E. A. Farrington was born in Williamsburg, NY, on January 1, 1847. In 1866 he graduated from the Homeopathic Medical College of Pennsylvania. In 1867 he entered the Hahnemann Medical College, graduating in 1868. He entered practice immediately after his graduation, establishing himself on Mount Vernon Street.
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Today, I shall lecture on Kali bichromicum, or the Bichromate of Potash. You would expect, in a drug having the combination of this one, to obtain not only the results of potash, which forms the base of the salt, but also the modifying influence of the chromic acid. You will find, therefore, that while there are evident general resemblances to the other Kalis, there are decided differences arising from the acid combined with it. Chromic acid, as you probably well know, is a highly irritating acid. It is a powerful escharotic, destroying animal tissue very rapidly, and penetrating quickly into the part, and so producing a deep ulcer or sore.
Kali bichromicum is a drug which acts generally, although not exclusively, on fat persons, especially on fat, chubby children more than on adults. We find that it possesses great virtues in inflammation of mucous surfaces, with tendency to plastic exudation and pseudo-membrane. It attacks mucous membranes, causing at first inflammation of these, violent in character and associated with a great deal of redness and swelling, and at first a production of an excessive amount of mucus, from over-action of the muciparous glands. This excessive mucous secretion is very rapidly turned into a fibrinous exudate; hence there is a tendency to the formation of false membranes.
This character of the exudation on mucous surfaces gives us the well-known characteristic of the Bichromate of Potash, discharges are ropy and stringy. This symptom is true of the coryza, it is true of the discharges in pharyngitis and laryngitis, and it is true of the vomited matters in gastric catarrh. It also applies to the leucorrhoea and also to the gleety discharge from the urethra, which may sometimes call for Kali bichromicum. Illustrations then of this general characteristic of the drug are not wanting in any part of the body. We find even in scrofulous children, for whose diseases Kali bichromicum is often an excellent drug, this same quality to the mucous discharges. For instance, it is indicated in inflammation of the middle ear, particularly when it affects the membrana tympani. There is ulceration not only of the membrana tympani, but also of the mucous surface of the middle ear. The distinction between Kali bichromicum and other remedies in these cases is that the discharge is tenacious, stringy and purulent. With this there will be earache, with pains of a sharp stitching character which shoot up into the head and down into the neck. You will find the glands of the neck swollen and also the parotid gland on the affected side. This becomes large and indurated, and pains shoot from the ear down and into the swollen parotid.
In diseases of the mucous membrane of the throat we find this same character to the exudation. Thus in diphtheria we find Bichromate of Potash indicated under two or three contingencies. It may be a remedy when diphtheria assumes the croupous form. The membrane is quite thick and is decidedly yellow-looking, like wash-leather. The discharges, whether coming from the nose or throat, or both, are decidedly stringy. This has been, in my mind, a sufficient distinction between Kali bichromicum and the Iodides of Mercury. When I am giving Iodide of Mercury in diphtheria, so soon as I find that the expectoration becomes stringy I change to Kali bichromicum, if it suits that condition, and also because it may prevent the extension of the disease to the larynx. Although in general Kali bichromicum is suited to rather sthenic types of inflammation, yet we have indications enough to prove that it may be suited to the adynamic cases also.
The IODIDE OF MERCURY is to be thought of in diphtheria when the membranous deposit is more or less profuse, involving the tonsils and posterior nares. The glands in the neck are swollen. The tongue is coated dirty yellow. There is excessive production of mucus in the throat, causing a great deal of “hawking.”
We find Kali bichromicum indicated in still other forms of inflammation of the throat than diphtheritic. Thus it is called for in follicular pharyngitis. The follicles of the throat become hypertrophied and look like little tubercles on the pharyngeal walls. These discharge a white cheesy-like mass, which when crushed between the fingers, gives forth a foetid, disagreeable odor. These are attended by a feeling of roughness and dryness in the throat and at times by an accumulation of tenacious mucus. You will find this disease a stubborn one to treat. In addition to Kali bichromicum, it will be well enough to remember HEPAR, KALI CHLORICUM (especially when there is a great deal of foetor of the breath) and AESCULUS HIPPOCASTANUM, or the horse-chestnut. Aesculis resembles Kali bichromicum very closely, but lacks the tenacious stringy mucus. There is dry, rough, burning feeling in the throat and pharynx and yet no swelling. The face is sallow and digestion is slow. There is tendency to portal congestion, as shown by deep throbbing in the hypochondrium, and constipation and hemorrhoids.
In other cases you will have NUX VOMICA indicated by well-known symptoms, which I need not here repeat.
Still other cases call for SECALE CORNUTUM, which has hawking up of these little follicular exudates.
We have Kali bichromicum indicated in yet another form of throat disease which is neither scrofulous nor croupous nor diphtheritic, but syphilitic. Ulcers form on the fauces and tend to perforate. The surrounding mucous surface is of a coppery-red color.
It is also indicated in nasal catarrh. It produces, at first, dryness of the nasal mucous membrane with tickling in the nose and sneezing, these being especially marked in the open air. The secretion from the nose is ropy and stringy and often collects in the posterior nares. It may or may not be offensive.
At other times, as in ozaena, there are discharges from the nostrils or posterior nares, consisting of plugs, or clinkers, as they are sometimes called. Lumps of hard green mucus are hawked from the posterior nares, particularly in the morning. At other times (often in syphilitic cases) you will find ulcers which carry out the perforating character of Chromic acid and tend to perforate the parts on which they are located.
Kali bichromicum is indicated in true membranous croup. It suits best, although not exclusively, light haired, fair-complexioned children, who are rather fat and chubby. The cough has a decidedly metallic sound. It has more than the mere bark of catarrhal croup. The fauces you will generally find quite red, the tonsils, perhaps, are somewhat red and a little swollen. The cough seems to descend, that is, the rattling goes down lower and lower until it apparently reaches the upper part of the epigastrium, or rather the lower third of the sternum, the irritation of the cough seeming to start from there. In this position, as well as in the throat, there seems to be a smothering, oppressive sensation; breathing becomes very labored. The child has smothering spells, arousing it from sleep, choking. The whole chest heaves with the efforts at respiration. The membrane forms quite thickly in the larynx, narrowing its lumen. The expectoration is tough and stringy, and perhaps mucous, and contains pieces looking like boiled maccaroni. The patient is worse in the morning from three to five o’clock. Sometimes there is a tendency in these cases of croup to extend downwards and involve the trachea, and even the bronchi, giving rise to what has been termed croupous bronchitis. This is not a very common disease, but it is an exceedingly dangerous one. I remember treating a patient who after taking Kali bichromicum, expectorated pieces looking like vermicelli and having numerous little branches, probably casts of the ramifications of the bronchial tubes.
One of the remedies following Kali bichromicum well in throat and croupous diseases is LACHESIS. It suits particularly when the spasmodic cough becomes so violent as to cause choking spells, and when the patient drops off to sleep, he awakens as if smothering. Kali bichromicum has modified the inflammation, but has not succeeded in preventing spasm of the throat. Then Lachesis comes in and relieves the remaining symptoms. Then should the croupous symptoms increase, you may return to Kali bichromicum.
There is also a resemblance between MERCURIUS CYANATUS and Kali bichromicum in diphtheritic croup.
KAOLIN is very useful for membranous croup when it extends downwards, and when one of the characteristic symptoms is intense soreness along the trachea and upper part of the chest.
The mucous membrane of the stomach, too, fails under the influence of Kali bichromicum. The drug is so irritating that it causes gastritis. Thus it produces gastric symptoms varying in severity all the way from those of simple indigestion to those of malignant disease of the stomach. In the milder forms of dyspepsia we find it indicated when there is headache, the pain usually being supra-orbital. This may be periodical in its return, but is particularly excited by gastric irritation. Although it is neuralgic in its character, it is reflex from gastric irritation. Another form of headache which is associated with these gastric symptoms is one of a peculiar kind. The patient is affected with blindness more or less marked, objects become obscured and less distinct, the headache then begins. It is violent, and is attended by aversion to light and to noise, and the sight returns as the headache grows worse. I have met with that symptom in my practice four or five times. I have found the same symptoms precisely given under GELSEMIUM, but I have never used that drug under these circumstances, so I have not confirmed it. There are quite a number of remedies having blinding headache, but Kali bichromicum is the best of them. We have CAUSTICUM sometimes indicated for blindness with the headache, but not diminishing as the headache increases. We also find it under NATRUM MUR., IRIS VERSICOLOR, PSORINUM, and SILICEA. In the latter remedy the blindness comes after the headache.
With this headache of Kali bichromicum the face is apt to be blotched and bloated, and covered with pimples or acne. It is also sallow and yellowish as if the patient were bilious. The whites of the eyes are yellow and a little puffed. The tongue is thick and broad and scalloped on its edges, as though it had taken the imprint of the teeth. The stomach seems to swell up immediately after a full meal, just like LYCOPODIUM. The bowels are constipated, or else there is early morning diarrhoea, as you find under SULPHUR, RUMEX, BRYONIA, and NATRUM SULPH. The stools are watery, and are followed by tenesmus. These are some of the gastric symptoms which will yield to Kali bichromicum. They are particularly apt to occur after excessive beer drinking. Kali bichromicum is one of the best remedies for the chronic effects of excessive indulgence in beer and ale.
We also find Kali bichromicum producing gastritis, herein very much resembling ARSENICUM. The vomited matter is sour, and is mixed with clear mucus. You see how Kali bichromicum everywhere excites an over-production of mucus. The vomit may be bitter from admixture of bile. It is renewed by every attempt at eating or drinking, and is associated with a great deal of distress and burning rawness about the stomach. With this kind of vomit you may give Kali bichromicum in the vomiting of drunkards and in the round, perforating ulcer of the stomach.
In dysentery, Kali bichromicum is sometimes indicated. The disease occurs periodically in the spring or in the early part of the summer. The stools are brownish and watery, and mixed with blood and attended with great tenesmus. The distinctive symptom is the appearance of the tongue, which is dry, smooth, red, and cracked.
In its action on the skin, Kali bichromicum causes first of all, a rash which very much resembles that of measles. Kali bichromicum has been given in measles with these symptoms: It is particularly indicated after PULSATILLA. The latter remedy is suited for the milder symptoms, the former for the more severe. The inflammation of the eyes grows worse with the formation of vesicles or pustules on or about the cornea. The meibomian glands or other structures of the lids ulcerate, so that the lids agglutinate, and there is more or less purulent discharge from the eyes. The ears, too, become involved, and there is a discharge from the ears of quite offensive pus. There are also violent, stitching pains which extend from the ear to the roof of the mouth and to the parotid gland on the affected side. The external auditory meatus is greatly swollen. Kali bichromicum is one of the best remedies we have, when measles is associated with these ear symptoms and swelling of the glands, with sharp pains shooting from the ears into the glands. There is also diarrhoea which resembles that of Pulsatilla, but differs from the latter in the presence of slight tenesmus. The rash is the same as we find in nearly every case of measles. In a general way, we may say that it resembles Pulsatilla, only it is Pulsatilla much worse. It has the simple catarrh of Pulsatilla, watery or more commonly yellowish green secretions, made worse and even advancing to ulceration.
We next find Kali bichromicum like all the potash salts producing papules. These papules are hard, and tend to enlarge and develop into pustules. In extreme cases these pustules may even develop into ulcers.
We have also developed by Kali bichromicum symptoms resembling those of sycosis. This places the drug alongside of THUJA, PULSATILLA, and SARSAPARILLA. We find scabs on the fingers, often about the nails, and also on the corona of the glans penis. There is a gleety discharge from the urethra, which is very often stringy, thus keeping up the general action of Kali bichromicum on mucous membranes. Ulcers looking like chancres, and tending to eat deeply rather than spread superficially, form about the glans penis and prepuce. In addition to these symptoms you must have the inflammation of the nose and throat of the character already described, with perforating ulcers affecting even the bones.
Kali bichromicum is also called for in inflammations of the eyes; this inflammation being rather indolent in character. There is lack of reactive power, so that ulcers form which progress slowly and show but little tendency to heal of their own accord. The same is true of the conjunctivitis, which may be of scrofulous or of sycotic origin. The lids are swollen and agglutinated, especially in the morning, with thick, yellow matter, and, to keep up the indolent character of the remedy, you find very little photophobia. Sometimes we find chemosis with these cases.
You will find that iritis, whether syphilitic or not, may call for Kali bichromicum. It is indicated not in the beginning but late, when there has been exudation posteriorly between the iris and crystalline lens, causing adhesions of these structures to each other. These exudations, if not too great, will be absorbed under the action of Kali bichromicum. Characteristic of this iritis is indolence. There is little or no photophobia and not a very decided redness attending the inflammation. This is a general hint which will guide you to Kali bichromicum, and will save you the memorizing of less characteristic symptoms. Do not, therefore, forget the indolence of the ulceration, the absence or deficiency of inflammatory redness, and the disproportionate absence of photophobia.
“We next come to the action of Kali bichromicum on the chest. It is indicated in bronchitis, particularly if the glands are involved. Posteriorly, on either side of the spinal column, you find dulness on percussion. The cough is of a hard, barking character, almost as in croup. It seems to start from the epigastrium. The expectoration is generally of a stringy character. Sometimes it consists of bluish lumps, and is attended with a great deal of difficulty of breathing, arising mechanically from thickening of the lining membrane of the bronchial tubes. This cough is almost always made worse after eating, and is better when warmly wrapped up in bed. There is a great deal of feeling of tightness in the epigastrium.
You must also remember Kali bichromicum as a remedy indicated in asthma dependent upon bronchiectasia. The bronchial tubes are filled up with this tough tenacious exudation. But we find Kali bichromicum indicated in another form of asthma, which is worse from three to four o’clock in the morning, and is especially liable to return in the winter weather, or in summer time when chilly. The patient is compelled to sit up in bed in order to breathe. Relief comes when the patient raises stringy mucus. This kind of asthma calls for Kali bichromicum, whether the patient be stout or thin. If you have this after midnight aggravation and relief from sitting up and bending forward, and from the expectoration of stringy mucus, you have a certain remedy in Kali bichromicum. Here is it a perfect complement to ARSENICUM, which has nearly the same symptoms, but lacks the tenacious sputum. The low potencies have been most successful in the treatment of asthma. The high potencies have not failed, but in all of the literature that I have been able to see, the low potencies have seemed to be the most successful. Whether this is true or not, I do not know. I only give you the facts as I find them, that you may judge for yourselves.
Lastly, I have to speak of the use of Kali bichromicum in rheumatism, particularly in rheumatism which occurs in spring or summer weather, when there are cool days or nights. The smaller joints seem to suffer. Thus we have pains about the fingers and wrists more than in any other part of the body. Pains wander from one part of the body to another. Gastric and rheumatic symptoms alternate. I have had several instances in which I have been able to confirm this characteristic of the drug.