from about the nostrils, the commissures of the mouth are seen on the face, which become moist after scratching, or there may be a moist eczema of the face, especially about the chin and round the mouth. The whole scalp may be eczematous and covered with dirty crusts which mat the hair, are painful, sore and itch. The hair falls off in patches. One prover experienced an attack of pure herpes zoster which extended from the spine round the left side of the abdomen to the umbilicus. On other parts of the skin the eruptions are usually herpetic or papular and the skin is rough, hard and dry, but there is offensive perspiration with excoriation between the toes and copious sweat of the feet. The skin on the backs of the hands is hard, hot, fissured and bleeding; horny callosities are present on the palms, the finger-nails are thick, brittle, black and fall off, and the toe- nails are thickened and crippled. Graphites influences scar tissue, it inflames and softens it and often causes a burning pain in it. The skin eruptions are all very irritating, and are worse from heat and the warmth of the bed, while the patient himself is chilly, feels he cannot get warm and is very sensitive to cold air.
Digestive Tract.-Turning to the mucous membrane of the alimentary tract we find that the gums burn and string and recede from the teeth, there is a lancinating or tearing toothache, which is worse after drinking anything cold and in a cold wind, but is also worse at night, with heat in the face. Burning blisters appear on the lower lip and on the tip of the tongue, and painful ulcers on the under surface of the tongue. The gums and mouth emit a putrid odour that smells like urine. Saliva escapes on to the pillow during sleep but the mouth is dry on waking. There is a sensation when swallowing, as of a lump in the throat, and a constant spasm compelling swallowing. On empty swallowing a sensation of constriction is felt which induces retching. The patient is averse from all animal food, fish, salt and sweets; the aversion from both salt and sweets is peculiar to graphites. He craves beer, acids and cold drinks. Frequent eructations occur tasting of food eaten (puls.), or they are of bitter, sour, putrid, greenish water. Nausea is worse in the morning and during menstruation, it is accompanied by weakness and trembling. Vomiting is frequent. Constrictive, griping pains are felt in the stomach, and fulness, distension and pressure from the presence of much flatus which belching relieves (carbo veg.). Periodical gastralgia, with vomiting of food soon after eating it, may take place. Gastric pain is aggravated by cold drinks but relieved by warm milk. The pain gives him a false hunger, he feels he must eat to relieve the gnawing and burning in the stomach, and food does, as a fact, relieve for a time.
The abdomen is greatly distended from incarcerated flatus, the emission of which is preceded by griping. The patient cannot endure anything tight round the distended abdomen (carb. veg., calc., lach.). Herpetic eruptions appear on the groins, and the inguinal glands are swollen and hard.
From the rectum there is excessive discharge of offensive flatus. Diarrhoea is painless, with much flatus, the stool is watery, brown, putrid, lienteric, and excoriates the anus. The more usual condition is constipation, there may be no desire for stool for several days, the stools are large, hard and knotty, and are accompanied with or followed by copious, white or yellow jelly-like mucus, they take a long time and hard straining to pass. The presence of fissures and piles causes sharp, cutting pain, followed by constriction and aching for several hours after stool. There may also be burning pain and bleeding from the anus and a tendency to prolapse of the rectum.
Urine.-The stream of urine is a feeble one and dribbling may occur after urination. The urine soon becomes putrid on standing and deposits much red or white sediment; an iridescent pellicle forms on it after standing awhile. A peculiar symptom is “pain in the sacrum and coccyx when urinating.” A gluey discharge occludes the meatus urinarius.
Sexual System.-In the male generative system graphites produces, primarily, violent erections, and secondarily, a condition of weakness or impotency in the sexual act. Itching, vesicular eruptions occur on the scrotum, herpetic eruptions on the scrotum, herpetic eruptions on the prepuce and excoriation and fissure on the glans penis.
In women the ovaries become enlarged and tender, the vagina is hot and painful, and copious thin, white, viscid, offensive leucorrhoea comes in gushes day and night. Leucorrhoea may replace the menses, which are usually delayed, pale and scanty. There is great itching of the vulva before the period sets in, excoriation of the genitals and between the things during the flow and a corrosive leucorrhoea after. Concomitants of the menses are a dry, fatiguing cough, headache, morning nausea or sickness, pain in the epigastrium, swelling of the face and feet and pain in varices.
Head.-Graphites causes numerous head symptoms. There is vertigo, as if intoxicated, occurring mostly in the morning on rising and in the evening, it causes an inclination to fall forwards and is felt on rising from stooping and on looking upwards. There is apt to be hyperaemia of “the brain” in the evening in a warm room and frequent determination of blood to the head and face with faint feelings. The head feels numb, as if made of wood, there is a feeling in the forehead as if the skin is drawn in folds and a sensation as though a cobweb were spread over the face. a constricting pain occurs in the occiput which extends to the nape, and on looking up the neck is painful, as if broken. Or there may be an intense, heavy weight in the occiput, as if the head were drawn back by it. Another variety of pain is a one-sided headache in the morning on waking, a tearing pain that extends to the teeth and side of the neck. The headaches are worse in a warm room and better in the open air.
Eyes.-The coverings of the eye share in the affections of the skin caused by graphites. The lids are swollen, injected, thickened, and may be inverted, they are raw and bleed, itching, bleeding fissures are seen in the canthi, the lashes are covered with dry crusts, or are glued together by sticky discharge, or they fall out. Styes and cystic tumours occur in the lids, pustules and ulcers invade the cornea. There is extreme photophobia, which is worse in sunlight than in artificial light and is accompanied by copious lachrymation. Letters appear double or run together, flickering, fiery zigzags appear just outside the field of vision. Sight vanishes during menstruation.
Ears.-Humming, roaring, cracking sounds occur in the ears, “sounds reverberate in the ear, even his own words and every step.” With dryness of the ears is hardness of hearing, which is ameliorated in a noise, as in a railway train.
Nose.-The sense of smell is too acute and the odour of flowers is intolerable, but in conditions of dry coryza the sense of smell is lost. The nostrils are sore and cracked and are plugged with scabs and hard mucus. the bones and cartilages are sore to touch. There may be sneezing and fluent coryza or discharge of bloody, offensive, viscid mucus or pus.
Respiration.-Graphites causes but few respiratory symptoms. The larynx is dry in the daytime but secretes a copious, glutinous mucus at night; a cough is caused by tickling in the larynx or trachea and by deep breathing. The patient suffocates when falling asleep (lach.) and awakes in the night gasping for breath.
Limbs.-There is a weak, paralysed, sensation in the limbs and they easily “go to sleep”. Various pains occur, of burning, drawing, pressive or stitching character, but numbness is more distinctive a graphites than is pain. Tendons are apt to contract, especially those behind the knees. Overlifting and straining of any kind cause weakness in muscles and tendons. There is often a tremulous sensation through the whole body. The patient frequently feels faint and is suddenly exhausted, he is very sensitive to cold air and is nearly always chilly.
Mind.-He is restless when attempting close mental work and dreads and avoids it. His moods are constantly changing (puls.); at one time he is extremely depressed, and this is made worse by music, to which he is very sensitive and which makes him weep; at another time he is irritable about trifles, very excited and impatient. He is always irresolute, is more inclined to be depressed and apprehensive in the morning and excited and exhilarated in the evening. Thought is slow and recent events are soon forgotten.
There is drowsiness by day and sleeplessness at night. The patient is more chilly after meals, but feels better in himself after eating and when he is in the open air. He perhaps from slight exertion and sweats profusely at night. The sweat stains yellow (ferrum), is offensive, often with the odour of urine, and is cold. In many chronic complaints there is complete inability to perspire.
GRAPHITES is an “antipsoric (see article on sulphur), and mainly suitable to chronic cases, especially if the characteristic skin eruption with its viscid, glutinous discharge is present, or if the complaint has followed the suppression or disappearance of such an eruption. It has been found that the patients for whom graphites is likely to be useful are those who have a tendency to put on unhealthy fat, lethargic individuals who are always chilly and constipated, whose skin and mucous membranes are pale, women whose menstruation is pale, late and scanty. The patients are very sensitive to cold and need warm clothing, but nevertheless suffer from getting overheated, whether in a too warm room or in bed or from exertion; and they desire open air.
Skin.-The skin diseases in which graphites has been found curative are numerous, but the distinctive gluey, honey-like discharge from the eruptions should be present to give the prescription certainty of success. It has been useful in eczema impetiginodes, acne rosacea, mentagra, erysipelas of the face spreading from right to left, psoriasis palmaris, falling of the hair, disordered growth of and exuberant granulations about the nails and for ingrowing toe-nail. It is a remedy for keloid and for inflammations in old cicatrices, for neuralgia in the scars left by herpes zoster, for growths, even cancerous growths on old cicatrices and for indurations and cicatrizations of the mammae sequent to mammary abscesses. Dr. Royal reports a case of lupus cured by it.
It is a good remedy for eruptions about the genitals and the upper and inner parts of the thighs, the sticky secretion and prevalence of itching are the indications.
The eye affections for which it is used are blepharitis, entropion, ulcers of the cornea, styes and tarsal tumours, the indications being the sore canthi, thickened lids, and glutinous discharge. It has been effectual in relieving overflow of tears due to obstruction of the lachrymal duct by cicatrical narrowing. It has often arrested or prevented the recurrence of epistaxis when this has come on in the evening and has been preceded in the afternoon by a rush of blood to the head and face. It removes the crusts about the nostrils common in unhealthy children, as well as the eczema behind the ears or on the nape of the neck in the same class of patients. Foetid foot sweat and complaints occurring from its suppression have often been cured by graphites when the general symptoms indicative of the drug have been present. Old constitutional and syphilitic ulcers are benefited by it, they are callous, have indurated bases and secrete an offensive gluey pus.
In the alimentary sphere graphites is of great service in gastralgia, occurring either with gastric catarrh or duodenal ulcer, the indication for it being a hunger pain coming on an hour or so after food and relieved by eating, and by drinking warm milk. Gastro-intestinal complaints that alternate with acne or erythema of the face are likely to be benefited by graphites. The diarrhoea for which it is useful is a lienteric diarrhoea, very offensive and excoriating, and with stools that occur immediately after eating. It is one of the best remedies for chronic constipation and there have been a great many cures from its use, it is indicated by the necessity for great straining to pass a hard, large, knotted stool, covered with or followed by copious, whitish, gelatinous mucus, but the general constitution must also agree with that agree with that of graphites. It is a good remedy for mucous colitis.
Fissures of the anus, eczema round the anus and accompanying piles with great itching are well treated with this drug.
Sexual Sphere.-In the male it is useful for both priapism and impotence and for swelling of the testicles and hydrocele.
In the female sexual sphere it is a remedy for amenorrhoea and for scanty and delayed menses, especially if the patient is a sufferer from chronic constipation. She is anaemic, suffers from leucorrhoea, is fat and flabby and has many general symptoms accompanying menstruation such as headache, morning nausea, epigastric pain, &c. For pruritus of the genitals or anal region, worse before menstruation, graphites is very useful and may be also applied externally in the form of an ointment (graphites 1dr. to ung. cetacei 1oz., Dr. Clarke’s formula). It is of some service in “cauliflower excrescences” and other cancerous growths of the cervix uteri, and has obtained some reputation in diseases of the ovaries. It is a good remedy for cracked nipples and has removed hard lumps in the breasts.
Graphites is indicated in a suffocating cough that wakens the patient from sleep, generally after midnight, and also for a shattering cough which comes on immediately menstruation commences and goes away when it ceases.
It is useful for chronic nasal catarrh and for people of the graphites constitution who have frequent colds all the winter, which extend to the larynx and are worse from cold air.
Graphites is indicated in chronic recurrent intermittent fever; chill is intermingled with fever, the patient wants to be covered in all stages; nightly fevers, with chilliness but no sweat.
(1) Eruptions, with gluey secretions. Catarrhal discharges that are albuminous and viscid. Leucorrhoea occurs in gushes.
(2) Offensive discharges and secretions (carb. veg., psor., kali phos., kali ars.). Intolerably foetid diarrhoea.
(3) Fissures and cracks in the skin, mucous membranes and around orifices, especially the angles of the mouth. Nails brittle and deformed.
(4) Recurrent herpes, especially about anus the genitals.
(5) Every injury festers.
(6) Chronic diseases following sudden disappearance of discharges or eruptions.
(7) Induration and burning at the base of ulcers, inflamed tissues and old cicatrices.
(8) Contractions of tendons, especially behind knees.
(9) People who are fat, chilly and constipated. People who have been morbidly fat and are now emaciating.
(10) Wandering pains.
(11) Weakness in muscles and tendons after overlifting.
(12) Pain in the part not lain on.
(13) Numbness and heaviness of various parts.
(14) Irregularities in the distribution of blood. Epistaxis.
(15) Pallor of skin and mucous membranes. Anaemia.
(16) Haemorrhagic oozing of pale blood.
(17) Weak, exhausted, tremulous states. Ready fainting.
(18) Complaints from being cold or becoming overheated.
(19) Gastric pains with hunger, relieved by eating.
(20) Fickle, changeable mood.
(21) Fat women with scanty, delayed menses, irritating leucorrhoea and chronic constipation.
From motion, cold drinks, cold air, damp cold, washing, warmth of bed (itching), before during and after menses, morning, before menses (pruritus).
From rest, warmth (cramps in stomach), eating (gastric pain), hot drinks and hot milk.