– Douglas M.Borland.
THERE are three kinds of conditions calling for Kali bic. First is the acute catarrhal condition of the mucous membranes of the digestive tract, acute gastritis, gastric catarrh, gastro- duodenal catarrh or gastro-enteritis. The catarrhal condition is much the commonest for which Kali bic. is indicated. Second is the definite ulcerative condition, particularly a gastric ulcer. And third is ulcerative colitis. In all these cases you are dealing with a very typical patient. The Kali bic. patient tends to be fat, sluggish, restless, depressed and taciturn. You will usually get a history that these patients have been subject to chronic catarrh all their lives, and they mostly suffer from a degree of chronic nasal, or post-nasal, catarrh-very often with a perpetually choked sensation about the root of the nose. All these patients suffer from wandering rheumatic pains. They are not very severe in character, but tend to wander about from one place to another, and are always relieved by motion. Normally, the patients are rather pale, but with their digestive upsets they tend to become somewhat blotchy. Very often they suffer from attacks of acne. Depending on the type of lesion, you find two kinds of tongue associated with Kali bic. In catarrhal conditions they tend to have a thickly coated tongue, particularly at the base, and they have a nasty, flat, bitterish or sweetish taste and a good deal of sticky saliva. The coating may be anything from sticky white to thick yellow, and the base is particularly affected. In ulcerative conditions, especially in ulcerative colitis, you usually find a very dry, smooth, red, almost glazed tongue. The commonest story given by these patients is that they have absolutely no appetite, and very often they have a loathing of food in the morning. It may be that they start their breakfast but about half-way through cannot continue with it. Or they may have the typical morning nausea, with complete inability to face breakfast at all. After a meal they suffer from an intense feeling of fullness, heaviness and general malaise. This comes on quite soon after a meal, and is usually accompanied by a very unpleasant feeling of general chilliness. With this sensation of fullness, they are liable to have sudden attacks of nausea and vomiting. The vomit in Kali bic. is very suggestive. It is sour in taste, contains a great amount of mucus, is difficult to expel, and the mucus hangs from the patient’s mouth. There is one odd symptoms of which these patients sometimes complain : a strange feeling of irritation in the throat. It feels as if they had a foreign body hanging on the soft palate, and intense nausea and even actual vomiting may be produced by it. Very often they describe it as the sensation of a hair on the back of the throat, or something of that nature. Not infrequently this is associated with their nasal catarrh and is, in fact, a string of mucus, which makes them retch and gag. Kali bic. patients suffer from pretty extreme burning gastric pains, which may become very acute tearing pains going right through to the back between the scapulae. When the pain is bad it is usually accompanied by a good deal of acute water brash. During the day they mostly suffer from a general lack of appetite, and yet they feel faint and gone if they do not have some food. With this feeling of faintness there may be a suggestion of nausea, which is relieved by taking a little food. These patients are usually thirsty and very often they develop a marked craving for beer and sour or bitter foods, all of which tend to aggravate their distress. In some of the ulcerative conditions, particularly if the ulcer is towards the pyloric end of the stomach, they suffer from definite hunger pains which come on about three hours after a meal. A distinguishing points is that pain goes on to actual vomiting, and the patients bring up typical stringy mucus, which may be actually blood-stained. And, with this ulcerative conditions, Kali bic. patients are very liable to develop an extremely sore spot in a small area in the epigastrium. There is one condition in which Kali bic. is almost specific: the gastritis associated with excessive beer drinking. It has the typical morning aversion to food, the typical glairy vomit associated with the beer drinker, the horrible slack inertia in the morning, the hunger and dislike of food, and the recurring attacks of nausea. Kali bic. will not only clear up the gastritis, but it will also stop the craving for beer. In ulcerative colitis, Kali bic, patients have very acute, griping diarrhoeic attacks. The diarrhoea is exceedingly suggestive : it is brown, frothy, watery, offensive and usually accompanied by the passage of a quantity of stringy mucus. Not infrequently there is a quantity of pus mixed up with the stool. In the more chronic colitis cases, there is often a spring aggravation in Kali bic. patients. They are fairly comfortable during the rest of the year, but each spring the condition flares up again, and they get another bout of colicky griping and this violent, distressing diarrhoea. Quite frequently, in Kali bic. digestive cases, there is a history that the patients have been subject to migraine attacks all their lives. These attacks are very typical. The patients have violent, sick headaches, associated with pain situated in one small spot above one eye. The pain gradually becomes more and more intense until it produces violent vomiting of typical, stringy mucus. The particular point is that these migraine attacks are always associated with ocular disturbances-zigzags, disturbances of the field of vision, partial blindness, or something of that nature-preceding the onset of the acute pain. One drug should be mentioned which does not come into these digestive drugs but which should always be remembered in association with these Kali bic. recurring migraine attacks characterised by disturbances of vision, pains in small spots and the typical stringy vomit-Iris. Iris has almost exactly the same symptom picture, and occasionally you will come across a patient you think is typical Kali bic, but whose migraines do not clear on it; and you will find it clears on Iris. The picture of the migraine attack is identical; it is impossible to distinguish one from the other. So, when you encounter an apparent Kali bic. migraine that does not respond, always remember Iris.