(George Vithoulkas describes the homeopathic remedy Bismuth, carefully distinguishing it from Arsenicum and Phosphorus.)
Bismuth is a remedy which should be thought of in cases where the focus of the problem lies in the stomach region. Severe stomach pain of whatever origin is a strong indicator for this remedy, particularly in cases of pure gastritis, and inflammation of the mucous lining of the stomach. The Bismuth patient’s face is earthy, pale, with blue rings around eyes; there is great thirst for cold drinks in the evening, nausea and pressure in stomach after eating with great drowsiness in the morning. He may experience flushes of heat over head and chest and feel prostrated. Any derangement in the health of the individual has repercussions on the stomach; thus Bismuth may be classed with the group of remedies whose common factor is a weakness in the stomach region, such as: Nat-c., Ant-c., Nux-v., Rob., Kali-c and Kreosotum
The characteristics of the Bismuth gastritis are severe burning, pinching, cramping or lancinating pains with violent vomiting of enormous quantities of food. The epigastric pain usually extends to the spine. The pain is temporarily relieved by drinking cold water, but as soon as the water becomes warm in the stomach it is ejected by spasmodic vomiting. If this does not happen automatically a heavy load, like a stone, is felt in the stomach which prompts the patient to stick a finger into his throat to induce vomiting.
The patient vomits at intervals when the stomach becomes full and the amount of vomit is really enormous. It is as if food had been left there for days and is suddenly ejected. Here it is interesting to note another peculiar symptom of Bismuth that has been confirmed; eructations taste of food eaten 24 hours before.
The pain of Bismuth is so severe that the patient is in constant turmoil, writhing about in great distress. The arms, legs, and the entire body are all in constant motion. There is tremendous physical restlessness. The patient goes from one place to another, lies down, gets up, sits now here, now there, but he cannot stay long in one place. The pain is so intense that it provokes great fear in the patient.
He keeps repeating, “Am I going to be well? Will I recover? Please hold me! Don’t leave me alone”. These patients, because of the violence of the pain, have a great fear of being left alone and of solitude. They need somebody to be with them constantly, sometimes just to hold their hand. This fear of being alone during the pain is very characteristic of Bismuth.
If such are the symptoms of the case, the attending homeopathic physician will tend to prescribe other remedies first. Arsenicum will come to mind, because of the characteristic restlessness, or Phosphorus, because of the anxiety and fear of being left alone.
The selection of Phosphorus may be further justified in a case of Bismuth by the great thirst for cold water, the temporary amelioration from it and more particularly by the fact that the water is ejected soon after reaching the stomach, combined with the tremendous anxiety about health, the need for reassurance and the desire for company during the pain; all symptoms that are as typical for Phosphorus, as they are for Bismuth. However, in other areas the two remedies differ totally, as may be seen by the following description of Bismuth’s mental-emotional picture.
The Mental-Emotional picture of Bismuth
The typical Bismuth patient is one who has suffered a great deal in the course of his life, both emotionally and physically. The resulting stress has centred on the stomach which is now inflamed. The patient is nervous, fleshless, irritable and hysterical, and his emotions are hardened. This type of person does not forgive easily, and may pursue a ruthless course of action even with the knowledge that in so doing the other person will be hurt. You will find a combination of excitability, amounting to hysteria, and near cruelty or indifference for the pain of others. The Bismuth patient’s behaviour can be so contradictory that one may get the impression that he is sociopathic. In the text it says, ‘want of moral feeling.’ In this respect Bismuth is totally different from Phosphorus, whose characteristic emotions are sympathy and compassion. When in pain Bismuth cases become extremely fearful; worrying that others will not care for them and that they will be deserted at this time of suffering. They develop an obsession with the fear of being left alone. They dread solitude, especially in times of trial, and they want to cling to persons around. When suffering with a headache, they become apathetic and sullen, and their mood becomes one of complaining and peevish dissatisfaction. Actually the Bismuth patient suffers from an alternation of headaches with stomach pain. There are periods when the headaches are in excess and then the stomach problems subside and vice-versa. Headaches appear mostly in winter.
These patients do not like to talk, especially during the day when they appear to be irritable and complaining, ill-humoured, morose and discontented. This mood is better in the evening when they become more talkative and communicative. Indolence is also better in the evening. Their minds may be unstable, even confused, as if intoxicated. They start on one subject, then change to another, holding but a short time to any one thing. This lack of consistency would seem to indicate a weak will and lack of ability to make a decision. Lastly, the Bismuth patient is easily frightened on waking.
The Bismuth Child
Bismuth children are slender and irritable, with a tendency to show chronic diarrhoea. This remedy is indicated in infants where a difficult teething period is accompanied by vomiting, offensive eructations, intermittent diarrhoeic stools, or soft semi-liquid stools of a light colour and foul odour, preceded by crampy pain and pinching in the stomach. Children with summer diarrhoea, watery offensive stool and great prostration fall into this category if vomiting predominates.
This is one of the main remedies in cholera infantum with a sudden onset of the disease and where the case looks very serious. The stools are watery but excessively offensive and cadaverous smelling, and there is excessive vomiting, especially of cold water as soon as it reaches the stomach. The tongue is thickly coated white, there is rapid exhaustion and dehydration which show the severity of the case. The child is restless and anguished; he wants his mother next to him all the time holding his hand. The case bears a strong resemblance to Arsenicum, with one important difference: the surface of the skin is warm, while in Arsenicum it is cold.
Other Characteristics
Another striking characteristic of Bismuth is that the pain is ameliorated by rubbing or massaging the back. Massaging the region of the solar plexus itself cannot be tolerated, but rubbing the region of the back ameliorates. Such massaging may relieve not only the pain and writhing, but also the tremendous anguish. Here it must be stressed that the Bismuth epigastric pains ares felt behind as if they were in the spine; they are not felt on the outside of the back, like Belladonna, but rather deep in the spine.
While the acute exacerbation of pain is continuous for days at a time, chronically the pain recurs in paroxysms with an irregular periodicity. This periodicity may vary from every fifteen to thirty to forty-five days, and, once the paroxysm begins, its violence, anxiety, and characteristic great thirst for cold drinks (which are vomited) are unmistakable signposts to Bismuth.
It is strange, however, that once the pain abates, these patients can eat and digest virtually anything. During the paroxysm, the body and head may feel as if fever is present. Eventually the extremities become cold, but the torso and head remain warm to the touch, even though there is no actual fever.
Bismuth is indicated in the chronic non-febrile vomiting following an acute gastritis, or indigestion. It is important to remember that in spite of the fact that there is such a strong inflammation of the stomach lining, fever is lacking or very low. This will help you to differentiate it from the Belladonna gastritis, as both have the intensity of the pain and the extension to the back.
I have used the oxide of bismuth with success in a number of cases:
- for a wearing, nightly cough, in a hysterical female patient.
- in a case of sub-acute cystitis, (after plumbum), accompanied with violent crampy pain at the bladder, which came on in irregular paroxysms.
- in several cases of dysmenorrhoea in hysterical female patients.
- and lastly, with spectacular success in a case of phlegmasia alba dolens (phlebitis of the femoral vein). The left lower extremity was the principal seat of the disease.
Generalities
Restlessness, driven from place to place, driven out of bed.
Faintness from pain in stomach.
Most symptoms are ameliorated by motion.
All muscles of body, particularly those of legs, from toes to are spasmodically contracted. Great debility; languor; prostration.
Cold drinks and bathing ameliorate the stomach pain, headache and toothache.
Vertigo
Vertigo on exercising.
Vertigo; a sensation as if the anterior harf of the brain were turning in a circle, several times during the day, lasting several minutes.
Confusion of head.
Head
Constriction of head alternating with relaxation.
Heaviness in head on motion, while sitting, on forehead, on occiput, in temples.
Headache alternating with pain in stomach. Violent neuralgic headaches which alternate with gastralgia, the pain in the head involves the face and teeth, worse eating, better from cold water in the mouth.
Headache attended by gashalgia.
Headaches in winter.
Boring pain in forehead after eating, while sitting, extending to nose, motion ameliorates.
Burning, cutting and contracting pain from forehead to occiput.
Pressing pain as from a weight in forehead above nose.
Dull cutting pain in the brain, which begins above the right orbit and extends to the occiput.
Dull pressive-drawing in the head, now here, now there.
Pressure and sensation of heaviness in the forehead, more violent on motion.
Violent pressive heavy pain in the forehead.
Eyes
Distended feeling.
Boring, contractive, digging, pressing pain.
Mucus discharged in both canthi. Thickened mucus in both canthi.
Pressure on the right eyebail, from front backward and from below upward.
Ears
Tearing pain in ear, pressure of hand ameliorates.
Nose
Nose-bleed, dark blood.
Heaviness of root.
On attempting to swallow, liquids come out through the nose.
Face
Pale, cold face; earthy complexion; blue borders around eyes; features changed, as if he had been very sick during headache.
Pain in face alternating with pain in stomach (see also stomach).
Motion aggravates.
Pressing pain in cheek.
Mouth
Gums swollen.
Pain in gums as if excoriated.
Swelling of mouth, of one side of the tongue.
Taste is bitter-sour, bloody in the morning.
Taste: sweetish, sour, or metallic on back part of tongue.
Copious secretion of brown, thick, metallic_tasting saliva.
Mucus bloody.
In the evening, white-coated tongue.
Slight salivation, with marked tumefaction of inner surface of cheek, and side of tongue.
Sensation of looseness of teeth.
Toothache relieved by taking cold water in mouth; worse when water becomes warm.
Pain in teeth, anything cold ameliorates.
Pain from warm food and drinks.
Drawing pain in molars.
Throat
Ulcers spreading on uvula.
Inflammation of the throat wakes him at night.
Phagedenic ulceration of uvula, with burning and tearing; difficulty swallowing of fluids, which return through nose.
Stomach
Convulsive vomiting.
Vomiting immediately after drinking the smallest quantity.
Violent retching, followed by fearful vomiting.
Vomiting with oppressive anxiety.
Vomiting and diarrhoea.
Vomiting and purging with great prostration; warm surface; flatulency; white tongue; cadaverous-smelling stools; patient desires company.
Water is vomited as soon as it reaches the stomach.
Vomiting in teething of children.
Nausea in the stomach; he feels as if he would vomit, especially violent after eating, with pressure in stomach.
Nausea, ameliorated after cold drinks.
Nausea from warm drinks.
Nausea after operation on abdomen.
Pain alternating with pain in face.
Periodical pain.
Pain in stomach with fainting.
Pain on small spot.
Pain as if something would break inside.
Pain as if pressing food in one spot.
Pressure in the stomach, especially after eating.
Cancer of stomach.
Foetid eructations.
Pain made better by cold drinks.
Eructations that taste of the food eaten 24 hours before.
Rubbing back ameliorates.
Pain in stomach relieved by bending backwards.
Abdomen
Rumbling when standing, right side.
Frequent passage of flatus.
Pinching pressure in the lower abdomen, and rumbling with desire; a sensation as if he must go to stool. Abdomen painful to touch.
Rectum
Urging in the evening.
Clinical symptoms: painless diarrhoea, with great thirst.
Cholera infantum, with tongue thickly coated white, vomiting.
Urinary Organs
He is obliged to urinate frequently, every time profusely; the urine is watery.
Genitalia – male
Aching, pressing pain in right testis.
Ejaculations without erections, wakes frequently.
Chest
Burning, hot constriction.
Pain in lower chest when walking, extending transversely.
Pain in the chest and back, with burning and boring.
Boring pain in right side.
Pinching pain in diaphragm.
Pressing, stitching and tearing pain in nipple, Left side of sternum.
Tearing pain in lower ribs.
Back
Pain as after prolonged stooping. Must bend backward from pressure in spine.
Extremities
Trembling in upper limbs when and after eating.
Blue discolouration of upper limbs, forearm, thighs.
Paralytic weakness and weariness in the right arm.
Paralytic tearing pressure in the right forearm, especially in the bones of the wrist, toward the outer side, at times more in the upper part.
Paralytic pressing in upper arm, forearm, touch ameliorates.
Pain in forearm, touch ameliorates.
Cramp like pain in anterior muscles of upper arm.
Pain in elbow, motion ameliorates.
Motion ameliorates lameness in forearm.
Sore bruised pain in ulna and radius.
Pressing, tearing pain in wribt.
Trembling in hand while eating.
Yellow spots in fingers.
Tearing in the metacarpal bones of the right index and middle fingers.
Fine tearing in the tips of the fingers of the right hand, especially under the nails.
Itching of lower limbs and feet, scratching aggravates.
Corrosive itching in leg.
Drawing pain in calf, extending downward.
Tearing pain in tendo-Achillis.
Pressing pain in bones of ankle.
Boring pain in bones of foot.
Pressing pain in outer side of foot.
Dryness in soles of feet.
Pressing pain in tip of first toe.
Skin
Corrosive itching near the tibia and the back of both feet near the joints, which becomes much worse on scratching; patient is obliged to scratch himself until it bleeds.
Sleep
In the morning, a few hours after rising, an excessive sleepiness, but after eating he was unable to take his accustomed nap for several days.
At night, frequent waking in sleep as from fright.
Restless sleep at night on account of voluptuous dreams, without, or frequently with, emission of semen.
Starts in sleep; thinks that he is falling; wakes in a fright.
Fever
Flushes of heat over the whole body, mostly on head and chest, after rising in morning.
Heat in entire body, with accelerated, contracted pulse; temperature not increased; no perspiration; coated tongue; vertigo; pressure in forehead and reddened conjunctiva.
(Excerpted from Materia Medica Viva ( 12 Volumes) by George Vithoukas.)
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