Spigelia Anthelmia | Materia Medica by Carrol Dunham
Dr. Dunham (1828-1877) graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York.
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A native of the West Indies and of South America. It must not be confounded with the SPIGELIA MARYLANDICA, a native of the United States and the officinal Spigelia of the United States Pharmacopoeia. The latter is a different species, is much less powerful in its action on the system, and is a well-known and very frequently employed anthelmintic, under the name of Pink-root.
The SPIGELIA ANTHELMIA is likewise a powerful anthelmintic, but it exerts also a powerful action on the nervous system, so much so that it is thought to have been a chief ingredient in the “POUDRES DE SUCCESSION” of the famous French poisoner, Madame de Brinvilliers.
Our knowledge of its physiological properties is derived from Hahnemann’s proving in ” Materia Medica Pura,” vol. v.
The whole plant is used in medicine. A general survey of the proving leads us to the following.
The action of Spigelia is manifested chiefly upon the nervous system of animal life ; and it is eminent among our remedies for the extent to which its action seems to be exerted upon the nerves themselves and their envelopes; upon the nervous centers, however, in so far as we are able to make the distinction, its action is probably very slight. The nerves of special sense are excited in a marked degree, and this without any well-defined lesion in the organs of special sense (except the eye); and even here the exception is more apparent than real, for the inflammation produced by Spigelia is in the sclerotic and choroid, while the functionary alteration of special sense is in the optic nerve and retina. In this regard, Spigelia differs from Belladonna, Rhus and other drugs which excite the animal nervous system. In the tissues of the eye it excites inflammation, giving a well-marked picture of rheumatic sclerotitis. It acts decidedly on the trifacial nerve ; producing prosopalgia which involves the orbit, the zygoma and the superior maxilla; also on the nerves of the tongue; perhaps, also, on the portio dura.
The prosopalgia of Spigelia is distinguished by sticking burning pains, with subsequent swelling and soreness of the parts affected. In this respect it closely resembles the prosopalgia of Colchicum, from which, however, it is distinguished by the exaltation of the special senses and the general nervous erethism and excitement, and the intolerance of pain which characterize Spigelia; whereas Colchicum, on the other hand, is distinguished by an equally remarkable tolerance of pain and a patient, enduring disposition, with a general semi-paralytic condition.
ORGANIC SUBSTANCE. There is no evidence of definite modification of the organic substance of the body, unless the action on the pericardium and upon the fibrous tissues, which we infer EX USU IN MORBIS, may be so regarded.
The sphere of action of Spigelia is not extensive. It embraces only the nerves of animal life and of special sense, and the fibrous and muscular tissues of the eye, heart, and perhaps of the extremities.
Upon the mucous membrane it produces no very definite action, save in the pharynx and posterior nares. The high repute of Spigelia as an anthelmintic might lead us to expect a more decided action on the apparatus of digestion. The absence of such decided action gives ground for supposing that in helminthiasis Spigelia acts rather as a palliative, killing and expelling the vermin, than as a radical curative remedy, modifying that condition of things in which they developed and flourished.
The pains of Spigelia are sticking, tearing and burning-pressing. They are aggravated by motion, and in the afternoon and at evening, often preventing sleep.
There is great lassitude and heaviness of the limbs; great restlessness; great sensibility of the whole body to touch. The least touch on any part of the body sends a shudder through the whole frame.
(This is different from the sensibility of China, which accompanies and characterizes only the parts which are already the seat of pain, and in which the sensibility is more in imagination and apprehension than in reality.)
There is no marked periodicity in the symptoms.
The sources of knowledge of the pathogenesis of the drug are the provings of Hahnemann and his associates, in vol. v. of the ” Materia Medica Pura.”
HEAD. Vertigo, as if one should pitch forward; this occurs when looking down (as in Kalmia); or as if everything were going around when walking, relieved by standing still. (Arnica, Colchicum.)
Memory is weakened; intellectual effort is irk-some.
HEADACHE. The symptoms are well marked and characteristic, and present a good picture of one form of so-called ” nervous headache.” To take a general view of the head affections, before stating the parts especially acted upon and the varieties of sensations, we may say: There are dullness, heaviness and pain in the head; the pain is much increased by shaking and jarring the head, as when one walks, and especially by a false step, by coughing or sneezing, by moving the facial muscles, by speaking aloud, or by any loud noise, as well as by touch or bright light (increased sensibility of the special senses) ; these things increase the pain so that it seems as though the head would burst. There is a disposition to press upon and support the head with the hand, or to bind it around. See Apis. (Keep it warm is Silicea.)
The varieties of pain are, as affecting the whole head, chiefly heaviness or feeling as of a load or weight in the head; a pressing from without inward, much aggravated by stooping forward, unless the forehead be supported by the hand (Apis, China, Rhus); a sensation of swashing or surging of the brain within the cranium at every step or on the least motion or loud speaking; very severe when the head is concussed by a false step, much ameliorated by repose. (Rhus.) This swashing sensation is often attended by a tearing digging sensation in definite parts of the head, generally semi-lateral, as in the left parietal region, the left occiput and forehead.
As regards the localities particularly affected, it may be observed that the pain is generally circumscribed, is often confined to one side, more frequently the left. The occiput is the seat of many pains which extend into the nape, causing stiffness of the neck and at the same time restlessness. In the forehead, and especially in the frontal protuberances, we find : Pulsating stitches ; pressure from without inward; boring and burning pain, the latter (burning) is probably superficial, and indicates an affection of the supra-orbital nerve.
In the frontal protuberances, tearing pains extending into the eye, and aggravated by motion of the globe of the eye.
In the temporal region we find pulsating stitches; pressure inward, and burning extending into the zygoma. As to the time of their occurrence no special mention is made save once, when the pains for the most part occur in the evening and continue violent through the night.
The aggravations and ameliorations are uniform and as have been stated. The whole head is externally very sensitive to touch, and this is aggravated by motion of the scalp.
In the skin of the temples, forehead and eye-brows, a burning, tingling pain is felt, which extends down the cheek or into the eyes, and is aggravated by touch and motion. Near the orbit, swelling of the sub-cutaneous tissues occurs and of the skin, which is sore when touched.
The eyes also are affected in a special manner by Spigelia. Its action is exerted on all the tissues, but especially on the muscular and fibrous tissues and upon the function of special sense. In addition we have, especially in the left orbit, neuralgic pressing pains extending down to the zygoma and leaving, after the pain subsides, a tumor which is sensitive to the touch. (Colchicum.)
Compressive pain, generally in the orbits. The margins of the eyelids are sore, burning and painful. In the lids and their margins fine stitches, as from needles. In the margin of the left lower lid a fine cutting, as with a little knife. With these exceptions, which seem to imply an organic affection, the lids are not acted upon in their substance. On the other hand the innervation of their muscular tissue is modified as follows, along with the nervous affection of the pupil and retina: The upper lids are relaxed and paralyzed; they can be elevated only with the aid of the hand, the pupil being at the same time dilated.
The conjunctiva is moderately inflamed; we have pain as from sand in the eye, muco-pus and acrid lachrymation.
The globe of the eye is seriously involved, as we gather from the following symptoms: Dull and flat aspect of the eye; supra-orbital pains; redness and inflammation of the sclerotic with ptosis; pain in the eye and brow; the eye is painful when moved, and feels tense, as if it were too large for the orbit; sticking pain in the eye, also, when it is moved; digging pain in the middle of the eye (violent) with ptosis; pressure in the eye, from without inward; the eye is painful when moved in any direction; intolerable pressive pain in the eyeball, worse from moving the eye; in order to look around, rather than move the eye in the orbit, one moves the whole head; heat and burning pains in the eye, with perverted vision, occasional spasmodic, involuntary motions of the eyes.
As regards the secretions, we have moderate acrid lachrymation and a formation of muco-pus.
VISION. The special sense of the eye is exalted. The sensibility of the retina is increased, inducing photophobia, and perverted, causing illusions, as if hair or feathers were upon the lashes, aggravated by wiping the eyes, as if sparks or a sea of fire were before the eyes. The pupils are dilated. Vision is also impaired.
EARS. The ear, the zygomatic region, the maxillae and the throat are involved in an affection, evidently neuralgic, characterized by pressing and occasional burning pain extending through these regions and aggravated by loud noise.
Beyond this, the ear is affected as follows: In the external ear, pinching, drawing, itching. In the meatus auditorius, pressure as from a plug deep in the meatus, extending to the zygoma and molar teeth.
In the inner ear, occasional dull, boring stitches extending into the throat.
In the ear generally, sudden stitch extending to the eye, zygoma, throat, jaw, teeth.
The special sense of hearing is exalted, in connection with headache. Loud noises are painful. Otherwise we have deafness, sensation as if the ears were loosely stopped, with ringing and rustling sounds, and yet without deafness. When speaking, the sound of one’s voice resounds like a bell through the brain.
Moreover, there are signs of catarrh, as sudden obstruction of the ears on blowing the nose, relieved by working the finger into the meatus. Roaring before the ears, rustling and rushing as of wings, ringing of distant bells.
Itching of the alae nasi of the nostrils, and of the dorsum of the nose. Unpleasant sense of obstruction at the root of the nose.
The part of the face chiefly affected is the zygomatic region. In preference, the left side is affected. The pains are burning or tearing-pressive, leaving a dull sensation of swelling when the pain abates. Stitches from the upper maxilla to the vertex and in the cheek and temple in front of the ear.
The facial muscles are distorted and swollen; the whole face is puffed in the morning, with a feeling of illness. (This and nose-itching signs of helminthiasis.)
Burning and tension in the upper lip.
Painless pustules upon the chin.
In the lower jaw, painful pressure upon the angle. In the articulation, pain as if dislocated only when chewing; otherwise a dull pain.
In the teeth, drawing, fine sticking or sudden jerking pains at short intervals in the molar teeth, generally in several or in all the teeth simultaneously, but most severe in the carious teeth. The toothache is worse at night and after eating, though not while eating ; also by cold air and water, and particularly at night. It is accompanied by spasmodic closure of the jaw.
The tongue presents also neuralgic phenomena, confined chiefly to the right side; fine stitches, boring stitches from behind forward, with a sour taste.
The remaining symptoms belong rather to a gastric affection; the tongue is full of cracks, as if about to lose its epithelium. The tongue and palate have vesicles, which burn when touched. The tongue pains, as if swollen posteriorly. It is coated white.
Swelling in the fauces, with enlarged and painful cervical glands and pain on swallowing, with difficulty in opening the mouth. This affection is preceded by chill and shivering. Stitches in region of larynx, worse and worse, relieved by swallowing.
Mucus accumulates in the fauces. It is repulsive to the taste, and cannot be swallowed.
Offensive, putrid taste, and offensive odor from the mouth (helminthiasis), yet food has its natural good taste.
Great dryness of the mouth in the morning, as if full of pins, yet not really dry. No thirst.
Appetite sometimes gone, sometimes greatly increased (helminthiasis) ; great thirst.
GASTRIC SYMPTOMS. Frequent eructations after a meal. Nausea, as from too long abstinence.
EPIGASTRIUM. Pressure, as from a load or ball, relieved by pressing with the hand ; feeling as if it would be relieved by an eructation, which, however, is impossible.
Stitch in the epigastrium, with dyspnoea, aggravated by respiration, relieved by lying down.
HYPOCHONDRIA. In the left hypochondrium, stitches compelling to bend forward, worse on inspiration; these are sharp, extending to the crista ilii, only on motion or inspiration.
In the right, deep inwardly; sharp stitches at regular intervals, relieved by full inspiration, recurring on expiration (evidently not inflammatory); stitch on making violent exertion only.
ABDOMEN. Flatulence; audible rumbling and gurgling, attended occasionally by pain, and preceding diarrhoea.
In the umbilical region, cutting pain with chill, diarrhoea. Pinching pain, as if all the intestines were twisted up, with dyspnoea and great anxiety. The abdomen is sensitive to touch. This group is attended by flatulence, and followed by diarrhoea.
In the abdominal ring, cutting and sticking, with protrusion of the old hernia.
STOOL. Spigelia produces irritation in the rectum, much tenesmus, without or after stool, increased discharge of thick mucus; and occasional stools consisting first of faeces, solid or soft, and then of tough yellow mucus.
URINARY ORGANS. Frequent tenesmus of the bladder, and copious discharge of urine with white sediment. Also on externally pressing the bladder and on rising from a seat, incontinence of urine, followed by burning in the urethra.
SEXUAL ORGANS. Frequent erections with lustful thoughts, but no sexual instinct. Discharge of mucus from the urethra at stool.
Itching and burning in the right testis and in the penis. Tingling in the scrotum.
RESPIRATORY ORGANS. Nasal catarrh, first dry, then fluent; discharge of bloody mucus from the nose.
Nasal catarrh, with hoarseness and heat of the body, without thirst or sweat. Profuse coryza, headache and depression.
The peculiarity of the Spigelia nasal catarrh is this: The discharge through the anterior nares is but slight, while through the posterior nares into the pharynx it is great and constant, and very sensibly felt. Sometimes it is quite liquid, but generally tough, stringy, and in such quantity as to threaten suffocation unless frequently removed by hawking. This prevents sleep at night; trickling into the larynx, also, it causes a kind of suffocative cough.
COUGH. Spigelia is not prominent among the cough-producing drugs. It causes a spasmodic cough which stops the breath; is provoked by a tickling deep in the trachea, is violent, dry and hollow, and is excited especially by stooping forward.
RESPIRATION. Several symptoms betray impeded respiration, the impediment seeming to result from sticking pains in various parts of the thorax, which are independent of respiration, though aggravated by it.
CHEST. Pressure upon the chest in various localities, under the clavicle, over the center of the chest, over the whole chest, and over the xiphoid cartilage.
Stitches in various parts and on both sides, more frequent on the left side, from within outward; aggravated by inspiration and by motion.
The following symptoms deserve special notice: Violent stitch in the left side, just under the heart, recurring periodically; stitch “in the diaphragm” on the left side, so violent as to arrest respiration; dull stitches (Colchicum) synchronous with the pulse in the region in which the heart’s impulse is felt; stitches between this latter spot and the epigastrium. These symptoms, together with the following, which denote modified action of the heart, viz.: very violent pulsation of the heart, audible to the patient and visible to the by-stander; violent palpitation and anxiety; tremulous motion of the heart; palpitation increased by sitting down and bending forward, and by deep inspiration and retention of breath; palpitation as soon as he sits down after rising in the morning; and in the praecordial region a heavy, painful pressing load, causing constriction and anxiety, with cutting and griping, as from wind in the abdomen;—these two series of symptoms point clearly to an organic affection of the heart or pericardium, such as clinical experience has proved to find its curative agent in Spigelia.
BACK. In the lumbar, dorsal and scapular regions various stitching pains are noted, generally worse on motion and inspiration, along with general lassitude.
EXTREMITIES. Pains, aching, restlessness, isolated tingling and numbness. Similar sensations to those already described in other parts of the body.
UPPER EXTREMITY. In the shoulder, arm and forearm, sticking and pressing pains, with a sensation of lassitude and weakness. The two symptoms, sensation in the forearm, as if the bones were compressed by tongs and the pressing, cutting, tearing pains in the wrist and finger joints, worse by motion, indicate the action of the drug upon the nervous and fibrous tissues respectively. The numbness and paleness of the hand (Symptom 381) does not indicate any variety of organic paralysis or depressed vegetation, but rather such a condition as results from pressure on a nerve, or when the hand, in popular phrase, “goes asleep.”
LOWER EXTREMITY. The action of the lower extremity is more decided and more definite. As in the upper extremity, we have lassitude, fine sticking pains and spasmodic twitching of individual muscles. In addition, there is very great restlessness of the limbs, especially at night, preventing sleep and causing constant motion and flexion and extension of the limbs; this is attended by digging pain in the left knee (Aurum, Rhus toxicodendron, Taraxacum, Causticum). The knees are sensitive, and are painful when walking, and worse the longer the walk is continued. Luxated pain in knee, causing limping; sticking in the calf and pulsation in patella when knee is extended. Ankle; boring pain on flexion, as if tendons were too short; tearing stitches in the feet; soles sore when stepping.
SLEEP. Frequent and great sleepiness, yet inability to fall asleep until very late in the evening; sometimes from great restlessness of limbs.
Sleep disturbed by lively dreams; he is fatigued on waking; more tired in the morning than on going to bed.
FEVER. The entire paroxysm is often without thirst. Chill partial; frequent sensation of heat in the body; none external.
Chill generally in the morning, partial and wandering, often not followed by heat; it starts from the epigastrium and extends to the back, head and upper extremities.
During the heat, desire for external heat. The hands feel warm to each other but cold to the face; heat is partial.
DISPOSITION. Irritable, excitable, with depressed anxiety for the future, and despondency.
Hahnemann remarks in his introduction to the proving of Spigelia (A. M. S. R., 5,238) :
This annual plant, which was first used in South America as a domestic cure for lumbricoides, became known to our physicians about eighty years ago, who, however, have learned since that time to use it for nothing else than what the simple negroes of the Antilles first taught them, viz., to expel the lumbricoides.
Yet let one only reflect that the accumulation of lumbricoides in the intestines is never an individual independent disease, but only a symptom of some other fundamental disease in man, and unless this be cured, the worms, although some may be driven away will yet perpetually re-appear in the intestines.
It would therefore be foolish to use so extremely powerful a drug as Spigelia merely for the expulsion of worms, if this plant did not, at the same time, remove the disease which lies at the foundation of the existence of the worms. This it can do, as many cases show, in which the patients recover, even without having passed a single worm.
Spigelia, however, has short-sightedly enough been regarded and used only as an anthelmintic. When people know not how to devote this most precious remedy to a more important use (a few cina-seeds would do for this), they act as inappropriately as they would do in applying a costly machine to do a trifling bit of work. The wonderful and many-sided power of this drug shows a much higher design for it than to bring a few worms from the intestine.
1. The chief indications are in semi-lateral neuralgic headaches involving the eye, chiefly the left side.
2. In prosopalgia, involving the eye, the zygoma, the cheek, teeth and temple.
3. In rheumatic sclerotitis.
4. In pericarditis and endocarditis with stitches and violent pulsation.
It comes after Aconite; competes with Bryonia; precedes Spongia and Lachesis, Arsenicum and Lithium.