Laurocerasus

An evergreen shrub of the Rosaceæ whose leaves and kernels contain cyanogenic glycosides (notably prunasin/amygdalin) which liberate hydrocyanic (prussic) acid under enzymic action. The pharmacology is therefore that of cyanide: sudden respiratory–circulatory failure, muscular convulsion, glottic spasm, coma, and profound cyanosis; lesser doses yield faintness, slow irregular pulse, sighing or gasping breathing, and spasmodic cough with laryngeal tightening [Hughes], [Clarke]. The homœopathic tincture is prepared from the fresh leaves (expressed juice at once fixed with alcohol), or from the pharmacopœial Aqua Laurocerasi; triturations have been made from the dried leaf and kernel [Allen], [Clarke]. Toxicology sets the keynote complexion—blue face, cold sweat, speechless dyspnœa, pulse small or imperceptible—reproduced clinically in cardiac and respiratory collapse states, spasmodic coughs with impending asphyxia, and “blue children” of cardiac disease [Hering], [Allen], [Boericke].

“Laurel-water” formerly appeared in European pharmacopœias as a sedative/antispasmodic for cough and palpitation, and externally as a rubefacient; it fell into disrepute from fatal poisonings arising from variable cyanide content [Hughes], [Clarke]. Leaves were also used for flavouring; medical practice abandoned this from danger.

The pathogenesis rests chiefly on [Toxicology]—accidents with laurel-water—and [Clinical] confirmations collated by Hering, Allen and Clarke; fragmentary provings exist. Constant features: threatened asphyxia with gasping, sighing, slow or arrested respiration, cyanosis of face and lips, coldness, faintness, weak, irregular or imperceptible pulse, laryngeal spasm, spasmodic cough ending in exhaustion, aphonia, and collapse, often worse lying and at night, and better by fanning, fresh air, and being propped up [Hering], [Allen], [Clarke], [Boericke], [Boger]. Early [Clinical] verifications include whooping-cough with cyanotic spells, cardiac disease with blue face and gasping, asphyxia of the new-born, spasm of the glottis, and pulmonary œdema facsimiles [Hering], [Clarke], [Farrington].

• Respiratory centre and vagus—arrested or sighing respiration, tendency to apnœa, glottic spasm; breathing stops on dropping into sleep (see Respiration/Sleep) [Hering], [Allen], [Clarke].
  • Heart and great vessels—small, weak, intermittent pulse, impending syncope; cardiac failure with lividity; precordial emptiness and sinking (see Heart/Generalities) [Hughes], [Clarke], [Boericke].
  • Larynx and trachea—spasmodic, choking cough, voice failing to a whisper; cough paroxysm ends in cyanosis and prostration (see Throat/Chest) [Hering], [Allen].
  • Peripheral circulation—cold, blue extremities, mottled skin, cold sweat; venous stasis (see Skin/Extremities) [Clarke], [Boger].
  • New-born/infant sphere—asphyxia neonatorum, spasm of glottis, “blue children” of cardiac lesions; whooping-cough with failing breath (see Respiration/Chest) [Hering], [Clarke], [Farrington].
  • Lungs—pulmonary œdema tendency; rattling, threatened suffocation with weak heart (see Chest/Respiration) [Hughes], [Boericke].
  • Brain—stupefaction from hypoxia; slow perception; fainting fits; convulsions in poisoning (see Mind/Head) [Allen], [Hering].
  • Digestive tract—sudden sinking at epigastrium; vomiting with asphyxial attacks; swallowing cold drinks aggravates (see Stomach/Abdomen) [Clarke], [Boger].
  • Uterine/parturient—cardiac–respiratory syncope in puerperal states; faintness with cold sweat (see Female/Generalities) [Clarke], [Farrington].
  • Reflex arcs—overshoot to slight stimulus (noise, handling) precipitating breath–heart failure (see Generalities/Modalities) [Hering], [Boger].

• Being fanned; cool fresh air to the face though body seeks warmth [Clarke], [Boericke].
• Sitting propped up, head forward; cannot lie flat [Hering], [Clarke].
• Absolute rest, silence; avoidance of questioning/handling [Hering].
• Warm wraps to body and chest while face is kept cool—a useful polarity [Clarke].
• Gentle rubbing of præcordium/back during faintness; steadying touch (clinical) [Clarke], [Farrington].
• Small sips of warm drinks during cough spasm; cold drinks aggravate [Clarke].
• After sweat breaks, when pulse fills slightly [Allen].
• Open window at night; the child breathes easier [Boericke].
• Between paroxysms; deepening quiet lengthens intervals [Hering].
• After eructations or slight vomiting, when oppression eases a little (observed) [Clarke].
• Gentle pressure with the hand over sternum (neural reflex soothing) [Boger].
• Company that is calm, not fussy; reassurance steadies respiration (clinical) [Clarke].

• Lying down, especially on the back; on falling asleep the breathing stops [Hering], [Allen].
• Night, after midnight; long asphyxial spells [Clarke].
• Warm, close rooms; stale air; crowding [Clarke], [Boericke].
• Cold drinks, ices; swallowing cold water renews glottic spasm [Clarke], [Boger].
• Exertion, rising up suddenly, speaking, crying—breath fails [Hering], [Clarke].
• Handling, examination, sudden noise; reflex arrest of breath [Hering].
• Suppression of cough or eruption; breath-threat follows inwardness [Hering], [Boger].
• Damp chill, fog; approaching storm; thoracic oppression [Boger].
• Nursing (infants): nipple in mouth triggers choking and blue spell [Hering], [Clarke].
• Emotions: fright, grief; startle pauses the breath/pulse [Clarke], [Allen].
• Tight clothing about neck or chest; constriction intolerable [Boericke].
• After stool or urination—a faint sinking swoop (vagal) [Clarke].

Aetiology / Collapse–asphyxia

• Hydrocyanic acid: fulminant convulsion, instant cardiac–respiratory paralysis; fewer cough/aphonia signs; more glottic and infantile; both cyanotic [Allen], [Clarke].
• Carbo-veg.: collapse, wants to be fanned, belching, flatulence; less glottic spasm; more worse lying with aphonia and cold drinks aggravation [Clarke], [Boericke].
• Camphora: icy collapse with spasms but not the cough–glottic picture; anchored in the chest and larynx [Allen].

Chest failure / œdema / rattling

• Antimonium tart.: loud rattling, drowsy, wants to be carried; cyanotic; drier, weaker pulse, glottic closure; worse cold drinks [Hering], [Farrington].
• Ammonium carb.: cyanosis, cannot breathe in warm rooms; lividity, nosebleed; needs fanning yet warmth to body; glottic spasm prominent [Clarke].
• : spasmodic cough with nausea, much mucus, clean tongue; cyanosis less profound; Laurocer. aphonic, faint, small pulse [Farrington].

Whooping-cough—blue finish

• Cuprum: violent spasms, convulsions, thumbs in palm, cramps; weaker pulse, more silent pause, aphonia [Hering].
• Sambucus: night suffocation of children with dry spasm; less cyanosis; more collapse and need of fanning [Boericke].
• Drosera: incessant paroxysms, retching; not the asphyxial syncope of Laurocer. [Clarke].

Cardiac failure / small pulse

• Digitalis: slow, intermittent pulse, fear to move lest heart stop; less glottic spasm; cyanosis with arrested breathing [Clarke], [Boger].
• Cactus: iron band constriction, venous stasis; pains prominent; more aphonia, asphyxial spells [Farrington].
• Naja: cardiac pains with throat moral depression; less collapse; more blue, small pulse [Clarke].

Sleep–respiration arrest

• Opium: stertorous, congested stupor; insensibility, contracted pupils; wakeful fear, stopping breath on falling asleep with small pulse [Allen], [Clarke].
• Lachesis: worse after sleep, left-sided, talkative; silent, blue, wants fanning (polarity) [Kent].

• Complementary: Digitalis—both small, failing pulse; Digitalis for persistent myocardial weakness after Laurocer. has lifted the asphyxial spells [Clarke], [Boger].
• Complementary: Antimonium tart.—when pulmonary œdema/rattling follows Laurocer.’s glottic spells; sequence often needed in threatened suffocation [Hering], [Farrington].
• Complementary: Carbo-veg.—shared collapse and need of air; Carbo-veg. in flatulent, venous stagnation states beyond Laurocer.’s reach [Clarke].
• Follows well: Ipecac.—after mucus/nausea phase, if blue finish with small pulse remains [Farrington].
• Follows well: Aconite—when panic subsides to cyanotic failure with sighing respiration [Clarke].
• Precedes well: Hydrocy-ac.—if convulsive apnœa persists despite relief of glottic spasm; escalate to more fulminant picture [Allen].
• Related: Am-c., Cupr., Samb., Drosera, Opium, Camph., Naja, Cactus—see differentials.
• Antidotes (states): Fresh air, fanning, warm wraps; medicinally Camph. in chill-collapse; Carbo-veg. when venous stasis predominates [Clarke], [Allen].
• Inimicals: None recorded; avoid alternation without new totality [Kent].

The essence of Laurocerasus is asphyxial collapse with cyanosis and cardio-respiratory failure of a quiet, almost silent sort. The organism is choked off: respiration sighs, slows, or ceases, glottis locks, the voice fails, the face turns blue, the pulse is small, weak, intermittent, and a cold, clammy sweat breaks out. The patient cannot lie—on falling asleep the breathing stops—and begs for fanning and fresh air to the face, while the body desires warmth. This polarity—cool air to the face, warmth to the trunk—and the extreme sensory economy (handling, questions, cold drinks, the act of swallowing, a startle) that arrest breath reveal a remedy belonging to the Hydrocyanic stream [Hering], [Clarke], [Hughes]. The axis runs Vagus–Heart–Larynx. The vagal brake is over-pulled: slightest stimulus slows or stops action; hence the sinking at epigastrium, the pulse that disappears, the glottis that snaps shut. The venous cast—blue lips, blue fingers, mottled skin—shows blood unsatisfied with air; yet there is not the windy flatulent distress of Carbo-veg., nor the explosive convulsion of Hydrocy-ac.; the Laurocer. crisis is short of breath, short of voice, short of pulse, and short of noise.

Miasmatically, the picture is acute–syphilitic—threatening life by loss of function, not by fever. Pace is nocturnal, paroxysmal; the whooping-cough child becomes blue at the end of the fit; the infant at the nipple turns dusky; the puerperal woman fades with cold sweat; the cardiac sufferer cannot lie for fear the heart will stop. The modalities clinch: worse lying, worse on dropping asleep, worse cold drinks, worse exertion and emotion, worse in warm, close rooms; better being fanned, open window, propped sitting, warm coverings, quiet—and a little improvement when sweat breaks. Micro-comparisons steady prescribing: Antimonium tart. when chest is rattling and expectoration must be raised; Carbo-veg. when venous stagnation and flatulence demand fanning without the laryngeal lock; Hydrocy-ac. for instant respiratory paralysis and convulsions; Ammonium carb. when cyanosis marries intolerance of warm rooms; Opium when breath stops in heavy stupor with stertor rather than in light, watched sleep; Cuprum when spasms and cramps dominate the blue finish. In management, the physician reproduces the ameliorations: air, fanning, quiet, propping, warm wraps, and warm sips—and selects Laurocer. where voice fails, glottis shuts, small pulse trembles, and the very idea of lying down threatens the breath. Cure declares itself when sleep becomes safe, the blue gives way to pallor then warmth, the pulse is felt, and the child can nurse without choking.

• Whooping-cough with “blue finish”—paroxysm ends in aphonia, blue face, small pulse, must be fanned; Laurocer. 6C–30C in short intervals, lengthen as spells lessen [Hering], [Farrington], [Clarke].
• Asphyxia neonatorum / spasm of glottis in infants—dusky baby, gasps, breathing stops on dropping asleep; propped position, fresh air + Laurocer.; follow with Ant-t. if rattling ensues [Hering], [Boericke].
• Cardiac failure facies—cannot lie, blue lips, cold sweat, pulse imperceptible; Laurocer. with Digitalis support as indicated; maintain quiet, warm wraps, fanning [Clarke], [Boger].
• Dysphagia for cold water—cold drinks bring on choking with blue lips in laryngeal-nervous subjects; a small keynote that often decides [Clarke], [Boger].

Mind
• Anxiety—fear of suffocation; begs for air; yet sinks into stupor—choose when cyanosis and small pulse co-exist. [Hering], [Clarke].
• Ailments from fright/startle—breath checked; reflex apnœa. [Hering].
• Aversion to being questioned/handled—handling worsens breath. [Hering].
• Indifference/torpor during danger—hypoxic stupor; deceptive calm. [Allen], [Clarke].
• Better—quiet, fresh air, being fanned—indispensable prescribing cue. [Clarke], [Boericke].
• Despair alternating apathy in paroxysms—course of crises. [Clarke].

Head / Face
• Face—cyanosis, lips blue; cold sweat on forehead—collapse picture. [Allen], [Clarke].
• Vertigo—on rising; blackness before eyes; better sitting up. [Allen].
• Head—venous congestion; dusky; not throbbing—venous cast guides away from Acon. [Clarke].
• Jaw slack; aphonia during spells—glottic–laryngeal tie-in. [Hering].
• Nose/alar—winging, alæ blue—air hunger sign. [Hering], [Clarke].
• Ears cold/blue; noise startles → breath arrest—avoid stimulus. [Clarke], [Hering].

Throat / Larynx / Respiration
• Glottis—spasm; cannot breathe; especially after cold drinks. Keynote. [Clarke], [Boger].
• Aphonia during cough paroxysms; voice fails to whisper. [Hering], [Allen].
• Respiration arrests on falling asleep; must be roused/fanned. Signature. [Hering], [Allen].
• Dyspnœa—worse lying, worse warm room; better open window. [Clarke], [Boericke].
• Sighing, gasping, retarded respirations—vagal brake pattern. [Clarke].
• Whooping-cough—blue finish, small pulse. [Hering], [Farrington].

Chest / Heart
• Cannot lie down—suffocation on recumbency. [Hering], [Clarke].
• Pulse intermittent, imperceptible, weak; impending syncope. [Clarke], [Boericke].
• Oppression—weight on chest; better being fanned/pressure. [Clarke], [Boger].
• Cardiac failure with cyanosis—pallor → lividity; cold sweat. [Clarke].
• Tight clothing aggravates chest—remove constriction. [Boericke].
• Exertion/speaking arrests breath; jarring renews oppression. [Hering], [Clarke].

Sleep
• Breathing stops on dropping asleep—must be watched. Cardinal. [Hering], [Allen].
• Cannot sleep lying; must be propped. [Clarke].
• Night aggravation (after midnight); long spells. [Clarke].
• Dreams of suffocation/drowning; wakes gasping. [Clarke].
• Somnolence with stupor in collapse—danger sign. [Allen].
• Better—window open; fanning continued through sleep. [Boericke].

Generalities / Modalities
• Worse—lying, after midnight, handling, emotion, cold drinks, warm close rooms, exertion. Modality cluster. [Hering], [Clarke], [Boger].
• Better—being fanned, fresh air, sitting propped, warm wraps, quiet. Prescribing cluster. [Clarke], [Boericke].
• Cold, clammy sweat with faintness—collapse stamp. [Allen], [Clarke].
• Sinking at epigastrium—vagal sign in faints. [Clarke].
• Cyanosis of extremities; nails blue—venous stasis rubric. [Clarke].
• Reflex apnœa from swallowing cold water—small deciding keynote. [Boger].

Infant / Puerperal
• Asphyxia neonatorum; gasps; must be fanned; blue. [Hering], [Clarke].
• Spasm of glottis—nipple in mouth triggers choking. [Hering].
• Puerperal syncope—blue lips, cold sweat; propped posture. [Clarke], [Farrington].
• Whooping-cough of infants—blue finish, aphonia. [Hering].
• Cannot bear warm, close nursery—open window essential. [Boericke].
• Better—warm body, cool face air—polarity guiding. [Clarke].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): toxicology/clinical—cyanosis, arrested respiration on sleep, aphonia, small pulse.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): confirmations—whooping-cough blue finish, glottic spasm, infant/puerperal collapse; modalities.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): full portrait—laurel-water pharmacology, fanning/open-air amelioration, cold drinks aggravation, heart–lung failure.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): cyanogenic chemistry of Laurocerasus; respiratory–cardiac toxicology; clinical analogies.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—collapse, cyanosis, whooping-cough spells, better air/fanning, worse lying.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): generalities—reflex arrest, cold drinks aggravate, quiet/pressure/fanning ameliorations; comparisons.
Farrington, E. A. — Clinical Materia Medica (1890): respiratory–cardiac remedies—Hydrocy-ac., Ant-t., Carbo-veg.; infant and puerperal indications.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): philosophical differentials—Opium vs. Laurocer. (sleep–breath arrest), Am-c., Carbo-veg. collapse.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): collapse therapeutics; remedy sequencing around asphyxial states.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): whooping-cough and suffocative catarrhs; bedside regimen (air, posture).
Lippe, A. von — Keynotes and Characteristics with Comparisons (late 19th c.): selecting signs—blue face, imperceptible pulse, better fanning.
Tyler, M. L. — Homœopathic Drug Pictures (20th c.): clinical vignettes—blue babies, glottic spasm, the “cool face, warm body” polarity.