Calcium sulphide. (CaS.).
IN homoeopathic pharmacy the name of hepar sulphuris is given to an impure sulphide of calcium and not to the mixed potassium salts, so called in general chemistry. It is insoluble in water and its action in ordinary therapeutics is due either to its solvent action on epithelial or warty tissues or, in the form of mineral waters, to the sulphuretted hydrogen evolved. It is used in chronic respiratory, gouty, and rheumatic affections.
In the doses in which it is likely to be taken accidentally it may have some destructive effect on mucous surfaces, but these are of a non-specific kind.
PROVINGS AND CLINICAL EXPERIENCE
Form the foundation of the following account, in which the expressions “cause” and “cure” may be regarded as almost interchangeable. The drug has a wide therapeutic action and its indications are found chiefly in its “general” or constitutional symptoms, though these should be used in connection with its local effects.
Hepar combines effects due both to its calcium and sulphur elements-from the former it derives its power to influence the respiratory and lymphatic glandular systems; and from the latter that over the skin, the mucous membranes of the alimentary tract and the liver, while both elements affect connective tissues. It is nevertheless an entity therapeutically.
General symptoms.-These will be first described and it will be understood that these general symptoms and modalities, or a proportion of them, should be present in any patient to justify the prescription of the remedy. It will therefore be unnecessary in describing local conditions for which hepar is useful to repeat each time that the general symptoms of the patient must correspond with the general symptoms of the drug, though such is actually the case.
(1) The first of these is a great sensitiveness to cold and to open air-both dry and damp cold. The patient himself is chilly and he wears an unusual amount of clothing in the daytime and in bed. Exposure to cold is liable to bring on or aggravate various ailments-even putting an arm out of bed while asleep may bring on a fit of coughing and sneezing, or increase any symptoms present. Dry cold especially brings on hoarseness, aphonia and rough cough; and damp cold aggravates rheumatic pains and stiffness. Heat usually relieves, but relief to toothache by cold is an exception.
(2) Great sensitiveness to pain; even apparently slight pain may induce faintness; patients appear to exaggerate their sufferings.
(3) Sensitiveness to impressions and surroundings is another characteristic of hepar. This means that small things irritate and annoy; and that the patient is constantly desiring a change, yet each change of position or environment brings fresh sources of annoyance and irritability.
(4) Sensitiveness to touch is conspicuous-local lesions, such as ulcers, boils, eruptions and whitlows are abnormally sensitive to touch. The patient fears even to be approached lest his wound or sore should be touched.
(5) Acuteness of sense of smell is great (except in advanced cases of rhinitis, ozaena, &c.).
(6) The chief time-modality is aggravation in the morning and the evening-e.g., in laryngeal cough, &c. There is a nocturnal aggravation in the case of sweating.
(7) Mental Condition.-Irritability has been referred to-the patient is impatient, hasty, cannot be pleased. Spells of sadness and even weeping may accompany or alternate with irritability, and outbursts of passion occur from trivial causes.
In more serious mental cases sudden unaccountable impulses may seize the patient and impel him to some excess-to murder, burn, destroy or even commit suicide. These impulses are usually resisted, though perhaps, with an effort, but if resisting power lessens they may ultimately be yields to.
(8) Sharp, short pains, of considerable severity sometimes, and described as sticking or shooting, are present in any local lesions-ulcerations, fissures, pimples, &c. This type of pain is sufficiently widespread to be regarded as a general symptom. In the throat it is described as like a fishbone or a splinter; the same type of pain may be felt in ulcerations of the skin, in whitlows, on the prepuce or labia pudendi.
(9) another general tendency of the drug is to induce catarrh or “discharges” from mucous surfaces and to promote suppuration if impending. The discharges are usually offensive of foetid-sometimes described as like bad cheese in smell. Reference will be made to this offensiveness of discharges or secretions in different localities. If given when glands are tender and throbbing, before suppuration has actually begun, high dilutions may arrest the process. If it be too late to prevent, the second or third decimal dilutions of hepar would promote and facilitate maturation and healing.
(10) Perspiration is a secretion strongly influenced by hepar. Profuse sweats occur on the slightest exertion or motion; they are sticky, sour or offensive, and worse at night. In the axillae and between folds of skin the sweat is particularly unpleasant.
(11) The hepar patient is sleepy all day, especially morning and evening; sleepy with yawning. After midnight he is sleepless, he has frequent startings.
(12) The patient feels better in warm, moist weather.
(13) Hepar antidotes many of the symptoms of mercurialization. It is antidotal to metals in general.
Attention may now be turned to local lesions or conditions.
Head, including Scalp.-The most characteristic headaches are: (a) Pressing pain in a small spot (one side) as from a nail or plug; (b) full bursting headache, especially above the nose, relieved by firm support from a bandage, but made worse by the weight of a hat; (c) pain (aching) in right side of occiput to throat, nape and scapulae. The scalp may have the soreness to touch, and moist, offensive eruptions or boils which are characteristic of hepar. Pruritus on rising in the morning followed by burning and soreness on scratching is present; also alopecia.
Eyes and Ears.-Both these areas have sticky discharges of offensive odour; the lids may stick together at night. Photophobia is great in keratitis and the pain is relieved by warm applications. Hepar is one of the remedies which have cured ulceration of the cornea, and recent corneal opacities and hypopyon; also dacryocystitis and aural polypi.
Nose.-The sense of smell is very acute, or, in ozaena, it may be lost. Offensive and blood-stained nasal discharge with tenderness to touch of the nasal bones may be present.
Face and Mouth.-The breath may be foetid; soreness of the commissures of the lips, swelling of the upper lip and a fissure in the centre of the lower lip, recall some graphites symptoms. An exception to the hepar temperature modality exists in the case of toothache, for it is worse from warmth, but the symptom “worse from biting the teeth together,” i.e., aggravation from touch or pressure, comes into line with the general sensitiveness to touch of hepar cases. A bitter taste in the mouth is not uncommon.
The throat affords a good example of shooting pains, extending to the ears, worse on swallowing and on moving the head, and also of the very characteristic feeling as of a splinter or fish bone stuck in the throat. A feeling of constriction or suffocation is also indicative of hepar.
Stomach.-Some of the digestive symptoms of hepar cases are characteristic, ex.gr.: (a) desire for acids, wine and highly- seasoned dishes, and aversion from fats and food in general; (b) pain in epigastric area on walking, and distention there; hunger in the middle of the morning (like sulphur or sepia).
Abdomen.- Paroxysms of griping round the navel and flatulent distension, oppression of breathing with rumbling and tenderness and shooting pain in the hepatic region, represent the intra- abdominal effects of the drug. Jaundice may be present. With these are soft, sour, pale stools, expelled with difficulty. Haemorrhoids are often present with much constipation of hard, dry stools. In children, diarrhoea with whitish, sour or offensive stool may be present; blood-stained mucus with some straining may occur. Inflamed inguinal glands represent the external effects.
Urinary System.-The urine reflects metabolic disturbance rather than local disease; it is hot, dark red, turbid on standing and may contain blood. Micturition seems to be impeded, the flow being tardily initiated, slow and intermittent; residual urine after attempting to empty the bladder is sometimes present and has been interpreted as “weakness of the bladder”; it is more likely to be due to obstruction by an enlarged prostate (compare alumina).
Limbs.-Although the “sulphur” waters of various spas have a reputation in rheumatic and gouty affections the muscles, fibrous tissues and joints are not very strikingly affected by “hepar,” nor are the modalities very well marked. There are tearing and drawing pains in all the limbs, pains as from a bruise of the bones in arms and thighs; sore pain in hip-joint (as if sprained) when walking, and in nates and hamstring muscles when sitting; swelling of knees, ankles and joints of feet; shooting pains in the great toes.
In the upper extremities the pains are more prevalent on the left side, but in the lower they are equally distributed.
Stiffness and numbness or “paralytic sensations” are described, cracking in joints, especially in right ankle, when walking.
The soles of the feet burn at night (like sulphur cases) and are sore and tender when walking on uneven ground. Cramps attack thighs and calves of legs, worse in morning and when walking. Uneasy restlessness in legs at night compels patient to keep them stretched out, jerking pains. There is usually aggravation at night from cold, after midnight, from touch and on walking, but pain in nates and hamstrings is worse when sitting.
The hands tremble when writing and the knees when walking.
These are a selection from a variety of symptoms they are not very characteristic and taken alone would hardly be safe guides to the remedy.
Sexual Organs.-Ulcerations of the genital organs, with offensive discharge and pain and soreness, like a splinter sticking into the tissues, may require hepar; also free, very offensive leucorrhoea, irrespective of its source if the “general” characteristics of the remedy are present.
Respiratory System.-Though hepar does not, like some other drugs, produce definite pneumonia or pleurisy, it is a very reliable remedy for catarrhal conditions of some parts of the respiratory mucous membrane. The coughs for which it should be prescribed vary with the source and stage of irritation. It may be hoarse and paroxysmal in laryngitis, being suitable when the dry stage is over and secretion has commenced. It is a noisy cough, but not the harsh barking or sawing cough of the early stage of laryngitis or so-called croup. It may have a somewhat spasmodic element, producing “crowing” inspiration when the cough is becoming loose; free secretion is setting in. The paroxysms are excited by the slightest breath of cold air, by tickling, especially on the left side of the throat or larynx. It is worse after drinking, and a child with such a cough will-cry before the attack-herein resembling cases requiring bellad., bryonia and phos., which are all indicated when the fear of an impending cough causes crying, or alternatively interpreted, the irritation of crying brings on a paroxysm of coughing. The voice is hoarse or nearly aphonic.
Hepar is indicated in bronchitis with a loose rattling cough, worse towards morning and aggravated by cold air.
During a late stage of pneumonia when resolution is slow in completion, when a septic element seems to co-exist, indicated by a persistence of fever, by free, offensive, purulent expectoration, loss of flesh and appetite, with some degree of perspiration at night, hepar may rapidly clear up the condition, if the tubercle bacillus be not present. Even if it be present hepar may be the most indicated remedy. Paroxysms of cough in the evening on first lying down would be an extra indication. Similarly if a pleural effusion is threatening to become purulent hepar will stimulate absorption. After the opening of an empyema it will help to check suppuration and restore a healthy condition of the serous surfaces.
Skin.- The skin of a hepar patient is very sensitive to touch and to cold; it is unhealthy, perspiring unduly, especially in the folds, where it readily becomes raw and sore. Cracks appear on the hands and feet.
The perspiration and discharge are sour or foetid.
Ulceration requiring hepar has the usual features- sensitiveness to touch and to cold, and pain, as of a splinter or of a burning and itching kind Itching is usually worse in the flexures and is aggravated at night. Superficial injuries readily suppurate.
Suppuration in any part of the body-skin, cellular tissue, glands, &c., may require treatment by this remedy.
In the early stage of a cellulitis, due to a staphylococcal infection, hepar given frequently in the sixth centesimal potency or upwards may abort the condition. At a later stage it helps the process, relieves pain, and promotes healing. For a streptococcal infection some more toxic drug may be indicated by the patient’s general condition, which should guide to a drug causing a similar state.
Hepar is useful for individual boils and has been recommended for carbuncles, but in our experience sulphur is more effectual in checking a recurrence of boils, and rhus, lachesis and silica for carbuncles. In paronychia and with low with extreme sensitiveness it gives rapid relief and may save destruction of tissue.
The febrile state in hepar cases has a conspicuous early chilly stage. A slight draught or exposure of skin surface to the air causes shivering, especially marked at night, when also any accompanying pain is worse. After the hot stage sweating comes on from the least exertion; it is sticky, sour or offensive, especially in the axillae, between the toes, or in other folds of skin.
(1) the twelve general indications already given categorically need not be repeated (see pp.496,497).
(2) Headaches : (a) unilateral, as if a nail were pressing in, (b) bursting, relieved by even support as by a bandage, worse from weight of hat.
(3) Acuteness of sense of smell.
(4) Indigestion; flatulence; aversion from fats and longing for acid things; jaundice, dark, scanty urine, with sediment.
(5) Urine flows tardily, slowly and without force; residual urine.
(6) laryngitis, bronchitis, pneumonia, pleural effusions, empyema (after evacuation)-not in the early stages of any of these; cough excited by cold air, by exposure of surface of body outside bed-clothes; by tickling in throat or by drinking on first lying down. Crying before and after cough.
(7) Unhealthy skin-sour odour of body and of perspiration; boils, ulcerations.
(8) Tendency to suppurations, especially staphylococcal.
(9) Torpid, sluggish persons, with fair complexion and flabby muscles.
(see generalities): From uncovering the head; when swallowing (dysphagia); in dry, cold and windy weather; from lying on the painful side.
From wrapping up head and body; warmth in general; even damp weather, if warm; from eating.