CROTON TIGLIUM

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Croton oil, when applied to the skin, produces both vesicles and pustules upon an inflamed base, and the part becomes very red and sore. The inflammation often increases until it resembles erysipelas, but more commonly the eruption produced resembles a vesicular eczema. This eruption will come on for a few days and will then desiccate, and in a few days longer it will desquamate.

When one has been overdosed, as is done in a too prolonged proving, or by the crude drug, or when the prover has been markedly sensitive, we get an alternation of states, the internal alternating with the external. After the eruption is out the internal manifestations are not present, as is seen in the rheumatic state, the cough and the bowel symptoms. If we study these groups separately we will find they are all interesting.

First, its cough. It has an asthmatic cough, coming on in the middle of the night, often arousing the patient from a sound sleep. Attacks of violent coughing, with dyspnoea and choking, worse at night and worse on lying down, compelling him to sit up, to be bolstered up in bed, or to sit up in a reclining chair. His friends wonder if he is not going into consumption. If it is a child they wonder whether it is not whooping cough. There is extreme irritation of the air passages, so that the inhalation of air brings on the cough. Sensitive to deep breathing. Now, this will go on for a while and finally he will break out with an eruption somewhere upon the body, vesicles and pustules, in clusters and patches, that become inflamed and red and finally dry up and desquamate and disappear, and then back comes his cough. This may go on as a chronic state, and when such is the case it will be very well to know this remedy.

The next most important symptoms are the bowel symptoms, and perhaps they are the best known of any of its symptoms outside of the eruption. It is suitable in both acute and chronic diarrhoea. It is suitable in cholera infantum. The marked feature is the extreme suddenness with which the stool is ejected. It seems to come out in one gush of yellow, watery or pappy stool; soft, thin faeces, coming out with one gush. So marked is this that it is not an uncommon thing for a rural patient to describe it as "like that of a goose." It all gushes out in one squirt. The mother says of the little patient: "You would be astonished, doctor, at the violent rush, for it all comes out with one squirt." That is descriptive. Many remedies have a holding on and a prolonged effort at stool, until it takes quite a long time. Many of the diarrhoeas are prolonged with numerous little gushes of thin faeces or water, but this particular feature is striking. It may not always be so, but this violent gush of thin, yellow faeces or yellow water is a striking feature of the remedy. With this the abdomen is very sensitive, and is greatly distended; there is much gurgling in the bowel, and when the physician puts his hand upon it the patient will say he feels the gurgling, as if he were full of water, and it probably is so, for the expulsion of the stool would not occur in one strong gush were it not for the fact that the colon and rectum were full of fluid. Another peculiar thing commonly attending Croton tig. diarrhoeas is that pressure over the abdomen or pressure about the umbilicus causes a pain in the rectum and urging to stool, and a feeling, with the expulsion of the stool, as if the rectum would protrude. Clinically it has been described as if the pain followed the intestines all the way down to the anus. The taking of a little water, or of a little milk, what would ordinarily be suitable food for such a diarrhoea, will at times cause an instant urging to stool; he must go to stool immediately after eating. This gives the general features of the Croton tig. diarrhoea. If it is in an infant there is great exhaustion, tympanitic abdomen, much rumbling of the bowels, great sinking, and as soon as the infant takes one mouthful of milk or draws from the mother's breast it expels a gush of liquid or pappy stool.

Another most important group of symptoms is its eye symptoms. It has eye symptoms of an inflammatory character, and around the eyes and upon the lids are vesicles and pustules. Pustules upon the cornea, granular lids. Inflammation of all the tissues of the eye. It has an inflammation of the iris and conjunctiva. The blood vessels of the eyes are distended, the eye looks red and raw. The eyelids when turned out are seen to be greatly inflamed and granular, covered with vesicles and pustules. With this inflammatory condition there is a sensation very commonly present in the Croton tig. eye cases, as if the eye were drawn backwards by a string, or as if the optic nerve were dragging the eyes backwards into the head. This drawing in the back of the eye as with a string is also peculiar to Paris quadrifolia, but the conditions are different in Paris quad. In headaches -from overuse of the eyes in engravers or those doing fine needle work, with much neuralgia in the head, due probably to the overuse of the eyes, when the pains in the eyes are not attended with inflammation, but are more of the type of dull aches and pains that you might call only rheumatic or neuralgic, with this sensation as if the eyes were drawn back into the brain; in these neuralgic cases use Paris quad. But in the inflammatory conditions such as I have described, with the same drawing back as with a string, Croton tig. is the remedy.

Troublesome eczema of the scalp in infants, either purely vesicular or intermingled more or less with pustules. The vesicles dry up and then desquamate, and now there is a red, raw, inflamed surface, sensitive to touch. After desquamation has pretty nearly finished, a new crop of pustules and vesicles comes out, and while one place is clearing off another is vesicular. This is how it goes on with a chronic eczema. The eruptions are often about the eyes, on the temples, over the face and on top of the head. The appearance is so nearly like Sepia that the two very often cannot be distinguished. Sepia has the same vesiculation intermingled with pustules, the bleeding and rawness of the surface and the eruption of new crops. Sepia is more frequently indicated in this raw and bleeding state of the scalp, in crusta lactea, or the eruption of children than Crot. tig. Under Croton tig. infants in this state very often have attacks of gushing diarrhoea, coming on from the slightest disturbance or indigestion; this is a great help in guiding to the remedy. When the two groups of symptoms are combined, the scalp symptoms and the diarrhoea, you can hardly make a mistake. You will see this also, that if the diarrhoea is at all prolonged, the head will steadily improve and you will think your patient is getting well of the scalp trouble, but when the diarrhoea slackens up a little out will come a fresh crop. If the diarrhoea becomes chronic the external eruption will disappear, and if the diarrhoea improves the external eruption gets worse. It seems necessary in such a constitution to have a vent. The mucous membrane is but the internal skin, and the integument of the body the external skin, and this remedy especially manifests itself upon one or the other of these, the mucous membrane or the integument.

It has another manifestation that you want to carry in mind, a group of symptoms in relation to lactation. After confinement the mother may go on a little while with all things following normally, but all at once she commences to have pains in one or the other mammary gland, and the drawing as with a string comes up again. It feels to her as if a string were attached behind the nipple pulling backward, a sharp, drawing, stinging pain that will in some instances keep her walking the floor night and day. Though it is but a little thing it is a very important symptom to know with Crot. tig. We see this drawing, as with a string, in the eye and in the breast, and also the symptom, very like the Plumbum symptom, drawing in the navel upon pressure, somewhat like a string. Associating such things together will enable you to understand them as a part of the nature of the remedy and to keep them in mind. I once cured a woman of this painful drawing from the nipple as with a string. I watched her walk the floor and saw that the suffering must be very intense, for at times it brought tears to her eyes. She had borne it several nights, which shows that Croton tig. is capable of curing a pain that is very prolonged or tedious. The breast had been poulticed, hot applications had been put upon it, and they did not give relief, a point which is worth remembering.

In cholera infantum we will naturally have the symptoms of vomiting, which, however, are not so common to Croton tig., although it has some vomiting. So in cases of cholera infantum, in which the vomiting is not so important a feature as the loose bowels, the remedy may be Crot. tig. A symptom is reported that is of great value. Excessive nausea with vanishing of sight, vertigo, worse after drinking, with frequent discharges of yellowish-green water from the bowels; excessive nausea, much water in the mouth. So we note the excessive nausea and not so great vomiting. The nausea is more like that of Ipecac., but in Ipecac. we have nothing like the stools of Crot. tig., we have only scanty little gushes, every minute a little gush with tenesmus. Vomiting is the all important symptom in the cholera infantum of Ipecac., and when the stomach is emptied there is overwhelming retching and exhaustion from it, and the stools are scanty; but in Croton tig. the stools are copious, and while there is nausea the vomiting is seldom and scanty.

Another feature to be considered in this remedy is its relation to Rhus. It is an antidote to Rhus. Croton tig. is closely related in its vesicular eruption to the Rhus family (particularly Rhus tox.). Anacardium, Sepia and Anagallis. The eruptions of Croton tig. very often select as a location the genital organs. Rhus does the same, and when the genital organs are the principal seat of the eruptions in Rhus poisoning Croton tig. will commonly be its antidote; also when the eruptions are most about the eyes and scalp Croton tig. will often furnish an antidote. When the symptoms, however, confine themselves to the palms of the hands Croton tig. is not the remedy, but it is Anagallis. Anagallis does upon the palms of the hands just what

Croton tig. does upon the genitals. If you examine Anagallis you will find that the eruptions will come out and desquamate, and no. sooner does the surface look as if it would heal than a new crop comes out. Rhus is similar in that it locates upon the palms of the hands, but Rhus does not repeat itself upon inflamed surfaces. In the Croton tig. eruption there is some burning, but nothing like that of Rhus. The Rhus burning pain in eruptions that are marked is almost like fire. It is worse from the air, and it is better from dipping the part in water as hot as it is possible to endure it. Persons who have these Rhus eruptions talk about scalding their hands to relieve the itching and burning. So it is with Croton fig., but it is usually so sore he cannot touch it; when the eruption is so mild that he can handle it, we find that the slightest rubbing relieves the itching. In Rhus touch aggravates the itching. In bad cases of Rhus poisoning he will hold his fingers far apart if they have very large blisters upon them, and he will not touch the place because it establishes a voluptuous itching that nearly drives him wild. Although this is not so with Croton tig., still they are similar enough to each other to be antidotal ; they do not have to be exactly alike, but they need to be similar. It is true that remedies that are relieved by scratching are more nearly antidotal to such remedies as are relieved by scratching. The more similar the better ; but medicines will antidote each other when they are similar only in general character, and they will cure disease when they are similar in general character. It is also true that medicines while they are not similar in general character may be similar enough in special localities to remove the symptoms in these localities, while the disease will go on. The remedy in this case is not similar enough to cure the disease, but it has removed some of the symptoms. That is the most miserable kind of a prescription, as it changes the manifestations of the disease without changing its nature. In that way a very poor prescriber may hunt around and get one remedy for one group of symptoms and another remedy for another group, and the patient be worse off than before. If the remedies are similar as to their general nature, then the little superficial symptoms are not so extremely important.

"Frequent, corrosive itching on glans and scrotum." "Vesicular eruption on scrotum and penis." It is a remedy for vesicular and pustular eruptions upon the genital organs. It is closely related to Petroleum, which has fine red vesicular and granular elevations, intermingled with fine red rash upon the genitals, itching intensely, worse at times by scratching until burning comes on and then bleeding which relieves.