A nosode : a product of ” Psora.”.
THE sources of the pharmaceutical preparations going under the name of psorinum are uncertain. That proposed by Hahnemann was purulent or semi-purulent material taken from an “itch” vesicles or pustule. Another was the dried epidermis from some scaly eruptions on the skin. It is not certain that the cases known as itch were in all cases due to the Acarus scabiei.
In spite of the doubtfulness of origin of this agent the preparations on the market at the present day have secured the confidence of many careful prescribers, who record undoubted successes.
Psorinum ranks as one of the most important antipsorics, and the use of such a term raises the question in one’s mind, ” What is Psora ? ” In Hahnemann’s mind the name represented an entity which is not easy to define or identify nowadays. It seems to be a compound of tuberculosis (or at any rate of the constitutional state which renders a subject specially susceptible to the influence of the tubercle bacillus and its toxins), the strumous diathesis of the last quarter of last century and the dartrous diathesis of the French, and so-called gouty eczema, without the arthritic symptoms.
Recently Drs. Bach and Wheeler have traced many of the symptoms of chronic disease considered to be distinctive of “psora” to intestinal toxaemia, the result of the action of various types on of non-lactose-fermenting bacilli belonging to the coli-typhoid group.
The most obvious lesions are cutaneous, but mucous surfaces, especially intestinal and respiratory, show signs of its influence. Changes in the chemistry of the body appear to underlie the surface manifestations. It is, however, quite unnecessary, for therapeutic purposes, to identify psora. The use of psorinum or other antipsoric agencies is called for, not on the supposition that a person is suffering from a disease once called psora, but by a complex of symptoms, objective and subjective, with their personal modalities, which corresponds with the pathogenetic complex of psorinum or psora “antigen,”
To present the elements (features) of such a a complex or picture will be the aim of this short article.
Skin.-The kind of skin for which psorinum is required as a remedy is usually thick, coarse and dirty-looking, even when its owner is in average health. With any departure from the normal these features are exaggerated and added to. The coarseness develops into scaliness, the dirty look is intensified so that no washing will give it a clean appearance. As an alternative to the dry, scaly conditions, a liability to the formation of cracks and chronic eczema comes on, and there occurs an oozing, which dries into crusts, under which ulceration of the skin takes place. Two features of outstanding importance as indications for psorinum must be noted : (a) Extremely offensive odour of the oozing, and, indeed, offensive odour of the skin (or body-odour) apart from lesions; (b) severe intolerable itching, worse at night, and especially worse from the warmth of the bed, of warm clothing (especially woollens) or other warm application. The itching is so severe as to cause scratching until bleeding occurs. The aggravation of the itching by warmth is an exception to the general rule for this drug, of amelioration by warmth. the patient throws off the clothing to ease the irritation and is liable to develop ” a chill ” in consequence, causing some from of catarrh.
Besides the dermatitis already referred to with lymph-like oozing, forming crusts, and accompanied by bleeding, vesicles, papules, scales and boils occurs, and the skin may, here and there, be studded with dilated capillaries or venules. The favourite sites for lesions requiring psorinum are : (a) The scalp, the whole scalp may be affected with the characteristic crusts and itching, relieved by cool air; (b) the lips and mouth; (c) the external genitals, especially the vulva, which may become ulcerated; (d) the circum-anal region, with cracks which itch and bleed; (e) the nose, which has a gluey discharges, reddening the edges; (f) the eyelids, which become thickened, like gristle, causing ectropion and loss of the eyelashes; (g) alopecia of scalp or elsewhere, without definite eczema, the hair is dry and readily tangles; (h) skin over tibiae; (i) dorsum of hands and feet; (j) less frequently elsewhere.
Perspiration.-Before leaving the skin, reference should be made to the ease with which a psorinum patient sweats, with subsequent liability to chill. The palms of the hands and the perinaeum are the chief sites. The odour,like that of other secretions in these patients, is remarkably offensive, it is putrid or, as the old books describe it, ” like carrion,” washing fails to remove the odour. In some acute cases, which end by crisis, a free perspiration of this character is followed by relief of all the symptoms. It will be judged from the foregoing how large a place cutaneous manifestations occupy in the so- called psoric was requiring psorinum as a remedy.
Digestive Tract.- The lips are dry and there is swelling of the upper lip and itching of its right half. The mouth and tongue (especially the tip) are dry, tough mucus is hawked from the posterior nares, and extremely offensive caseous plugs from the tonsillar crypts can be removed by pressure, swallowing or hawking. The gums recede as in people who are said to be gouty.
The characteristic appetite is great hunger, especially in the middle of the night, but is soon satisfied by eating a little. There is constant thirst, sometimes with a craving for beer, Heartburn and eructations, tasting of rotten eggs, are present, also chronic vomiting of extremely sour, slimy fluid or of food.
There are various abdominal pains which, on the whole, are more pronounced on the right side, but pain in the region of the spleen in also experienced. Cutting or griping round the umbilicus in the morning is accompanied by urgent call to stool. The characteristic motion is brown, offensive and fluid, slimy, or with undigested particles in it. It is occasionally involuntary. Or the stool may be soft, the bowel being difficult to empty at one sitting, straining is required.
Kent says : ” In psorinum we find the taste of sulphur, the flatulence of oleander and aloes, and difficulty of expelling a soft stool, like alumina, china and nux moschata.”
Chest.- There are various pains on either side of the chest, worse on deep breathing. Clinically, oppression of breathing, amounting to asthmatic dyspnoea, has the unusual feature that it is better lying on the back; the arms must be removed from the chest wall. This is an important indication for the remedy in cardiac dyspnoea or asthma.
Head.- Headache in the middle of the night, with a red face and hot head, is frequently associated with excessive hunger; the pain is relieved by eating. Perspiration of the scalp is sometimes a feature, though the hair is usually dry; the head is very sensitive to cool air, the patient likes a warm head dress, he is liable to get a cold in the head after having the hair cut. There is offensive otorrhoea, with pain in the mastoid region and noises in the ears, causing difficulty of hearing.
Genito-urinary System.- There seems to be a loss of expulsive power, which prevents complete emptying of bladder (or rectum) at one sitting. A discharge of prostatic fluid occurs while the patient is straining to start the flow of urine and afterwards a few drops of urine escape involuntarily. There is little residual urine, as in cases of prostatic enlargement.
In men there is an aching form the groin down one or other spermatic and the testes feel heavy and aching in association with lumbar pain. the prominent functional change is indifference to sexual matters, with aversion from intercourses and absence of enjoyment of the function, though impotence is not a necessary feature. There is often an offensive odour about the scrotum. Psorinum has been useful in old gleets.
In women metrorrhagia persisting after abortion or parturition, with slow recovery of strength, is often benefited by psorinum. Recurrence of haemorrhage every time the patient gets on to her feet is given as an indication. It would be easy to say that such an occurrence is merely due to an accumulation of blood in the vagina and its escape is accounted for by the erect posture and the muscular effort in rising. As, however, there are many cases of menorrhagia where this feature is not present it may be used as a clinical indication. an explanation of the not very important phenomenon need not be held to explain away its value as a drug indication.
Fever.- Vascular phenomena, such as flushes of heat, have been included under this heading, with palpitation; sudden heat over the whole body, sweat over the face, occurring mostly in the evening, or waking the patient at night recall menopausic symptoms : ” steamy, boiling sweat.” At night, with slight but definite rise of temperature, there may be stupor, bewilderment or mild delirium.
Sleep is liable to be disturbed by the foregoing or by dreams or robbers and dangers, or the patient dreams of going to stool and awaking with the impression of having soiled his clothing.
Generalities.- There is little re-active power, little response to apparently suitable remedies. The patient recovers slowly after an illness or after child-bearing; she is easily tired, is worse on standing and in the open air.
The psorinum patient is extremely sensitive to cold air and wears heavy clothing, even in warm weather; he feels stormy weather and is uncomfortable and restless before a thunder-storm. He is liable to giddiness in the open air.
Mind.- The mental condition suggestive of this remedy is one of sadness and hopelessness, both as to this life and its prospects and the next. He has an ” all is lost ” feeling, has no pleasure in his family or in his life, even if prosperous; he may even dream that he is a failure. He is fearful and nervous-afraid of riding in a carriage, be is restless and trembling. In extreme cases such patients long for death and dwell upon suicide to end it all.
Aetiology.- As exciting causes of a so-called psoric condition, the following are worthy of remembrance : (a) Acute illness of various kinds; (b) especially those accompanied by loss of fluids; loss of fluids even if not acute; (c) suppression of rashes of discharges; (d) emotions; (e) storms-felt even before.
(1) Irritable rashes, eczematous or suppurating, always with strikingly offensive discharges.
(2) Itching, apart from definite eruptions, worse at night and from warmth of bed and wraps.
(3) Great sensitiveness to cold air-except as regards the above; heaps on the clothing.
(4) Foetor of all discharges and secretions.
(5) Lack of reaction and power of recovery after illness; absence of response to medicines.
(6) Sadness, even to melancholia, religious or other; the patient desires death and dwells on suicide; has no enjoyment, even of prosperity.
(7) Great hunger, especially at night. Hunger before and during a headache (phos.).
(8) Profuse sweats on the least exertion.
(9) Feels unusually well the day before an attack of illness.
(10) Many menopausic symptoms-flushes, palpitation, sleep disturbed by perspiration and dreams.
(11) Pale, delicate children, who sleep all day, and scream all night.
(12) Named diseases or conditions : Psorinum has been successfully prescribed for the following : (a) skin diseases : eczema, acne, boils; (b) diarrhoea, leucorrhoea; (c) melancholia; (d) epistaxis; (e) headaches; (f) otorrhoea; (g) dyspepsia;(h) gonorrhoea (old)’ (i) vomiting of pregnancy; (j) hypertrophied tonsils; (k) asthma and hay fever; (i) insomnia.
(a) From change of weather and before storms; (b) form open air and cold; (c) between 1 and 4 a.m. (diarrhoea); (d) effort, even sitting up (dyspnoea); (e) morning (diarrhoea, &c.); (f) at menstrual period; (d) warmth of bed and clothing (itching); (h) from coffee, fat, sugar and meat.
(a) Free perspirations (after acute illnesses); (b) in summer (scaly eruptions); (c) epistaxis (headaches); (d) lying on back with arms out from body (asthma), warmth (except itching).