Copper. (Cu.) Atomic weight 63. Triturations.
PATHOGENESIS.
UNDER the heading cuprum are included cuprum metallicum, cuprum aceticum, and cuprum sulphuricum, as there seems to be no material difference in their action and Hahnemann used indiscriminately in his provings and citations from authors.
The soluble salts precipitate proteins from solution, and are therefore astringent when applied to mucous membranes and raw surfaces; they have a harsh, astringent, metallic taste.
When swallowed in large quantities corrosion of the walls of the stomach and intestine occurs and give rise to violent vomiting and purging. The copper gives a blue or green colouring to the vomited matter and stools, and blood may appear in both. Violent pain is felt in the abdomen, the patient is collapsed with weak pulse and respiration, and cold, clammy perspiration, headache, giddiness and unconsciousness. There follow delirium, coma, convulsions and paralysis. Death may occur in a few hours, but is more usually delayed for several days, when the patient sinks from exhaustion. IN the case of a girl, aged 24 who swallowed two ounces of verdigris (acetate of copper) and died sixty hours afterwards, the post-mortem showed a yellow colour of the skin, the body was stiff, the mouth firmly closed, eyes half shut and nails blue. In the abdomen the omentum was inflamed, the bowels coloured green, distended with air, and in some places gangrenous; the stomach, especially towards the pylorus, was green and much inflamed, an there was gangrene the size of a half-crown in one spot near the pylorus. The intestines were filled with green excrement, and there were inflamed and gangrenous; this extended to the rectum. The liver, in its upper, thin border, was slightly inflamed. In the thoracic cavity the diaphragm near the oesophagus was inflamed: the lungs in their upper posterior part were inflamed and full of blood; the heart and large vessels were filled with clotted blood. In some fatal cases the membranes of the brain and cord were hyperaemic, but no organic lesion was discovered.
Copper is absorbed from the intestines and also passes into the blood from mucous surfaces and from wounds, it is lodged chiefly in the liver and to a less extent in the spleen kidneys and thyroid. It is excreted in the bile, urine, salvia, milk and the intestinal secretions. When copper is injected intravenously into mammals, locomotion becomes slow, clumsy and weak, and later, complete paralysis of spontaneous motion ensues. The heart and respiration gradually fail, respiration first. Violent, sometimes bloody, diarrhoea occurs, but no vomiting. The animals experimented upon lose flesh rapidly, their urine often contains albumin and occasionally haemoglobin and blood. Fatty degeneration of the liver, kidneys, and heart has been observed. Copper is a normal constituent of the blood in many invertebrata, and in these performs the same function that the haemoglobin of the blood dose in vertebrates. It has a very poisonous influence on algae, and some of the parasites of plant life.
The more detailed account gleaned from the provers of copper and brass foundries show that the alimentary and nervous systems are those pre-eminently affected by it, and we will consider first the symptoms referable to them.
Alimentary System.-The mouth is dry, hot and sore; the tongue is moist, pale, covered with a white, green or yellow fur, red, at the borders, swollen and stiff and may be paralysed. The gums are ulcerated and there is a purple or dark green line at the edges of them. Blisters are present in the mouth, which is filled with viscid saliva. Thirst is violent and unquenchable. The fauces are constricted. Spasms of the throat cause difficulty in swallowing. Nausea and loathing of food are conspicuous, but the patient desires acids. Eructations of metallic taste, hiccough, violent retching and vomiting occur. In the stomach, which is sensitive to touch, violent burning, tearing and cramping pains are felt and sometimes a contracted sensation. The abdomen is very sensitive to pressure, is distended and tympanitic, and violent burning, twisting colic is felt in any part but chiefly from the epigastrium to the navel. The pains are cutting or cramping and the abdominal walls are hard very sensitive. Accompanying the abdominal pains may be either constipation or diarrhoea, more usually the latter. The rectum is painful and there is frequent urging, the stools are green, liquid and perhaps bloody. The spasms of colic frequent intermittent. Constipation occurs mostly in chronic poisoning and is then obstinate but associated with tenesmus. Vomiting and colic are not due to any central lesion but to reflex irritation of the mucous membrane of the stomach and intestines.
Nervous system.-The head feels heavy, throbs, and is confused, and there is intense giddiness. Severe pains are felt mostly in the forehead. Confusion may go on to stupor and this to unconsciousness, coma and convulsions. The patient when conscious is depressed, restless, taciturn, fearful of what will happen, wants to do something desperate, is malicious and ill-humoured. Sometimes he indulges in incoherent prattling and silly behaviour. Convulsions of all sorts are pre-eminently an effect of copper, from twitching of small muscles or single muscles to violent spasms of the same and general convulsions. With the latter the thumbs are usually first affected, they are drawn into the palms, then the fingers close on them violently, the spasms increases and extends to the limbs, which are strongly contracted, the trunk muscles and muscles of respiration may be affected, trismus is common. Tonic contractions may give place to clonic, when the limbs are alternately forcibly flexed and extended. A less degree of clonic spasm is shown by jerkings and twitchings of the limbs or of individual muscles, and a minor degree of tonic contraction by cramps, which are very common, may occur anywhere but are most frequent in the calves, hands and feet. Convulsions, even when general, are not necessarily accompanied by unconsciousness and delirium, but these states are often present. A general convulsion is often ushered in with a shriek. It is followed by great prostration. The patient, especially if a child, as after a paroxysm of whooping-cough, may lie for a time as if dead. Weakness and exhaustion between the convulsions are very marked and there may be repeated fainting. In some of the workers in copper a genuine paralysis was noticed in the right forearm, which was in constant pronation with the hand bent at right angles to the arms, the thumbs drawn into the palms, the fingers flexed, extension of the hands and fingers was impossible and flexion only partial. The upper extremities, especially the right, were much emaciated, and the right hand was “nothing but skin and bone.” This is a picture resembling “amyotrophic” paralysis. No sign of organic mischief in the brain or cord has been found; notwithstanding the power of the drug to produce mental disorder and convulsive phenomena, only hyperaemia of those parts has been observed.
Chronic Effects.-One of the provers of cuprum, after he had otherwise recovered from the effects of the drug, had for a long time an intermittent tertian, with periodic diarrhoea. A number of apprentices in a watch manufactory, who were almost exclusively employed in filing copper, had acute colic, fever, burning thirst, vomiting, diarrhoea or obstinate constipation; their nutrition was impaired, their muscles badly developed and the aspect haggard. In other workers periodic toxic and febrile symptoms occurred, which resembled ague attacks and which went off in abundant but weakening perspirations.
The urine in some cases was suppressed, in others it was turbid, dark, and with a yellow sediment. Urination was sometimes difficult, occasionally involuntary.
The skin as a rule is bloodless, inelastic and dough-like. Jaundice occurred in some of the provers, and in some petechiae were found on the chest, abdomen and neck, and a rash on the hands and chest. Discrete raised, red spots the size of a sixpenny-piece and covered with small blisters are occasionally seen.
Face.-The face is red, or in some parts red and in others very pale. The expression is sad, anxious, wild, or expresses much pain. It is bluish or purplish during a convulsion, and is then covered with a cold, clammy sweat that it most observable on the forehead.
Eyes.-The eyes are deep-set and dull, fixed and glassy; the pupils are dilated, the lids red and swollen.
Epistaxis is frequent.
Respiration is accelerated, soft and laboured. Laryngeal and bronchial spasms cause dyspnoea, and there are occasional paroxysms of coughing. There are cramps in the chest and the voice is faint. A spasm occurs in the neighborhood of the xiphoid cartilage as of a severe constriction, or a pain as of a knife thrust through from the xiphoid to the vertebrae; the voice is weakened, cracked and squeaky, and the patient feels and looks as if about to die; this symptom appears to be due to a cramp in the diaphragm.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,