ANTIMONIUM TARTARICUM [Ant-t]:

-M.L.Tyler.

Tartar emetic.

Introduction:
HERING says of this drug, "An invention of the alchemists, very popular with them, forbidden by the French Academy, finally introduced and much used and much abused by the Old School." Old School, Farrington says, does not make much play in these days with Tartar emetic: and he is borne out by its present day teachings, for we are told (Hale White) that "many years ago an ointment, of Tartar emetic was applied as a counter irritant: but it causes too much pain and is now seldom used". That Tartar emetic "cannot be recommended as an emetic, its action is slow and its general depression great. It should never be given to produce purgation". It is also pronounced "an undesirable expectorant". But this is qualified." The only cases in which it is permissible are those in which an emetic is required for laryngitis, bronchitis, or some other acute inflammatory condition of the respiratory tract for then its depressant action on the circulation may perhaps be beneficial, but usually Ipecacuanha is preferable. For its uses in the nervous and muscular systems, "it has now been abandoned": and "it is much less used in medicine than formerly". Thus Old School, with its crude methods and crude dosage, fails to realize the precious life-savers at its command, and leaves practical and curative medicine to the disciples of Hahnemann. "Ant. tart." was proved by Hahnemann and some of his students: but his provings were only published in Stapf's Archives:--in our Hospital Library: but one does not joyfully grub in the old German books, when one can get the desired matter in other, later, English works. His proving of course appears in Allen, Hering, etc. Hering (Guiding Symptoms) "makes use" also "of the masterly monograph of Dr. R. Hencke (1874) who collected all poisonings, provings and cures". In the hands of homoeopaths Antimonium tartaricum is a very precious and indispensable remedy and has saved innumerable lives: the lives of infants and small children especially, dying of bronchitis and broncho-pneumonia, cyanosed and almost moribund; and, at the other end of life, of old people, with chest full of rattles and wheezes, with lungs filling up, and no power to raise the phlegm. One of our early recollections was of a baby brother gasping, with blue lips and nails: a mother's distress; how she took the matter out of the doctor's hands, and slipped into the baby's mouth a few of the little sweet things-- so powerless, seemingly!--and yet so powerful where they fill the picture: and then the allopathic doctor's surprise at his next visit! after which he only looked on, while she prescribed. Knowing the Law of Healing, one could do quite good curative work, if put to it, with an allopathic materia medica: going, however, by the rule of contraries when it comes to its deductions and teachings, and leaving its suggestions and warnings severely alone. They do not apply! Old School calls Tartar emetic a powerful irritant of the skin. We use that action, and give the drug internally for just such powerful irritations of the skin as it can excite. One has seen over and over again, for instance, how a dose or two of Ant. tart. cm has cured impetigo contagiosa in a few days, without any external application whatever, except a little plain starch powder to "slop it up". One remembers a grown-up brother and two little sisters who appeared at "out-patients" with extensive patches of the infection, even extending, in one case, to the neck. Ant. tart. cm, as usual, sufficed. Pustular eruptions-- here, of course, it is one of our most useful remedies in small- pox. Among our great remedies in pustular eruptions are Ant. tart., Cicuta, Rhus, Thuja, and especially Variolinum--Burnett's great remedy in herpes, by the way!--but, each and all, only according as the rest of the symptoms agree. We shall see, again and again emphasized, how Ant. tart. comes in for gastric and intestinal conditions, and its magnificent use in chest troubles, and most especially in the broncho-pneumonias and pneumonias of little children. Here, with us, the large mortality of the old school is almost obliterated. HUGHES says, *"Pharmacodynamics." "The best known action of Tartar emetic--that to which it owes it name--is its power of producing nausea and vomiting. The nausea which it causes is very intense and long lasting": and he reproduces a useful little drug-picture: "The face is pale, the skin cool, moist and relaxed, the pulse feeble, frequent and often irregular, the saliva flows copiously, and feelings are usually experienced of gastric uneasiness, languor, and unusual weakness, which are, sometimes, in the highest degree distressing; so much so as, if long continued, to render the patient utterly prostrate in body and mind, and indifferent to all things around him, even to life itself.' To these should be added universal muscular relaxation." Hughes quotes (in dogs poisoned by Ant. tart.)" the lungs were always more or less affected: orange-red or violet throughout: destitute of crepitation, gorged with blood, and in some parts hepatized. Lepelletier independently confirmed these observations and naively remarked, `One would imagine that, admitting its action in man to be similar, far from being useful, its administration would be particularly pernicious in pneumonia; but it is not so, for, instead of favouring engorgement of the lung, it promotes its resolution.'" FARRINGTON points the characteristics, and gives valuable tips in regard to this drug. "Head confused: warmth of forehead and confused feeling, as if the patient ought to sleep (in passive congestion of brain). If the patient is a child we notice an unwillingness to be looked at or touched. If you persist in your unwelcome attention, it will have a convulsion. "On awaking from sleep the child seems stupid, and is so excessively irritable that he howls if one simply looks at him. "Suppressed eruptions with these head symptoms and great difficulty in breathing. Face bluish or purple, the child becomes more drowsy and twitches. There is rattling breathing. These symptoms that I have mentioned accompany two grand sets of phenomena for which Ant. tart. may be useful, namely pulmonary and gastro-enteric affections. "For children, invaluable in diseases of the chest, when the cough is provoked whenever the child gets angry, which is very often. Eating brings on the cough, which culminates in vomiting of mucus and food. "A nursing infant suddenly lets go of the nipple and cries as if out of breath, and seems better when held upright and carried about. Now, this is the beginning of capillary bronchitis. There are fine crepitant rales all through the chest. Ant. tart. here nips the whole disease in the bud and saves the child much suffering. Another form of cough marked wheezing when child breathes. The cough sounds loose, and yet the child grows drowsy. Its head is hot and bathed in sweat. The cough grows less and less frequent. The pulse is weak. Symptoms of cyanosis appear. The quicker, in these cases, you give Ant. tart., the better for your patient. "Ant. tart. is also indicated in the affection of old people and particularly in orthopnoea, or threatening paralysis of the lungs in the aged. You hear loud rattling of phlegm in the chest yet the patient cannot get up the phlegm. (Here Baryta carb. is complementary, and may suffice when the other only partly relieves.) "In this threatening paralysis of the lungs you must compare Antimonium tartaricum with several other drugs: with Lachesis, which has aggravation when arousing from sleep; with Kali hydriodicum, especially where there is oedema pulmonum and a great deal of rattling of mucus in the chest. What little sputum is raised is frothy and greenish, and looks like soapsuds. "Carbo veg. also suits these cases, but here the rattling is accompanied by cold breath and by coldness of the lower extremities from the feet to the knees. "Moschus in paralysis of the lungs, when there is loud rattling of mucus and the patient is restless. Especially after typhoid fever. The pulse grows less and less strong and finally the patient goes into a syncope. (Ant. carb.) "Ant. tart. produces a perfect picture of pleuro-pneumonia. Portions of the lungs are paralysed. Fine Rales are heard, even over the hepatized portions. Great oppression of breathing, especially towards morning. The patient must sit up in order to breathe. "Pustules very nearly identical with those of small-pox. "Diseases of intestinal tract. Very like Veratrum: only here Veratrum has more cold sweat on forehead, Ant. tart. more drowsiness." NASH, as usual, sums up the action of Ant. tart. in a few words of vital import. "Great accumulation of mucus in air passages, with coarse rattling and inability to expectorate; impending paralysis of lungs. "Face very pale or cyanotic from unoxidized blood. "Great coma or sleepiness in most complaints. "Vomiting; intense nausea, with prostration; general coldness, cold sweats and sleepiness. "Trembling: internal; head and hands. "Thick eruptions like pocks, often pustular; as large as a pea. "Relief from expectoration. "Both ends of life, childhood and old age. "Child clings to those around; wants to be carried; cries and whines if anyone touches it; will not let you feel the pulse. "Nausea as intense as that of Ipecac., but less persistent, and with Ant. tart. there is relief after vomiting." And Nash says, "If Antimonium tart. possessed only the one power of curing, that it does upon the respiratory organs, it would be indispensable. No matter what the name of the trouble, whether it be bronchitis, pneumonia, whooping cough or asthma, if there is a great accumulation of mucus with coarse rattling, or filling up with it, but, at the same time, there seem to be inability to raise it, but, at the same time, Tartar emetic is the first remedy to be thought of. This is true in all ages and constitutions, but particularly so in children and old people". "There is one symptom that is very apt to be present in these cases, i.e. great drowsiness, sometimes amounting to coma." "In pneumonia, both Tartar emetic and Opium may have great sleepiness, but there is no need for any confusion here as to choice for in Opium the face is dark red or purple, and there may be sighing or stertorous respiration. With Tartar emetic the face is always pale, or cyanotic, with no redness, and the breathing is not stertorous." He also says, "Antimonium tart. is also one of our best remedies for hepatization of lungs remaining after pneumonia. There is dullness on percussion, and lack, or absence of respiratory murmurs, and the patient continues pale, weak, and sleepy." KENT gives a wonderful picture of Ant. tart. We will quote, condensing. He says, "About the first thing we SEE in an Ant. tart. patient is expressed in the face. The face is pale and sickly-- the nose drawn and sunken--the eyes are sunken with dark rings around them--the lips are pale and shrivelled--the nostrils dilated and flapping, with a dark sooty appearance inside them. The expression is that of suffering. The atmosphere in the room is pungent it makes you feel that death is there." He says, "We find this state and appearance in catarrhal patients, in broken down constitutions, in feeble children, in old people: in catarrhal conditions of trachea and bronchial tubes. And we HEAR coarse rattling and bubblings in the chest-- coarse, like the `death rattle'. The chest is steadily filling up with mucus. At first he may be able to throw it out, but finally he is suffocating from the filling up of mucus and the inability of chest and lungs to throw it out. It is a paralytic condition of the lungs. The first few days of the sickness will not point to Ant. tart. So long as reaction is good and strength holds up you will not see this hippocratic countenance--sinking--and coldness, and cold sweat. You will not hear this rattling in the chest, because these symptoms are symptoms that indicate a passive condition. Antimonium tart. has weakness and lack of reaction." He contrasts it with Ipecac. which may come in for the first period. He says, "Ipecac. has some of this coarse rattling, but it is attended with great expulsive power of the lungs. Ant. tart. has the coarse rattling that comes after many days. It has, like Ipecac., the coughing and gagging and retching, but only in the later stage of great relaxation, prostration and coldness. When you hear him cough you are impressed with the idea that there must be some profound weakness in his lung power. The lungs have lost the power to produce an expulsive action with deep inspiration. Here the chest is full of mucus and it rattles: the cough is a rattling cough,, but the mucus does not come up, or only in such quantity as does not relieve. His chest is full of mucus, and he is really passing away, dying from carbonic acid poisoning due to lack of expulsive power." He says, "Unlike Aconite, Bell. and Bry., which come down with violence, the very opposite is present in Ant. tart., where you have little fever, cold sweat, coldness, relaxation, hippocratic aspect. Most of these severe cases of bronchitis and pneumonia die in the Ant. tart. state. In very old people who have had catarrh of the chest for years, where every sharp cold spell brings on catarrh of the chest with thick white mucus-- dyspnoea- -must sit up and be fanned--cannot lie down because of the difficult breathing and filling up of the chest, Ant. tart. will ease him over a number of these attacks before he dies. `When the expectoration is yellow, Ammoniacum will pull him through, and Ant. tart. when it is white, and attended with prostration, sweat, coldness, pallor and blueness of the face.'" Kent says further, "He does not want to be meddled with or disturbed. Everything is a burden. The child when sick doesn't want to be touched, or talked to, or looked at. Wants to be let alone. The infant is always keeping up a pitiful whining and moaning. Always in a bad humour, that is, extremely irritable when disturbed." Note that with Ant. Tart. the sputum is WHITE. "In most complaints this remedy is thirstless. Generally in these attacks of dyspnoea the friends of the patient will stand around with a very strong desire to do something, if it is only to hand a glass of water. This patient is irritated by being offered a swallow of water. He is disturbed and shows his annoyance. The child will make an offended grunt when offered water. Thirstlessness with all these bronchial troubles, with copious discharge of mucus and great rattling in the chest. "Desire for acids and sour fruit, and they make him sick. Stomach troubles from vinegar, sour things, sour wine, sour fruit. Aversion to milk and every other kind of nourishment, but milk especially makes the patient sick, causing nausea and vomiting. "With the stomach symptoms and bowel symptoms there is this constant nausea, but it is more than a nausea, it is a deadly loathing of every kind of food and nourishment, a nausea with the feeling that if he took anything into the stomach he would die; not merely an aversion to food, not merely a common nausea that precedes vomiting, but a deadly loathing of food. Kind-hearted people very often want him to take something, for perhaps he has not taken any food all day, or all night; but the thought of food only makes him breathe worse, increases the dyspnoea, increases his nausea, his loathing and his suffering." In the same way that expectoration is difficult with Ant. tart. vomiting"is not an easy matter with this remedy. It is not merely to open the mouth and empty the stomach of its contents. The vomiting is more or less spasmodic. `Violent retching. Gagging and retching and straining to vomit. Suffocation, gagging, through great torture.' The stomach seems to take on a convulsive action, and it is with the greatest difficulty, after many of these great efforts, that a little comes up, and then a little more, and this is kept up. `Vomiting of anything that has been taken into the stomach, with quantities of mucus.' Thick, white, ropy mucus, sometimes with blood. Old gouty patients, old drunkards, old broken-down constitutions. In children also that have broken-down constitutions, as if they had grown old. These take cold in the chest, with great rattling of mucus, and require this remedy. All the forms of Antimony have that dropsical tendency, relaxation and weakness, Ant. tart. is full of it.".
PECULIAR AND CHARACTERISTIC SYMPTOMS
Pitiful whining and crying before and during the attacks, or paroxysms, whatever they may be. Despair of recovery. A child coughs when angry. (Important symptom is whooping cough, etc.) Coughs and yawns alternately. In pneumonia, when the edges of eyelids are covered with mucus: also, eyes inflamed, staring, dull, half-open, or one closed. Sees only as through a thick veil. Nostrils flap (Lyc.). Face a perfect picture of anxiety and despair. Cold, distorted, pale, with bluish spots, bathed in cold sweat, livid. Face- muscles twitch. Sickly, sunken pale bluish or twitching face, covered with cold sweat. Tongue covered with a thick, white, pasty coat; open, parched upper lip drawn up; or tongue very red; in streaks; or dry down middle; brown, dry. Craves apples, fruits, acids, cold drinks, refreshing things. Aversion to milk. Thirstlessness, or intense thirst. Continuous anxious nausea with great effort to vomit, and sweat on forehead. The smallest quantity of drink is vomited, with eager desire for more. Nausea with great faintness. Waves of nausea with weakness and cold sweat. Violent pain in abdomen; seems stuffed full of stones, but it does not feel hard. Child at birth pale, breathless, gasping, although the cord feebly pulsates. Rapid, short, difficult and anxious respiration;seems as if he would suffocate without sitting erect the whole night; spell may come on at 3 a. m. (or 4 a. m.) and has to sit up. Great rattling of mucus in the bronchia, especially just below the larynx, like a little cupful about to run over, but very little is expectorated. Very drowsy, great shortness of breath, bronchial tubes over- loaded with mucus. Somnolency: waning consciousness on closing eyes. Weak, drowsy, lacking in reaction. Respiration very unequal, now shorter, now longer, worse lying, lessened when carried about in an upright position. gasping for breath at the beginning of every coughing spell. Noisy, whistling, purring, bellowing, or sawing respiration; with great rattling of mucus as if the child would suffocate, always relieved by spitting or vomiting the mucus. Cough excited by eating. In the difficulty of breathing, face may be pale, dark red, blue lips, hot and sweaty head, muscular twitching. Cough: compels one to sit up: it seems loose and rattling, but no expectoration: with great pain in chest or larynx, cries fro help and grasps at larynx. Sputa blood-streaked, rust coloured, adhering like glue. OEdema of lungs. Impending paralysis of lungs. Emphysema. Much palpitation: with uncomfortable warm, or hot feeling proceeding from heart. In croup, often we find neck stretched out, and head bent back. A chief characteristic of this remedy on the skin is to produce pustular eruption.
BLACK LETTER SYMPTOMS (Hering and Allen)
BAD HUMOUR. The child wants to be carried (Cham.) cries if anyone touches it; will not let you feel the pulse. Dim, swimming eyes. Pallor., Pale sunken face. Rheumatic toothache of intermitting type. During dentition, catarrhal hyperaemia. Tongue very red, dry in the middle. Tongue red in streaks, Tongue covered with chick, white, pasty coat, Much mucus in throat with short breathing. Disgust for food, frequent nausea and relief by vomiting. Belching which relieves. Nausea causes great anxiety. Continuous anxious nausea,straining to vomit, with sweat on the forehead. Nausea, vomiting and loss of appetite. Vomits with great effort. Absence of thirst the whole day. Vomiting, followed by great languor, drowsiness, loading, and desire for cooling things. Great precordial anxiety with vomiting of mucus and bile. Sharp cutting colic before stool. Child at birth pale, breathless, gasping,though the cord still pulsates. The mucus rattles in the chest. Rattling originates in the upper bronchi and can be heard at a great distance. Much rattling of mucus in trachea; cannot get it up. Shortness of breath from suppressed expectoration,especially if drowsy. Unequal breath, now shorter, then longer, much more frequent when lying. Better when child is carried upright. Respiration with great rattling of mucus. Suffocated and oppressed about 3 a.m., must sit up to get air;' better after cough and expectation. Cough compels the patient to sit up, is moist and rattling, but without expectoration. When the child coughs there appears to be a large collection of mucus in the bronchial tubes, and it seems as if much would be expectorated, but nothing comes up. Coughing and gaping consecutively, particularly children, with crying or dozing, and twitching of the face. Profuse mucus with feeble Expulsive power (bronchitis in infants and old people) Profuse mucus sputa,easily expectorated. Cough grows less frequent, patient shows signs of :"carbonized blood" Rattling of phlegm on chest, better when carried in an upright position, worse lying down; with oppression. Inflammation of respiratory mucous membrane. Sputa blood-streaked,rust coloured, adhering like glue to the vessel. Atelectasis, with symptoms of asphyxia belonging to the remedy;l with oedema of unhepatized portions of the lungs; breathing laboured,or orthopnoea, mucous rales. Oedema of lungs. Emphysema. Impending paralysis of lungs. Grippe: acute pneumonia; broncho-pneumonia; pleuro pneumonia. Pulse hard, full, strong sometimes trembling; very much accelerated with every motion. Pulse rapid, weak, trembling Great restlessness. Tosses with anxiety. Prostration and collapse. Violent pain in lumbo-sacral region, the slightest effort to move causes retching and cold clammy sweat. Trembling of hands. Great sleepiness; irresistible inclination to sleep, with nearly all affections. Coma Or, great sleeplessness. Worse at night and sleepless. Warmth aggravates; even getting warm in bed. Skin covered with a running, sticky sweat. The tissues it affects. Collection of synovia in joints. Mucous membranes: catarrhal inflammations; conjunctivitis; gastritis, enteritis; laryngitis, tracheitis, bronchitis, extending even into the air-cells, cystitis. Pustular eruptions; on conjunctiva, face, mouth and fauces, oesophagus, stomach, jejunum, genitals Variola: backache, headache, cough and crushing weight on chest before or at the beginning of the eruptive stage; diarrhoea, etc. Also when the eruption fails. Chest, anterior surface of upper arms, wrists, abdomen and inner side things covered with closely set, bright-red, small, conical, hard pustules, with an inflamed, letter-like base itching intolerably. Pustular eruption leaves bluish-red marks on face, et. Thick eruption like pocks, often pustular, as large as a pea.
NOTABLE OR PECULIAR SYMPTOMS, WHICH APPEAR IN ITA
LICS Furious delirium., The child will not allow itself to be touched without whining and crying, Howls if looked at. Flickering before eyes:-*A lady, very ill with bronchitis (as one remembers well from long ago), was given Ant-tart., several doses, low,which she proceeded to prove with curious, most distressing flashes of night, "What's that? There, again!" They, in her weak and suffering state, absolutely terrified her. The drug was discontinued, and no more was heard of the flashes. sparks before eyes. Convulsive twitchings in almost every muscle of face. Swallowing almost impossible. Great desire for apples. Vomits till he becomes faint. Nausea, then yawning and profuse lachrymation, followed by vomiting. Abdomen seems to be stuffed full of stones, though he has eaten nothing and it does not feel hard. Violent pressure in abdomen, as from stones, as if full; much worse sitting and stooping. (Coloc is (>) stooping and pressure.) Seems as if he would suffocate, in bed. Cannot get air. obliged to sit up the whole night. About 3 a.m. suffocated and impressed, had to sit up to get air; only after cough and expectoration she became better.] Dyspnoea: had to be supported in a sitting position in bed. Cold hands: icy-cold finger tips. Feet go to sleep immediately after sitting shown each time. Had scarcely fallen asleep when seized with electric shocks and jerks (which came from abdomen). Cold sweat all over body. Effects of vaccination,when Thuja fails, and Silica is not indicated. If the use of Ant-tart. was continued after it and produced an eruption like small-pox,the pustules got large, full of pus, deepened in the centre and became confluent: with great pain; crusts were formed, leaving deep scars. In prescribing Ant-tart., then, look, for drowsiness-nausea- irritability that hats to be touched or looked at: usually thirstlessness: and in "chests", breathing, expectorating, lying down, almost impossible. One sees how invaluable it is for desperate conditions, and how with Carbo veg., it is one of the "last gasp" remedies.