Next, we will consider HEPAR SULPHURIS CALCAREA. This is really an impure calcium sulphide, containing traces of the sulphide of lime, organic matter possibly and very likely, too, minute proportion of the phosphate of lime, since it is made from the middle layer of the oyster shell and flowers of sulphur. Hepar has some action on the nerves. It is to be remembered as a drug that causes over-sensitiveness of the nervous system. Pain seems to be intolerable to the patient, and may even cause fainting. An inflamed part feels sore and bruised, and cannot bear the touch of the hand or even of a dressing. I mention this as a universal characteristic of the drug. I have often given Hepar for cold-sores in the corners of the lips when they were about to suppurate, in inflammation of the eyes and in styes and pimples, when there was present this extreme sensitiveness to touch.
Mentally, the Hepar patient is rather sad and low-spirited, particularly in the evening. At times there is an impulse to suicide. While walking in the open air the patient feels discouraged and cross, and is annoyed by the recollection of all the past unpleasantnesses that have figured in his previous life. Memory is weakened so that he forgets words and localities.
Hepar is indicated in neuralgia, particularly of the right side of the face, after the abuse of mercury and after the unsuccessful exhibition of Belladonna, which seemed indicated, particularly after exposure to dry, cold winds. In the neuralgia and other nervous symptoms Hepar belongs with BELLADONNA, SILICEA and SULPHUR. It frequently follows Belladonna, as I have told you; and from Silicea and Sulphur you may distinguish it by the other symptoms. A symptom in connection with the mental irritability of the patient that I have not mentioned is hasty speech and hasty actions. We find precisely the same symptom under Belladonna. "Hasty speech and hasty drinking" is the way the symptom reads under the latter remedy. We find it also under LACHESIS, DULCAMARA and SULPHUR. To show you that this is a genuine symptom, I will mention the case of a physician on the other side of the ocean, who cured a case of hysterical mania with this one symptom to guide him. The patient's speech was hasty and words rolled out in profusion. The clinching symptom was that she had taken a great deal of mercury. Hepar cured the mental condition completely.
We next have to consider Hepar as a remedy in inflammation. It is suited to inflammations of a croupous form and inflammation with suppuration. In all the inflammations and congestions in which Hepar is the remedy, you will find that there is extreme sensitiveness of the affected part to touch. This is so characteristic that it must be present more or less permanently before Hepar may be the remedy. The parts feel bruised and sore, like a boil. This, as I have already said, you can carry through all the Hepar inflammations.
For instance, in ophthalmia, or inflammation of the eyes or lids, you will find that the eyelids are swollen and oedemafous, and sometimes, too, suppurating styes will form. With this there is a bruised, sore sensation. The patient cannot bear any touch to the eye; neither can he bear the cold air. Cold air and cold applications increase the suffering, and here you have a good indication separating it from Mercurius. So again in inflammation of the ear, whether of the external auditory meatus or of the middle ear, you will find the same soreness to the slightest touch.
We find Hepar indicated in earache when suppuration impends, after BELLADONNA, CHAMOMILLA or PULSATILLA. It is seldom indicated in the beginning.
We find these same characteristics of the inflammation present in the coryza. The nose is swollen and sore to the. touch, especially in the inside of the alae or wings of the nose.
So again in face-ache, the bones are exquisitely sensitive to any pressure. These are all illustrations of the character of the drug. I need not multiply them, because they occur in any part of the body in which inflammation occurs.
If suppuration occurs as the result of the inflammation, we have Hepar indicated and exercising a double function. If you give it in a high potency when the throbbing, stabbing pains in the affected part and the general rigor show the onset of inflammation, it may prevent the whole trouble. In other cases, you see that suppuration is necessary and so you wish to hasten the process. Then you give Hepar low. In tonsillitis and in boils, particularly in the former, Hepar is indicated after Belladonna, when the latter does not succeed in reducing the inflammation before suppuration commences. I will simply remind you here that I have already mentioned the distinctions between Belladonna, Hepar, Mercurius, and Silicea in this class of diseases.
Now if the inflammation becomes croupous, we may have Hepar indicated, whether it be the throat, larynx, bowels or kidneys that are involved. The symptoms which indicate Hepar in croupous inflammation of the larynx are these: After exposure to dry, cold winds the patient becomes hoarse, with whistling breathing. Respiration is so difficult that the child throws its head far back in order to straighten the air-passages. The cough is hard, barking, and ringing, and at the same time accompanied by rattling of mucus. So sensitive is the child to cold, that the least exposure, even uncovering an arm or a foot, re-excites a spell of coughing. Thus you see the extreme susceptibility of the patient to cold air. Hepar is especially indicated when the cough is worse towards morning. Occasionally Hepar may be given for cough which occurs before midnight, but then it must be moist and not dry.
You will see from these symptoms that Hepar follows rather than precedes Aconite and Spongia. ACONITE is indicated in the beginning of croup when there are great anxiety, high fever, and distressed breathing. I would advise you to continue the Aconite some time after the symptoms have been relieved, because these cases are very apt to relapse.
If, however, Aconite fails and the cough gets worse the next night, SPONGIA is usually the remedy, especially if there are dry, hard cough, sawing respiration, little or no expectoration, and starting up from sleep choking.
If towards morning, although there is increased secretion and moist sound, the croupous symptoms still continue, then the case calls for Hepar.
BROMINE usually follows Hepar when the latter is unable to remove the exudate.
Another use of Hepar was made by Kafka, and that is in Bright's disease following scarlatina. He was led to this by the power of the drug to produce fibrous or croupous exudations. Hepar has succeeded in these cases many times, so that it must have some action on the kidneys. Kafka gives it after scarlatina when the urine becomes albuminous and dropsy appears.
Next we have to consider Hepar in ordinary catarrhs, or what is commonly called a "cold" with aching through the body. Hepar should be here placed, not as a remedy useful in the incipiency, but for the advanced stage of " cold." If it be given at the commencement, it frequently spoils the case, whether it be one of coryza or of sore-throat, because it is more suitable to what has been termed "a ripened cold" when phlegm has formed. When the patient swallows, there is a sensation as if he were swallowing a fish-bone, or as if there were something sticking in the throat. Sometimes he will describe the sensation as if there were a crumb of bread or toast sticking in the throat. This symptom allies Hepar with MERCURIUS, NITRIC ACID, ARGENTUM NITRICUM, and ALUMINA. These colds for which Hepar is the remedy are re-excited by any exposure. It is often indicated when the abuse of mercury has developed in the system a susceptibility to cold.
In affections of the lungs, we find Hepar indicated in two or three classes of disease. We find it called for in pneumonia, especially during the stage of resolution. It comes in late in the disease (and not in the beginning) when, during resolution, pus forms and you have present suppuration instead of the normal resolution. Hepar ought also to be indicated in croupous pneumonia. Here, as in all other croupous inflammations, it is called for late in the disease.
You may also give Hepar successfully in the treatment of that frightful disease, pulmonary tuberculosis, when, with the deposit of tubercles in one or the other apex, you have a dry, hard cough, with production of mucus. It here frequently follows SPONGIA. It may bring about absorption of the tuberculous deposit.
In glandular disease, Hepar is indicated in the stage of suppuration, when the inflammation has gone on to the formation of pus. You will find it especially useful in the treatment of bubo, whether venereal or not, especially after the abuse of mercury. Even old buboes remaining open after mercury and discharging continually, sometimes heal under Hepar.
It is not uncommon to find cases of indigestion embraced under the name dyspepsia, which have resulted from a long course of mercurial treatment by physicians of the dominant school. Hepar, as one of the antidotes to mercury, will sometimes cure these cases. Sometimes a cure is impossible. Still, I think, relief is always obtainable from one remedy or another. We may also find Hepar indicated in dyspepsia, independently of this cause, by the following symptoms: There are usually a sour taste in the mouth and a longing for strong tasting substances, for alcoholic drinks, for wines, for acids, and for condiments of various kinds. These seem to relieve by stimulating the stomach; so it is the purely atonic form of dyspepsia in which Hepar is indicated. There is hunger, a gnawing, empty feeling in the stomach in the forenoon, a longing for something to eat. This craving for food shows the atonic condition of the stomach. At other times, although eating does him good and increases his general strength, yet it produces a fulsomeness about the stomach. He can bear no pressure about the epigastrium. Sometimes there is burning in the stomach from congestion of that organ. The bowels are usually constipated. Urging to stool is often ineffectual, although the faeces be not abnormally hard.
With BRYONIA the stool is large, brown and dry; it is not necessarily so with Hepar.
In NUX VOMICA the constipation is of a spasmodic, fitful urging and not ineffectual.
In these dyspeptic symptoms, Hepar seems to be complementary to LACHESIS, in that both have this condition : Any kind of food, no matter how wholesome, provokes indigestion.
Hepar must not be forgotten in the marasmus of children. Standing as it does between Sulphur on one side and Calcarea on the other, as a combination of these two, it must here be of value. The symptoms which lead you to Hepar in the complaints of children are these: There seems to be this same weakness of digestion ; they cannot manage their food, no matter how well-selected it may be. If they are old enough, they will tell you the symptoms that I have already mentioned. If you give them any strong substance, as a preparation of beef-tea, they will show signs of enjoying it very much. Diarrhoea is present, and is usually worse during the day and after eating The stools may be greenish or slimy, undigested, or white and sour; this last is a very important symptom. The whole child may smell sour. The most prominent remedies for sour stools are MAGNESIA OARB., next to that CALCAREA OSTREARUM, then HEPAR, and lastly RHEUM.
The symptoms for RHEUM are as follows: Sour stool; the whole child smells sour; the stools are frequent, brown and frothy, and attended with a great deal of straining and crying.
If the liver is involved under Hepar, we find soreness and stitches in the region of that organ. The stools then become clay-colored or even white.
The same condition is found in the bladder that we have already noticed in the rectum, viz., atony of the muscular coats. Hence, when urine is voided, it passes very slowly; it drops almost perpendicularly from the meatus urinarius instead of being ejected with some force. It takes the patient some time to empty his bladder. If with this trouble of the bladder you find wetting of the bed at night, Hepar is the remedy. It is not often indicated in this condition, however.
The ulcers which call for Hepar are very sluggish and are indolent in their healing. They have an odor like that of old cheese. They are rather superficial and often serpiginous. The discharge is bloody and purulent. They have this to characterize them, extreme sensitiveness of the border of the ulceration.
The action of Hepar on the skin is important. In the first place, it produces a condition of non-healing. Every little scratch of the skin suppurates. The same is also found in MERCURIUS, CHAMOMILLA, SILICA and LYCOPODIUM. It also produces a moist eruption in the folds of the skin. It is also indicated in moist eruptions about the joints. When Hepar is called for in eczematous eruptions which have a purulent discharge, we find it indicated by these symptoms: After the abuse of salves or ointments containing zinc or mercury, and the eruption is worse in the morning and accompanied by itching.
Hepar is an antidote to metallic poisoning generally, but especially to mercury and iodide of potassium.