RADIUM BROMIDE

GUY BECKLEY STEARNS M.D.

(H. G.,  JUNE 1980)

         The sole object of a remedy should be to increase the reaction of the body against disease.  For prescribing, the qualities which characterize the reaction caused by a drug are not the physical or the chemical or the obscure physiological ones; they are the effects which a child can describe or its mother observes where the child has been poisoned by a drug.  The other qualities are important but not essential.

         The chemical and physical properties of Radium are intensely interesting, so striking are they that it is difficult to force them into the background while studying Radium therapeutically.  Its spectacular qualities not only obscure its essential characteristics but tempt the careless to try it on the slightest clinical indications.

         Cases of Arthritis, Neuritis, Psoriasis, Enuresis, Arteriosclerosis and Rhus poisoning have been reported cured; most of its verifications are of Arthritis.  Many verifications of symptoms have been reported and many of the clinical cases have been very striking.  Few, however, have been linked up in such a manner that one can determine, from the reports, on precisely what indications the remedy has been prescribed.

         Of cases of chronic Arthritis reported by His, where Radium was used empirically, 2½% were cured and about 47% were benefited.  It causes pain in all the Provers and these pains are located both in the muscles and the joints; to understand the remedy, we must study the character of the pains, their predominant localities and their modalities.  All parts of the body are affected, but the great toe joints and the Sacrolumbar regions are the most important seats of pain.  The pains are of two predominant types, sharp pains (in some cases described as lightning-like) coming or going suddenly, or coming slowly and going gradually.  These are apt to change places and in some cases go from side to side.  The other type of pain is a severe, dull, aching, ranging from a pain situated deeply in the joints, to an aching all over the body, which torments the patient to a restless moving about all night, leaving him exhausted next day.  The type comes on gradually and slowly wears away.  Often the pains are hard to describe.  Throughout the Proving appears relief from continued motion, though often motion aggravates at first.  Pressure relieves and warmth is disagreeable.  Radium causes a marked desire for relief in the open air.   It should be noted that there is great weakness from the lumbar region down, a sort of paretic languor and great desire to stretch the muscles, which stretching gives relief.  Sometimes nothing relieves the pains; they simply gradually wear away.  Although local heat is disagreeable, there is marked relief of pains and other symptoms from a hot bath.  

        Vasomotor disturbances occur so that some experience a sensation of internal chilliness, relieved by warmth, and others have a sensation of heat all over, so that they have to throw off the clothing.  Another expression of this same type is a feeling as if the whole body were on fire, with the sharpest kind of needle pricks.  In the Provings there is no record of any actual increase of temperature.  Many of the symptoms appear late in the afternoon and continue until after supper.  Most symptoms are better after eating.  A most striking unintentional Proving was made on a chauffeur of 45, who was given a 12x tablet at night and another next morning, for Lupus of the nose.  He became so dizzy he “could not stand up or do anything”.  Every movement made him dizzy and he was “so weak” his muscles “just gave out”.  It was two weeks before he was normal, when the experiment was repeated.  This time the symptoms were much more intense.  He became so weak and dizzy that he could not stand and had to go to bed.  When in bed the vertigo left, but his legs, arms and neck felt hard and brittle, as though if he moved they would break.  He had no pain and was all right when lying still, but if he got up he felt, as he expressed it, “queer”.  It was three weeks before he was able to do his regular work.  So, to the other sensations, we must add intense Vertigo, with weakness and a feeling as though the muscles would break if they are moved.  The peculiar dis-equilibrium of the Radium atom seems to be equalled by the lack of equilibrium it causes in human beings, for Vertigo is a marked symptom: “so dizzy had to walk with the hand against the wall,” “tendency to fall to the left,” are expressions used by the experimenters.  This symptom is entirely relieved in the open air and when lying down, but remains when sitting, and is brought on or increased on rising.

         A woman of 65, with high Blood pressure but no kidney lesion, had, on two successive mornings, severe Vertigo, worse from motion,  better in the open air.  She had to support herself against the wall.  Radium bromide 200^th relieved her in a few hours.  She had several circular red, scaly spots that itched maddeningly on the calves of her legs; these were not helped by Radium, but were cured by Tellurium.  Probably the relief of the Vertigo, although a verification, was only palliative, as Tellurium causes Vertigo in the morning and was probably the remedy from the start.  To sum up these generalities, note the peculiar pains and their locations, especially in the toe joints and the lumbosacral region; paretic weakness from the lumbar region down; persistence of the pains gradually wearing away; aggravation from motion but relief from continued motion; general aching with restlessness; relief from hot bath; amelioration from pressure; aggravation in the late afternoon until after supper; relief after eating; overwhelming Vertigo; marked craving for and relief in the open air.  Remember that all the foregoing appeared early and characterized the first attempt at reaction.  But many organs and functions are disturbed and a knowledge of them must enter into our understanding.  Headache is a prominent symptom.  Like the pains in the muscles and the joints, there is in the head two types – a dull pain anywhere from a simple dullness to an intense, dull, incapacitating ache.  This type is usually in the occiput or forehead, at times in the vertex.

         These headaches are better in the open air, better from cold, better from pressure and aggravated from lying down.  The other type of headache is characterized by sharp pain which sometimes becomes throbbing.  Usually beginning in the right temple or over the right eye and extending backward to the occiput, or upward the vertex.  Sometimes it is on the left side; in one Prover, pain began in the occiput and extended up over to the right eye.  The aggravations and ameliorations are the same as described before, although in one case warmth relieved and pressure aggravated.  The muscles of the eyes are affected by the same paretic weakness as are those of the extremities and ptosis occurs, so that sometimes the eye has to be opened with the fingers.  The right eye is more affected than the left.  Sharp pains occur over and in the eyeballs. Radium causes the lids and conjunctiva to become inflamed and irritated with a feeling of dryness.  There is also a sensation of soreness and burning.  In one Proving, the right eye was inflamed and yellow discharge formed that ran down the nose and formed yellow crusts.  The nasal mucous membrane becomes dry and hard crusts form in the nostrils.  In the lower respiratory tract marked symptoms develop.  It causes irritation and soreness of the throat, with inflammation beginning on the right side.  This is followed in a day by tickling in the larynx, which causes a severe dry, spasmodic cough.  This is worse at night and when lying down, and it is impossible to suppress the cough after it once starts.  It is relieved in the open air.  The irritation is in the larynx and the suprasternal fossa, as though dust was in the throat.  Dryness appears to be a characteristic of Radiumbromide, as appears from the symptoms in the eyes, nose, throat and lungs.   It causes rawness and dryness of the throat and the hacking of small amounts of white stringy mucus.  The throat symptom is relieved by a drink of cold water and swallowing.  It causes a sensation of a lump in the throat.  The cough is irritated by smoking and from being indoors, better out of doors and after eating.  Expectoration is usually absent, and if present is scanty and stringy, yellow or white.  Note that there is a consistency in the character of yellow discharge from the eyes, the yellow, stringy discharge from the throat and the crusts from the nostrils.  The cough does not seem to originate below the larynx, though there is a constriction of the chest that centers about the heart and is accompanied by palpitation and sharp pain.  The same character of dryness is observed in the mouth.  The sensation in the mouth is dry and parched and one must sip cold water to moisten the mouth.  The breath feels hot.  The tongue becomes coated with a bluish white and is thick and feels swollen, so that speech is difficult.  This last is probably due to the paretic state of the muscles.  The teeth become painful and feel too long.  In one Prover a gum-boil formed on the lower jaw back of the molars and she could not talk on account of the soreness and swelling.  The mouth has a metallic taste.

         The digestive function is disturbed as shown by the coated tongue, also by the symptoms related to the appetite, stomach and bowels.  Radium  causes a craving for fresh air, lasting for several weeks.  Dr. C.M. BOGER says this symptom is occasionally observed in persons who later have consumption.  Aversion to sweets is marked, also a mild craving for sour.   Like many of the antipsoric remedies it causes an all-gone, empty feeling in the stomach.  This is relieved by eating, but a small amount of food satisfies.  Much gas is formed throughout the digestive tract.  There is an eructation of tasteless gas.  The sum of its effects on the digestion is sluggishness.  Lower down, gas rumbles around in the abdomen and causes sharp, colicky pains.  These pains are better when the flatus passes or the bowels move.   Pressure, bending double, and heat also relieve.  Much flatus passes without pain; at times quite offensive.  McBurney’s point is the seat of sharp pains which come and go quickly.  A physician, after one dose of the 30^th, suffered for three months with pain in the epigastrium, like a bruise on the second day.  He lost fifteen pounds in these three months and in two years has not regained his former weight.  At times, griping localizes around the navel.  The stools are markedly changed in character, but the effects are so varied as to be difficult to sum up.  It causes both Constipation and Diarrhoea, which may alternate.  The soft stools vary in different Provers, from clay color to watery brown or yellow.  The points that stand out most prominently are that the stools are apt to come with a gush, even though normal in character, and are accompanied with much flatus and the passage of the stools relieve all abdominal and rectal distress.  Sharp stitches occur in the rectum.  Upon hearing the abdominal and stool symptoms, Dr. BOGER remarked: “Radium must be a great gout remedy.”  The muscular effects of Radium are manifested in the bladder, causing great difficulty in starting the urine.  Clinically it has cured enuresis, a condition naturally following retention through muscular weakness.  The sexual organs are disturbed both in men and women.  In men emissions are frequent with dreams.  The effect on women Provers was to make the menstrual period easier and stop the usual monthly headache.  It causes delayed and intermittent menstruation.  It causes also a white, cheesy Leucorrhoea.  The skin hardly escapes a remedy of the magnitude of Radium bromide.  It causes macules, papules and pustules, which itch and burn, are aggravated from scratching, and better in the open air.  It causes a general scaly eruption, with desquamation of large amount of dry, branlike scales without sensation.  Sebaceous cysts develop under its influence.  Very significant is its effect in causing Bunions and Corns to become inflamed and tender.  The last to be studied, because appearing last in the Proving, are the mental symptoms.  There is irritability and touchiness, which tend to develop into Depression.  Great apprehension as though something was going to happen, characterizes the Depression.  Provers got blue and discouraged and disliked to be alone.  The desire to have someone near is particularly marked.  Fear of being alone in the dark.  The mental state projects itself into the dreams, which are vivid and troubled.  “Dreams of fire, and when waking it is hard to realize that she has been dreaming”.  Bad dreams at night and low-spirited by day.

         Reviewing all these local symptoms note how the general modalities already mentioned appear.  In addition, the right side is affected more than the left, the right side of the throat, and in some cases pains are more in the right side of the body.  Cold usually ameliorates and warmth is not agreeable, though warm bathing gives marked relief.  Dr. BOGER reports a case of Neuritis in which burning pains relieved by a hot bath were his indication.  All abdominal symptoms and some general ones are relieved by passage of gas up and down and by defecation.  One Prover, after the 30^th had pain in an old empyema scar every time the weather changed.  Even now, two years later, always before a storm he becomes exhausted and has bruised pains deep in the joints.  Of less specific interest as therapeutic guides, but of general interest as showing the ultimate result of the disturbances of reaction, are the tissue changes induced.  Albumin and casts appear in the urine, showing that either the kidneys are deranged through the effects of the Radium as it is excreted, or that the Radium has a specific action on these organs.  The urine was radioactive from the dilution used in the Proving, so that the kidneys may have been irritated by the drug.

         A patient, 39 years-old, had for years excreted an excess of Uric acid.  For a year her Blood pressure had steadily gone up from 110 to 185.  Albumin and Kidney epithelia appeared in the urine, but no casts were found.  Lameness of the right knee developed at first, made better by walking and later aggravated by use.  Slight puffiness and heat of the knee.  Characterizing symptoms were pain like a needle in the right hip joint and pain like a string down the right sciatic nerve.  Indescribable pains in the lumbar region and the right side of the neck and shoulder.  Hopelessness of recovery and of the future.  Too frequent urination and sudden urging.  Occasional Diarrhoea attack, especially if emotions were disturbed, sudden gushing, skin dry and the hair becoming grey within a few weeks.  Brown spots on the skin.  Awkward and dropped things; flatulence, frontal headache in the morning as though the forehead were loaded.  All symptoms were worse in the late afternoon, and hot weather.  Everything was better in the open air.  Lycopodium relieved the bladder and bowel conditions.  This was followed in a few months by Radium bromide.  Marked improvement of all other conditions occurred for several months, when an acute cold developed Causticum symptoms, which remedy appears to be finishing the case.  The kidneys are now normal, the lameness is nearly gone and the Blood pressure is down to 125.  Note the sequence of Lycopodium, Radium and Causticum.

         It causes a marked increase of the nitrogenous excretion of kidneys and loss of flesh, demonstrating its profound effect on metabolism.  It lowers Blood pressure, which is consistent with the muscular weakness and letdown  conditions which it causes.  Blood changes are very interesting.  It causes a marked increase in the type of blood cells that attack and destroy bacteria.  Undoubtedly to this quality is due its effect in causing gum-boils and pustules.  All verification should be reported, not as isolated symptoms, but as complete symptomatic and clinical pictures.

         Its abdominal symptom, its effects on the joints, especially of the great toe, its irritating effects on bunions, and its upset of nitrogenous balance all point to its relation to gouty and chronic rheumatic conditions.

         Its loss of flesh, its craving for pork, and its prostrating effect link it with the beginning of chronic wasting diseases, especially Tuberculosis.  I verified it in a case of incipient Tuberculosis of the right apex in a woman of 42.  She had not been well since a hard cold two years before, and a recent miscarriage had lighted the latent infection.  Her urine showed low elimination and her blood an increase of leukocytes.  Systolic pressure 100.

         She was mentally and physically prostrated was worse late afternoons, and could not stand the least hot weather.  She had pains all over the body which shifted about and made her restless.  Stiffness of the muscles and pains that followed the nerves.  Tired weakness, though if she walked in the open air she braced up; vivid dreams and apprehension.  Pulsatilla and Lycopodium failed to help.  After Sulphur, her temperature, which had been subnormal mornings and normal evenings, became normal mornings and one or two degrees high afternoons.  Otherwise no change.  Under Radium bromide in ascending dilutions, beginning with the 200^th, she steadily improved.  A year later no evidence of the lesion could be found.  Skin diseases come under its influence, especially Seborrheas and dry scaly eruptions.  The fact that makes scar tissue sensitive hints at its relation to Keloid and perhaps to Cancer.  Von der GOLTTZ says it is indicated in Cancer to arouse reaction, much as Sulphur does in sluggish reaction in other conditions.

         Acute conditions accompanied by much pain such as Grippe, inflammatory Rheumatism, Neuralgia and Neuritis, fall within its scope.  It is related symptomatically to Rhus tox and Rhus radicans and often cures where these help but do not hold.  Intractability seems to be one of its keynotes in rheumatic conditions.  Digestive symptoms and modalities relate it to Lycopodium and Pulsatilla.  Its catarrhal symptoms are like Kali bichromicum and Kali carbonicum.  It resembles Causticum even more closely and complements it.

         There is a variability about the action of Radium, in that it affects different people differently, e.g. in one, there is a marked aggravation  before a storm and in wet weather.  In my verifications, this has been absent, but there has been intolerance of summer heat.  The chauffeur Prover had no pains, but only weakness, a stiff feeling and Vertigo.  One young man Prover simply developed a frontal Headache with no modalities.

         This variability makes it a hard remedy to understand.  Low potencies should not be used.  Dangerous aggravations have occurred from the 30^th.

Discussion

         Dr. DIEFFENBACH, New York:  I would like to compliment Dr. STEARNS upon his arrangement of this Proving.  It was his close questioning of the Provers that helped us to give what has been published.  Since the publications of this Proving about five years ago, I have received many communications from physicians, some expressing their satisfaction with results achieved, and others expressing disappointment.  It would seem that a number of physicians, hearing of the use of Radium in Cancer, used it internally and as a local application, hoping Radium would cure.  This is an unfortunate deduction.  If, as homœopathic students, they had consulted the Proving, they would have seen that in no case had we stated that this was a cure for Cancer.  Condemnation of Radium in its use in this lesion was not just when applied in this manner.  Radium must be applied in crude, massive doses if its effects are to be noted upon local tissue growth.

         Dr. STEARNS has emphasized the action upon the skin.  I developed a number of small swellings, sebaceous enlargements, irritability, burning of the skin.  That was the extent of tissue changes I noticed in my own case, and I had the heaviest dose in the 6x.  it shows an action upon the skin, and the possibility of some form of Hyperplasia should be borne in mind.  In my own case, the Proving removed the results at an old x-ray dermatitis which had persisted for years.

         The effect of Radium in Rheumatic and gouty conditions is something that gave us a good deal of pleasure when we consider that the old school is now busy on the subject of Radium in Rheumatism.  They claim that large percentage of cases of Arthritis, Rheumatoid Arthritis, Gouty Arthritis are cured by Radium in hypodermic doses, or taken in the form of capsules in a very weak preparation of the salts.  When we made the Provings there were over one hundred and twenty-five symptoms referable to the nerves, muscles and joint involvement of a Rheumatic character.  A number had suffered backache.  Three of the Provers had distinct Lumbago.  Others had pain in the muscles.  Others’ symptoms referred to Neuritis and Rheumatism.  Thus we have a definite corroborative list of symptoms indicating the application of this remedy to rheumatoid conditions.  But we must not consider it a specific.  As specialists and therapeutists we must select the cases in which the therapeutics will fit.  First we must know the symptoms.  The Radiumbromide patient is hungry for air.  In some Provings they want to open the window and get air.  That is a cardinal symptom, and it can be explained on a physical basis.  Radium is the greatest oxidizing agent we know, therefore this craving for Oxygen is a symptom which we can verify.  The pains are better from exercise and gradually wear off.  The action on the kidney and blood, the objective symptoms, have been interesting.  Five Provers developed Albuminuria.  We made preliminary tests for a week.  Some developed hyaline and epithelial granular casts.  They developed symptoms of Nephritis.  One man claims he is not well yet.  In cases with lowered elimination of solids, Radium increased the solids markedly, showing that katabolism was increased.  The blood work, which was conducted with a great deal of care, showed some contradictions.  There was leukocytosis in some cases, and leucopenia in others.  But every one of the Provers in whom the blood work was done, had an increase of polymorphonuclear neutrophils, the protective cells of the blood.  All these “pollies,” so called, were increased, indicating that something had taken place to rouse the protective agents of the blood, and their fight on Radium produced this peculiar reaction.

         These objective symptoms, which in former studies have been neglected, can be utilized undoubtedly, or subjective symptoms may lead to the selection of this remedy.

         The mental symptoms were also verified.  We had one report about which we hesitated.  The Prover dreamed of fire, and her skin that night was hot.  It is possible the Radium produced that symptom.  Dr. STEARNS suggested that it be left in the Proving because it was so unusual.  Shortly after that I had a patient that curiously enough gave me that symptom.  She said, “I have had restless nights, and I dream of fire.”  I gave RadiumBromide 30^th, and she came back and said, “My mental symptoms disappeared”.

         As a whole, the Proving has met with a good reception by those who have studied it.  I especially call your attention to it in Rheumatism and Gout and ask you to differentiate it from Rhus tox, Bryonia, and other rheumatic remedies.

         Dr. GEORGE ROYAL, Des Moines, Iowa:  You know there are two groups of symptoms which apply in the treatment of all cases.   Besides those coming from the Prover, I am sure that the verified symptoms are the most important ones.  Then, again, our essentials of a symptom should be taken into consideration, especially location.  In deciding between Rhus and Radium, I have found that if the former is indicated, the sheaths of the muscles are affected; whereas, if the latter be indicated,  Periosteum and the bone itself are affected, and when, as in the case cited, the symptoms are almost identical in the two patients, I decide by making sure which tissue is affected.

         Dr. GRIMMER, Chicago:  This excellent paper and splendid discussion by Dr. DIEFFENBACH ought in some way to be given great publicity.  It shows an accurate method in studying drug action.  I have verified Radium in one case of Rheumatism in which the joints chiefly were involved.  The patient had the modality of relief from motion.  Rhus palliated, but succeeding potencies failed, and Radium promptly cured the case.

         Dr. DIEFFENBACH:  This modality that Dr. GRIMMER spoke of, “relief from motion,” is quite marked.  After a patient moves around, the improvement is gradual.  The pain will stop and return again when the drug is given the second time, indicating that the drug was producing the pain, and the increased elimination from exercise reduces the pain.  I would also emphasize Dr. ROYAL’s remark, that the drug has marked action on the joints producing and curing many cases of Arthritis.

         Dr. KRAUSS, Boston:  Dr. STEARNS has presented a paper that might be taken as a model for Materia Medica men to follow.  It is an excellent paper, and it has been a pleasure to listen to it.  I have used Radium in one case.  It was a case of chronic Nephritis, due to arterio-sclerosis, rather than to any other cause, with which there was connected a distinct neuralgia of the face.  I believe Radium is good for overcoming pain.

         We have learned from this paper and from Dr. DIEFFENBACH’s discussion that we should not jump at conclusions, but that we should prove all our drugs first on healthy human bodies, before we apply them to diseased bodies.

         Dr. ANN JOHNSTON, Pittsburgh:  At the 1911 meeting of the Institute while listening to Dr. DIEFFENBACH read his paper on ‘The Proving ofRadium Bromide’, I thought of a patient of mine whose symptoms seemed to be similar to those produced by this remedy.  He was very susceptible to Erysipelas following colds.  The next attack that he had I prescribed Radium 12x.  He recovered quickly and has not had an attack since.

         Dr. STEARNS (closing the discussion):  Dr. DIEFFENBACH should have the thanks of the Institute for the generous manner in which he has given this remedy to us.