– Douglas M.Borland.
CARBO VEGETABILIS, is the drug everyone thinks of who has a patient suffering from flatulence. But, unfortunately, not all flatulent patients respond to Carbo veg., and it is a help to have a fairly clear idea of the kind of flatulent patient who requires this drug and thrives on it astonishingly well. Carbo veg. patients are of course flatulent, and the typical Carbo veg. patient is the atonic dyspeptic. As a rule, they give a history of chronic minor indigestion lasting over a long period. There are two classes of patients who give that history. Firstly, the thin, tall, atonic long-stomached patients whom one looks on as abdominal neurasthenics. They always have a feeling of abdominal discomfort, and a feeling as if their clothes were too tight. These patients are always tired, always miserable and look unhealthy. They are pale and sallow. To stimulate their appetites, they want something either very salty or very sweet; they have a craving for coffee, acid drinks or acid fruits. They usually dislike meat, and any fatty food. If you attempt to put them on to a milk diet, they dislike it and feel much worse on it; and it appears to give them a marked increase of flatulence. The other type of Carbo veg. patients do not look abdominal neurasthenics at all. They are rather over-weight, look well- nourished, and give a history of over-eating and, probably, over drinking for years, particularly taking very rich, indigestible food; and their digestion is beginning to fail. They have the same feeling of distension and fullness in the abdomen as the first type, and they also have a lot of flatulence; but these overfed patients very often have much more burning discomfort than the emaciated ones. They are very liable to attacks of general abdominal colic or of definite hepatic colic, and very often have gallstones. On account of having done themselves too well, these patients go off meat food, particularly rich, very fatty foods, because they are made uncomfortable by anything of that sort. They develop much the same group of symptoms as the abdominal neurasthenics-in other words, the craving for coffee and sour things, and they get the same discomfort afterwards; they are just blown out. Both of these types find a certain amount of temporary relief from eructation, from getting rid of some of this flatulent distension. That is the chronic state of Carbo veg. patients. But they also suffer from acute attacks in which they get definite burning, epigastric pain, which usually come on some little time after food. With these burning pains, they very soon develop definite colicky attacks, which tend to recur, and which become more and more troublesome for about a couple of hours after eating. At the end of that time they usually bring up a quantity of wind and the attack subsides for the time being. Instead of bringing up wind,they may have a sudden gurgle in the abdomen and the whole trouble subsides. If these patients take anything in the way of ice cream, very iced water, or iced wine, it is liable to produce an almost immediate feeling of distension and acute abdominal colic. They go out and have a large dinner, take a quantity of slightly sour iced wine with it, and get acute abdominal distension. Add to that the little excitement of an after-dinner speech, and these patients collapse with acute heart failure. The overfed type of Carbo veg. patients normally suffer from a somewhat torpid liver, which is usually a little enlarged, and they almost always suffer from constipation. The neurasthenic type also suffer from constipation, but they do not usually get the enlargement of the liver, although it may be palpable on account of the general visceroptosis. There is one other complaint which both types of Carbo veg. patients frequently make. During their abdominal discomfort, when they are just feeling a bit distended and raw inside, they get a sudden flow of saliva into the mouth, and very often it is so extreme that it suddenly runs out of the mouth. This happens more during the night than during the day; they wake up and find their mouth full of saliva, and it may trickle out on to the pillow. All these Carbo veg. patients, whatever their type, are sensitive to cold, are rather chilly, suffer from cold hands and feet, and yet all have a definite air-hunger. They are uncomfortable in an airless atmosphere and, like the Pulsatilla patients, often feel definitely cold in a stuffy atmosphere. As regards potency, I find that the over-fed type of Carbo veg. does well on a single dose of a high potency. In the case of the abdominal neurasthenic, however, you are better to give low rather than high potency, and I should start off with a 30. Although Carbo veg. is usually indicated for an atonic stomach rather than for an ulcer, there are occasionally indications for it in chronic ulcer where there is delay at the pylorus and a dilated stomach as a result. Strangely enough, you sometimes get indications for Carbo veg. in ulceration at the cardiac end of the stomach, or the lower end of the oesophagus, and you quite frequently get indications for Carbo veg. in oesophageal carcinomas. After patients with oesophageal carcinoma have swallowed their food, they get exactly the same feeling; they are filled up almost to bursting point; and then there is either eructation with a little fluid and relief, or there is a gurgle and the fluid goes through, giving relief. Patients have come into hospital unable to pass anything-or, possibly, only a little fluid-through the stricture, and on Carbo veg. have gone out after a few months, on a solid or semi-solid diet. I usually start these oesophageal carcinomas on a low potency. Up to the present I have given them 30, though I should probably go lower still and give 12. A dose once a day for three, four or five days, and then stop the administration and watch the effect. Whenever there are signs of increased difficulty, start the administration again, giving a dose every day for another four or five days and then stop again. In most cases the appetite has steadily increased each time the drug was repeated. Each time I repeat the drug I change the potency. I start off with 30, go on to 200 when I have to repeat; next time 1m, then 10m. I have not seen any cases where I have had to go higher than 10m. I started to change the potency in this way because, in his last pronouncement on the question of potency, Hahnemann seemed to hint that if you changed it you could repeat more quickly than you could if you kept to the original one. It has been tried out in this country, and it is confirmed by experience. If you repeat the drug in the same potency you have to wait longer than if you give it in a different potency. It does not seem to matter whether you increase or decrease the potency so long as you alter it. For instance, if you have given 200, it does not seem to matter whether you go up to 1m or down to 30; the important point is that you must alter the potency.