12 H2O) is employed under the name of alumen and more rarely aluminium metallicum. The effects of alumina and alumen are so similar that we will discuss the simpler and better proven Al2O3, and mention the peculiarities of alumen only incidentally. The trivalent element Al is an earthy metal and stands at the transition from the earthy alkalies to the heavy metals. APPEARANCE AND SIGNIFICANCE IN PLANTS AND ANIMALS Aluminium in the form of complex silicates forms over 7 Percent of the earth’s crust. In clay and loamy soils it is even more abundant. Many plants take it from the soil. The lower plants as mosses (lycopodium) and ferns are richest in aluminium. The hygrophytes with considerable water exchange contain more aluminium than the xerophytes in which the water maintenance and transpiration is difficult. According to Stoklasa aluminium wanders through the membrane and prevents the exit of biogenic elements employed.
Of Group III of the periodic system only boron and aluminium have medicinal significance. Both are lithophilic elements. Both are positive trivalent.
Group III cannot be designated as the earthy metal group because the initial member, boron, has essentially non-metallic properties. As happens so often the lightest element of the group takes an exceptional position chemically. The great gap which seems to exist between the elements boron and aluminium becomes smaller when one considers the similar behavior of some of their compounds. And in the effects which their oxygen compounds unfold in conjunction with the living organism, the group relationship becomes still more distinct. However the boron compounds are much milder compounds than the aluminium compounds. Likewise the protein precipitation by aluminium is even less reversible than that of boron. This relationship is evident to some extent in the familiar local uses of boric acid and the acetate of aluminium. As an antiseptic boric acid and is even milder than the solution of the always weaker aluminium acetate. In the double sulphate salts, alum, aluminium has distinct general astringent actions on the tissues. Likewise the total action of boron compounds (as borax) is essentially milder than those of aluminium (for example, aluminium oxide), but the similarity of their trends of action is unmistakable.
The aluminium preparation which comes chiefly under consideration for us is aluminium oxide, Al2O3, which is designated in the materia medica as alumina. However alum, the double sulphate salt of potassium and aluminium (KAl(So4)2 + 12 H2O) is employed under the name of alumen and more rarely aluminium metallicum. The effects of alumina and alumen are so similar that we will discuss the simpler and better proven Al2O3, and mention the peculiarities of alumen only incidentally.
The trivalent element Al is an earthy metal and stands at the transition from the earthy alkalies to the heavy metals.
APPEARANCE AND SIGNIFICANCE IN PLANTS AND ANIMALS
Aluminium in the form of complex silicates forms over 7 Percent of the earth’s crust. In clay and loamy soils it is even more abundant. Many plants take it from the soil. The lower plants as mosses (lycopodium) and ferns are richest in aluminium. The hygrophytes with considerable water exchange contain more aluminium than the xerophytes in which the water maintenance and transpiration is difficult. According to Stoklasa aluminium wanders through the membrane and prevents the exit of biogenic elements from the cell. Thereby the cells cannot be plasmolysed. Aluminium in the plant cell membrane increases the swelling of the cellulose very markedly, the intake of water makes easy and limits or prevents the incorporation of metals as iron and manganese, perhaps, also calcium and potassium. In the plant aluminium is also an important regulator of membrane permeability for water and ions. In the animal body it is present in large amounts only in the lower forms, such a smedusa, otherwise only in traces. Since it is ingested with the plant foods, this speaks against the absorption of aluminium from the intestine. Actually resorption effects of aluminium from the intact intestinal wall are denied. The toxic actions described of the salts are provoked either by intravenous injection or are local in nature. Aluminium coagulates protein, but the precipitation under some conditions is reversible. Thus water plants whose protoplasm is coagulated by aluminium can grow again when they are placed in their original medium.
With this property is associated the employment of aluminium as a mild corrosive, astringent and mild antiseptic, which is generally known and commonly used. One need only think of aluminium acetate, Liqu. alumin. acetat. Apart from the protein precipitation, for the stronger corrosive action of burnt alum (in which the water of crystallization is driven out by heat) its hydroscopic effect comes into consideration. In the school in any case alum is employed in a weak solution in diarrhoea, and here just as on other mucous membrane catarrhs by virtue of a direct local action. Moreover aluminium is also present in the related Neutralon employed in acid dyspepsias. Even in his Apothecaries Lexicon Hahnemann mentioned that alum earth seems to be a suitable remedy in the gastric weakness provoked by acids and in diarrhoea due to relaxation of the alimentary tract. Moreover in small doses alum produces gastric irritation and vomiting, larger amounts leading to fatal gastro-enteritis.
INTOXICATIONS AND ANIMAL INVESTIGATION
In a case of poisoning Ricquet observed severe difficulty in swallowing, tormenting thirst, vomiting of blood, and constipation; moreover twitching of the muscles, spasms, anxiety, finally accelerated and irregular pulse, rapid respiration, repeated attacks of fainting, collapse type of temperature and finally death. In addition to these manifestations, Kramolik saw albuminuria, hematuria, and casts.
P. Siem first studied the actions of aluminium by injecting double aluminium salts in frogs and mammals, thereby avoiding the gastro-intestinal canal. After injection of sodium-aluminium lactate in frogs (lethal dose 0.02-0.03) he observed at first severe restlessness and then hour-long rest in a normal position; thereafter the movements be came uncertain and lethargic, the animal lay flat on the abdomen, reflex irritability was diminished and finally fell to zero. Then paralysis of respiration appeared and finally cardiac standstill in diastole. Nerves and muscles still react after death. Siem injected the citrate and tartrates of sodium-aluminium in small continuous doses (lethal dose about 0.15 pro. kg.) of about 0.25-0.3 Al2O3 into dogs, cats and rabbits. During a trial continued for a week nothing is noted at first; after 344 days loss of appetite, constipation, decrease in weight, lassitude, inertia, and vomiting appeared. The apathy continually increased; trembling and convulsive twitching appeared: the animal was almost completely devoid of sensation. The tongue could not be moved and there was a flow of saliva. The temperature was very low. The death occurred at times with special phenomena, at times with clonic spasms consequent to respiratory disturbances. Autopsy shows: hyperemia of the gastric and intestinal mucosa with single small ulcers, the large intestine is normal; the liver shows fatty degeneration; there is parenchymatous swelling in the kidney.
Of particular interest for us is that Siem believed he saw the picture of a chronic bulbar paralysis in the symptoms. Outside of the influence on the columns of the spinal cord and the medulla, in respect to the homoeopathic drug picture there is the delayed appearance of the action (in spite of massive doses) and also the constipation. The symptom of flow of saliva perhaps is to be considered as the secondary result of a paralysis of the tongue.
The results of Dollken differ from those of Siem in some respects, above all in that he found smaller doses fatal, rabbits dying suddenly 12-25 days after single doses of 0.015 g. pro. kg. aluminium-sodium tartrate. Again worthy of note is the long delay of stimulus. In injections of 5mg. pro. kg. subcutaneously there was a loss of weight after 6-8 days and after 14-35 days death without particular manifestations. In cats after subcutaneous injections of 2-5 mg. Al2O2 pro. kg. twice daily Dollken saw: after some days decrease of weight, loss of appetite, soon also decreased movements of the tongue and dragging of the posterior extremities; if they were again injected then depression, salivation, stiffiness of the extremities appeared, then twitching in these and pendulum movements of posterior half of the body; the tongue was always hardly moved, there was huskiness, increasing dullness and clonic spasms. Later the irritation phenomena ceased, the animal showed spastic paralysis and fibrillary twitching so that spontaneous progression was impossible. From the beginning there was constipation as a rule, the stools contained mucus or blood. With increasing intoxication sensitivity diminished, the anterior musculature showed tonic or clonic spasms, the posterior were paralyzed. 2-3 days before death the blood pressure is very low, the vagi hardly can be stimulated. Death may occur in convulsions or may be gradual. Dogs react like cats. The microscopic investigation of the central nervous system is reported by Dollken: constantly a turbidity of the pia over the convexity of the brain, often venous hyperemia of the brain and spinal cord. Neither systematic degeneration of the cord nor any myelitic foci to any extent were found in any case. In the white substance of the brain no alterations, relatively little in that of the cord. In the spinal cord slight column degeneration at the decussation of the pyramidal tracts, in the cervical cord somewhat more marked degeneration in the lateral and posterior columns, in the thoracic cord only very little, in the lumbar cord marked degeneration of the posterior columns, particularly in those parts which lie in the medium aspects of the anterior root zone and corresponding to the column of Goll, the nerve roots of the V, VII, XII were more than half degenerated, IX, X, XI contained degenerated fibres; anterior and posterior roots of the cervical enlargement of the cord largely degenerated, bronchial plexues hardly at all; anterior and posterior roots of the lumbar enlargement in part markedly degenerated, ganglia cells are at times markedly degenerated, glassy, granular, destroyed and show nuclear degeneration.
Also deviating from the observation of Siem are the clonic spasms early in the intoxication, also after previous paretic symptoms. Moreover, reference many be made to the more exact description of the psychic depressions with increasing dullness: while Siem speaks only of apathy, Dollken saw psychic depression, then increasing stupefaction.
QUESTION OF LIABILITY TO DAMAGE HEALTH
In studies on healthy men with large amounts of aluminium salts given by mouth nothing essential is observed outside of a delay and hardening of the stool, as by Wibmer after taking a dram of alum in 2 days; in him a mild diarrhoea present was stopped and soon recurred after discontinuance of the alum. With the appearance of cooking utensils, soldier’s canteens, etc. made from metallic aluminium, the question of injury to health from aluminium salts which go into solution was studied. Plagge found no disturbances of sensation in two soldiers. Ohlmuller and Heise permitted 2 physicians of 26 and 35 years of age respectively to take 1 gram of aluminium tartrate from the 22nd of February to the 26th of March. In the two was noted a mild constipation which expressed itself less through a temporal change in the faecal evacuation than in its firmness. The manifestations diminished each time on the 3rd day after omitting the administration of the salt and did not reappear after the study was ended. Since tartaric acid has a purgative action, this manifestation was ascribed to aluminium by the authors. Other disturbances of nutrition and of general well being even from 30 grams of aluminium tartrate were not observed One sees that also in studies, with massive doses it also makes a difference who observes.
Recently the question of the harmful effects which aluminium cooking utensils could have on human beings has been subject to animated discussion. A universal injury to all men is indeed not asserted by those who know the action of chronic administration of aluminium from the homoeopathic materia medica and nothing is contributed to this question when one testing or another is negative. For this reason the positive proving reports are designated as the exceptional manifestation of an idiosyncrasy. The sensitivity of man for aluminium is certainly graded differently. There need not be exactly a hypersensitivity present if aluminium symptoms come into evidence. There are also factors in respect to the effective material, the duration, the physical and chemical forms, entirely apart from the quantity and the site of application.
When one sees that the homoeopathic symptomatology of alumina corresponds in a striking manner to the experimentally determined actions in animals, then they cannot pass over the conception that these (indeed temporally too early) results of proving on the healthy are due to the subdivided state of the investigated material.
Provings of alumina are found:
1. Hahnemann: Chr. Krkhten, II Aufl. Bd. 2, p. 33.
1. Wibmer: wirk. d. Arzneimittel u. Gifte, vol. I, p.114, 1832- 1842.
2. C. N. Hottenroth: Diss. Leipzig, 1838 (1-2 scruples).
3. Barthez: Recueil de Mem. de Chair. et de Pharm. mil. Bd, 38 p. 195 1835 (1/2-3 drachms).
4. Woodward: Med, Era, Jan.1885, and Journ. de lasoc. gall. de med. hom, Bd.3, H 6 (D 1).
5. Hering: Mat. Med, Bd. 1, 1873 (7 provers with 3 and 12 C dilution).
6. Hering: Neues Arch. f. hom. Heilk, Bd. 1, H. 1, 1846.
The trends of alumina go to the central nervous system, in connection with it, to the trophic supply of the skin and mucous membranes and moreover and furthermore to mucous membrane catarrhs.
Aluminium belongs to the electropositive elements even if the cation character is only weakly expressed in its compounds. The sensitivity towards cold and change of weather which we have associated with the positive change is also present in alumina, even if not so prominently as in the elements of the first and second groups of the periodic system. In particular dry cold weather, the transition from dry weather aggravate, damp at times is said to improve. Deficient personal warmth is expressed in the desire for warmth and warm clothing. There is a desire for open air. In the easy chilling still to be mentioned and the tendency to catarrhs of the mucous membranes we must think
of this manner of reaction.
A second general characteristic is its chronic, slow but deep action. We have already noticed in the animal experiments a striking delay in the response. From the chief action, namely, on the depression or interruption of the stimulus transmitting centers, this becomes comprehensible. Because such paralysis are seen (for example also in lead) particularly in the action with very chronic effects.
CENTRAL NERVOUS SYSTEM
The chief trend on the cerebrospinal nervous system can be summarized in the phrase, disturbances of coordination. The mental personality, in particular the sphere of intellectual ideas and judgment is disturbed or broken in its associative capacities and similar interruptions are characteristic in the reflex centers of the spinal cord and medulla.
The disturbance and confusion of the sphere of comprehension, the ability to form ideas and decisions is characterized through the restraint of imagination. On this basis arises the impulse for murder, for example, at the sight of a knife, of blood, etc. The consciousness of reality is disturbed, things seem unreal, indeed, the consciousness is finally confused concerning the identity of the patient’s own personality. “When he sees or states something, he has the feeling as though another person had said or seen it, or as through he was placed in another person and could see only then”. He is not entirely certain whether he is still himself. He cannot follow a chain of thoughts, cannot draw a conclusion, makes mistakes in speaking, in writing, uses words which he does not intend to say. He is forgetful, is indisposed for any occupation. In this confusion it is understandable that he fears that he will lose his mind. The patient is completely envloped by fears, unpleasant thoughts that something evil will befall him. By his mental state his disposition is weighed down and encoumbered. Only when his mental state is somewhat better and his mind is also improved, he will rest. All is dependent upon the tormenting depression and confusion of thoughts through impulsively developing ideas. The confusion and depression is worse mornings on awakening. This is understandable because the delayed realization of actuality on awakening is to some extent still in the field of normality.
The vertigo of alumina can indeed be psychogenic as it often accompanies the state described as well as conditioned through interrruption of the reflex paths. Objects rotate, he stumbles as if drunk, worse in early morning, on bending and walking. For the coordination vertigo the appearance of Romberg’s phenomena on closing the eyes and in the dark speaks correspondingly. Moreover vertigo appears in a proving (Schreter); vertigo as if the eyes were closed. Alumina is especially suitable for old fragile people with vertigo. In the vertigo stiffness of the neck is noted. It also states: drawing in the neck during sleep, the neck muscles draw the head back during sleep.
There follow a series of motor paretic symptoms: from a sensation of paralysis to actual weakness up to paralysis is reported of almost all the voluntary muscles, although in the provings only the early phases are apparent: difficulty in moving the arms, must take a slow tottering gait as after a severe illness, must make slow movements, all muscles as if paralyzed, paralysis of one side of the body, or of the lower extremity, difficulty in swallowing, paretic state of the esophagus, squeezing sensation down to the stomach on swallowing each bite, the material seems to steadily go down; paretic weakness of the larynx, loss of voice, huskiness, weak voice, a singer or reader can only use the voice a short time then it fails; with this occurs a peculiar tickling in the larynx; also the movement of the chest is weak, sensation of heaviness on the chest which is increased by talking; weakness and paralysis of the eyelids, eye muscle disturbances, double vision, squinting of both eyes, cloudy vision as if in a fog.
Still more often a paresis and weakness of the rectum and bladder occurs in alumina; there is a constipation on account of the inability to evacuate a stool of normal consistence. The rectum thereby may contain enormous accumulations. Likewise soft stools are evacuated with difficulty, and when they are passed there is the sensation as if some were still retained. This paretic state of the rectum appears particulalry in pregnant women who otherwise do not suffer particularly from constipation, moreover in very small children who must strain excessively even from a soft stool. But in the peristent constipation a very hard, lumpy stool may be present and by this the occurrence of fissures is favored.
The bladder weakness is very similar: on account of the inability to empty the bladder, micturition proceeds slowly, the urine flows slowly, the stream is interrupted when the patient stands, many times it is voided only in drops; likewise retention with involuntary dribbling ischuria paradoxica appears. Characteristic is the symptom: must go to stool in order to void.
A related symptom is the evacuation of prostatic fluid at stool. Furthermore weakness up to paralysis of the male sexual functions, decrease or loss of libido, importance, nocturnal seminal emissions and painful erections.
Let us now complete the picture from the side of the centripetal nerves. There are many paraesthesias: feeling of tension, a peculiar sensation on the face or on other uncovered areas as from dried egg or spider web (as borax!). These sensations are so disturning that the patient seeks to rub the part constantly. The extremities go to sleep on sitting or from light pressure; a numbness of the heels develops on standing, pain in the soles of the feet on stepping as if they were too soft and swollen, a band sensation on the body or about a part, the prover cannot hold objects (observed with alumen), sticking and burning in the back and a pain as through a hot iron had been pressed through the lowest vertebra, drawing and beating pains in the back like electric shoks through the body, contractions of the extremities, lancinating pains. All these symptoms are more or less common in the course of posterior columns degeneration in tabes. If one considers the disturbances in coordination and the motor paretic phenomena, it is not surprising that since v. Boenninghausen, alumina is held as the chief remedy in tabes. Naturally expectations should not be placed too high and it is not surprising if later authors saw no results in completely developed tabes. I saw a strikingly favorable result in undoubted tabes some years ago.
The cerebro-spinal stimulus conduction is retarded in alumina, the prick of a needle will be felt with delay, and all senses are reduced in this way; impressions reach consciousness only slowly and this proceeds up to a dullness and inertia of understanding. Here again the above described mental status is included.
A series of symptoms in the skin and mucous membranes from alumina can be perceived as trophic disturbances. It is well known that this appears usually with partial injuries of sensory nerves (not so much with smooth section). Whether or not one assumes special trophic nerve fibres in any case there is an irritation of the sensory paths as seems to occur in degenerations, usually combined with an impairment of power of resistance of the tissue, which leads to dystrophies particulalry in the skin. One thinks of the irritative phenomena of the posterior nerve roots in tabes dorsalis with tendency of the skin to become ulcerated with preceding cornification (mal perforant) or the thickening of the skin with malformation, hyperkeratosis, ulceration in syringomyelia. The slighter grade of lowered resistance of the skin of a neurogenic type expresses itself in defective elasticity of the skin, dryness, desquamation, vesicular formation, glassiness and brittleness of the nails, falling of hair. This type of nutritive disturbance of the skin, according to all appearances of a neurogenic type, is described in alumina. The senile alterations in the skin show a similar picture to this nutritional disturbance. Alumina adapts itself particularly for withered, emaciated, decrepit persons. The skin is dry, withered, of sluggish reaction, does not perspire, becomes hot and itches from too many coverings but does not sweat; the action of cold is much suppressed, moreover fissures appear readily, thickening, hardenings, vesicles and ulcers occur; especially observed are cracking and ulcerations on the tip of the nose; above all an itching, worse, from the warmth of bed is characteristic in that no eruption appears; the patient scratches until the part bleeds and then has relief. The same happens in pruritus senilis. The skin is dry, rough, wrinkled and itching. The hair and eyelashes become dry and fall out; the nails brittle and broken. The appearance of ulcers with a hard base is favored. Therein lumina has found use in chancroid and lupus.