Most remedies which are used locally as astrigents yield proving symptoms of an inflammatory nature on the mucous membranes. This also is true of zinc on the conjunctiva, especially at the inner angle of the eye. Thereby it is assumed outside of the generalized local corrosive or astringent capacity on the conjunctiva that zinc produces a certain degree of diversion “from within” in this mucous membrane reaction.
The second trend of zinc effect on the vascular system, in particular on the venous system, is of much less importance than that on the venous system. H. Schulz ascribed a broad extent to this trend of action and explained the related and many other mucous membrane and organ actions in this way. Of more theoretic than practical interest here is the fact that the symptoms cited have a great similarity to those of mercury: amongst them are inflammation of the oral mucosa, salivation, bloody diarrhoea and nephritis. However all these actions are toxicologically established and only in the second or third line. If we did not have a much more directly effective remedy in mercury in stomatitis, dysentery and nephritis in the group chemically aderelated to zinc, then perhaps these indications of zinc would play a greater role with us. In the school of Rademacher this was actually the case with dysentery. thereby one ought not to forget that this involved large doses as was common in the practice of Rademacher.
As homoeopathic indications from the side of the venous system there are, though not outstandingly: cramps in the calves of the legs and in the external genitals (in particular after the use of pulsatilla). Also the earl appearance of frostbites or freezing of the peripheral parts, mentioned by H.Schulz, belongs here; again the tendency vessels; but bloody vomiting and blood in the stool is also cited.
Of the zinc preparations, zincum metallicum is used most often. Zincum valerianicum is preferred in neuralgias (particularly ovarian pains), and nervous insomnia. Zincum aceticum has retained the old Rademacher indications. Zincum oxydatum (not the most frequently used as Schulz believed) as zincum picricinicum and zincum phosphoricum, should be adapted more to the nervous sequella of sexual excesses. Zincum cyanatum is said to be suited especially to meningitis and other severe central nervous system diseases, zincum sulfuricum more in eye symptoms and, according to Loffer, to dysentery.
Trends of Action: Nervous System:
Great fatigue and weakness with excitation and motor unrest. especially in the legs. Insomnia. Trembling and twitching. Hydro- cephaloid and epileptic states. Irritative brain symptoms after suppressed exanthems or excretions.
Headache over the root of the nose, pressing inward. Neuralgias. Ovarian neuralgia, nervous dysmenorrhoea; paraesthesias, paresis weakness of sphincter. Backache on sitting (last thoracic or first lumbar) “spinal irritation.”
Nausea and vomiting, worse from movement, eating, and use of wine.
States of irritation and disturbance of micturition.
Varices, frostbites, tendency to bleeding.
Worse from use of wine; after eating.
Worse from suppressed eruptions, or secretions.
Worse from sitting, at rest, at night.
Better from appearance of secretions (for example, menses).
Zincum met. metallicum is usually prescribed in the lower and middle potencies (D 2-6), but in chronic central nervous system maladies has also proven itself in the D 30. The zinc salts are generally prescribed in the lower potencies, for example, zincum valerian, D 3.
Cadmium must be considered in conjunction with zinc because it stands at the transition of zinc to mercury Likewise as the sulphate or the carbonate cadmium almost always appears in common with zinc.
The first trial with cadmium sulphate (not cadmium sulphide as most homoeopathic encyclopedias report, which is the cadmium yellow CdS) was made by Burdach 669 in Finsterwalde: “When in complete health at 10 o’clock in the morning he took about 1/2 grain of this preparation which had a peculiar metallic taste. At 11:00 there developed a copious collection of saliva which had to be continuously expectorated, about 12:00 there was severe retching, which recurred every 2-5 minutes and much tenacious mucus was evacuated with great effort. This state continued until severe vomiting with retching appeared and recurred about 4:00 when severe pains were felt in the region of the stomach and umbilicus with an urge to defecate. The food eaten together with much sour mucus and bile was emptied by the vomiting. Outside of some lassitude nothing further occurred on that day since the nausea and other symptoms disappeared. On the following day Burdach had some pain in the throat muscles, probably the result of retching and efforts at vomiting.”
These symptoms from the oral ingestion appear exactly after copper or zinc sulphate, only the single dose of 0.03 gram is less than for the emetic action of zinc or copper sulphate (in which decigrams are necessary). Similar symptoms were noted in two non-fatal cases of poisoning with cadmium bromide which Wheeler 670 reported, only here the pulse was hardly palpable at times (with 0.25-1 gram).
TOXICOLOGY ———- Apart from phenomena varying from inflammation to ulceration of the gastro-intestinal canal in animals, vertigo, vomiting, diarrhoea, slowing of the pulse and respiration, loss of strength, loss of strength, loss of consciousness, spasms and death are observed. According to Marme in general the heart remains active longer than the respiration. 671 The same author reports about chronic poisoning from continuous small doses of cadmium in rats: disturbed digestion, emaciation, death; pathologic-anatomic findings are gastro-enteritis, at times subpleural ecchymosis and partial collapse of the lungs, frequent fatty degeneration of the liver and heart muscle and diffuse inflammation of the kidneys.
Schwartze and Alsberg 672 found cadmium chloride about 8-9 times as emetic as zinc sulphate in cats which should correspond approximately to the situation in man. But with the introduction in fluids the action is stronger than in concentrated solutions. In studies with chronic feeding in cats with doses which do not excite vomiting, outside of the anorexia, and emaciation, an epidemic of sneezing and coughing was observed, which did not cease until the cadmium was discontinued so that the cadmium must be considered as a predisposing factor for the disease. The storage of cadmium by the kidney, liver and spleen was demonstrated and it was found that cadmium is excreted in the urine.
In other long continued cadmium feeding experiments on growing rats 673 it was seen that food intake diminished with increasing doses of cadmium and the growth was affected in a corresponding way. Daily doses of about 1/2 mg. per day did not permit any cumulative effects to be observed. A double daily dose in males led to death within 50 days, in females much later (in one case not after 280 days).
Athanasiu and Langlois 674 made similar studies of chronic poisoning with cadmium in dogs. They also found digestive disturbances, emaciation, and finally death. Cadmium sulphate was about twice as toxic as zinc sulphate.
Severi 675 fed rabbits one large dose of cadmium salts. The animals showed hypersecretion of the mucous membranes of the upper respiratory passages and died after 5 and 11 days with severe nephritis.
Schwarz and Otto 676 found in cats after a longer introduction of smaller amounts of cadmium salts by mouth, apart from the emaciation, also a marked secretion from the upper respiratory mucous membrane and the conjuntiva. In the dead animals the gastric mucosa was usually reddened and swollen corresponding to the vomiting and diarrhoea of progressive poisoning. In single animals soon after the beginning of the study the hemoglobin fell as did the red cell count, the lymphocytes increased at the cost of the polymorphonuclears.
According to Koelsch, 677 Legge observed 3 cases of cadmium vapor poisoning in men with symptoms similar to those of zinc fever. Stevens 678 found considerable amounts of cadmium in the liver in chronic poisoning.
Cadmium sulphate was formerly employed in eye diseases, 679 in opacity of the cornea with still active chronic inflammation, in pterygium, 680 in conjunctival inflammations like zinc sulphate. In recent times cadmium has been used in place of mercury in syphilis, but usually in combination with salvarsan and bismuth, so that no sure decision on the value of the remedy is possible.
In homoeopathy only cadmium sulphate, CdSO4, is used. Apart from the first proving of Burdach with a single large dose, in homoeopathic literature there also exists a symptom report by Petroz. 681 If one adds the scanty provings to the results of animal investigation then the chief trend of action seems to be upon the gastro-intestinal canal and the mucous membrane of the gastro- intestinal canal and the mucous membrane of the upper respiratory passages, in particular the nose and the ocular conjunctiva.
Nausea and vomiting of acid, black and yellow masses (with blood or bile) with great exhaustion, cold sweat, anxiety, restlessness, trembling of the lower jaw (constriction of the pharynx), icy coldness and thirst, suggest an acute picture like arsenic particularly when diarrhoea is added. But while arsenic is indicated at the beginning of an acute febrile state, it is asserted that cadmium is suitable after the cessation of fever and indeed when the patient wishes to be left completely alone. As far as I know there is no suggestion of this in the symptoms of the provings. Cadmium has been recommended in yellow fever. In gastric carcinoma with constant vomiting cadmium sulphate has been recommended in yellow fever. In gastric carcinoma with constant vomiting cadmium sulphate has proven palliative. A peculiar symptom is the sensation of shuddering with gooseflesh after drinking cold water, for which a desire exists (similar as with capsicum). Sensation of chilliness even when near a fire is a further symptoms in this sense.
A second trend of cadmium sulfuricum on the nasal mucous membrane which is said to have found clinical confirmation is ozaena. In one or two cases personal prescriptions have yielded no convincing impression. The similarity with mercury is distinct here. The inflammation in the nose may go on to ulceration and caries of the bones with an odor like that of ulcer or cancer (compare aurum and kali bichromicum).
In chronic scrofulous inflammations of the nose and conjunctiva, cadmium perhaps deserves greater esteem but mercury is used much more commonly.
Moreover two cases of facial paresis have been reported cured by cadmium sulfuricum. However in these instances one may doubt the “propter hoc.” In this respect it is probable that a zinc-and mercury-like action could be worked out better in the future. In the proving are twitching, trembling and many paraesthesia (sensation of going to sleep in parts, formication and crawling, numb sensation of the nose) are noted.
Until further provings have given precision to the drug picture, one can make trials with cadmium sulfuricum in ozaena, finally also in scrofulous nose and eye inflammations, as a palliative in the constant vomiting of gastric carcinoma and will take the desire for lying entirely still and chilly sensation after drinking and even in the proximity to a fire into consideration as a guiding symptom.
Up to the present the middle potencies (D 4-D 6) have been employed mostly.
Mercury, hydrargyrum, Hg, is a chalkophilic element in the earth. Characterized by a strong affinity for sulphur, it appears predominantly as red cinnabar (HgS) in the earth and is contained from it by roasting.
BEHAVIOR IN THE ORGANISM
It is found in traces as a foreign substance in the organism. Here also its relation to sulphur is significant. Mercury once ingested is mobilized by sulphur (hydrogen sulphide and polysulphides) and excreted. This is well known from sulphur baths. More over it is probable that its chemical action on the protein compounds of the organism is effected through the sulphur containng group (cystin or gultathion).
The special toxicity of this inert, that is, not easily oxidized metal, is associated with the fact that it is liquid at ordinary temperature and volatilizes easily. Without special preparation it can, under ordinary conditions, also appear in reciprocal actions with the organism and therefore easily provoke acute poisoning. But thereby the state of division is decisive. Compact masses pass through the intestine without exerting other than a mechanical action; the more finely divided the metal, the more rapid and stronger its action on the organism, other conditions remaining equal.
For the trend and the intensity of actions of mercury the chemical form is important. Apart from the toxicity of the molecular vapor form, free mercury ions of the salts act most directly. The more dissociable the mercury compound is the stronger the acute action at the first site of contact. This can be determined by measuring the lethal action on bacteria by the various salts.
The rapid formation of mercury albuminate precipitates expresses itself as cell and tissue fixation. The immediate, disinfecting action depends on this. Sublimate, HgCl2, mercurius corrosivus kills cholera bacilli even in a dilution of 1:1,000,000 (D 6). But on the other side stimulating actions from smaller doses are known. The old investigations of H. Schulz for the support of the Arndt-Schuls rule report a stimulation of the fermentative capacity of yeast cells in a dilution of the sublimate at 1:800,000. The growth of micrococcus pyogenes will be promoted most markedly in a dilution of 10-6 682
If the dissociation of a mercury compound and the dependent diffusion velocity is important for the rapidity of action, then the duration of the effect will be influenced by the solubility of the compound given or formed. The relation of sodium chloride is particularly significant here. Angerer’s sublimate pastilles contain as addition of sodium chloride so that in the solution a double salt, HgCl4Na2, is formed. By this the transient protein precipitating and bactericidal action of the pure sublimate is reduced, but the solubility is maintained longer.
It is a fact of experience that mercury preparations have a more marked action on the sea coast and in sailors (Lewin). Perhaps this has its basis in the fact that mercury albuminate is soluble in an excess of protein and sodium chloride and circulates as mercury albuminate-sodium chloride. Through the excess of sodium chloride in the tissue fluids solubility is favored and thereby the action of mercury we must ascribe to its great tendency to the formation of complex compounds. In complex poorly soluble form it is taken up, as all heavy metals chiefly by the reticulo- endothelial tissues. Moreover the duration of stay and absorption in the organism is certainly decisive for the action at sites which are remote from the place of absorption and excretion.
SIGNIFICANCE OF FORM OF COMPOUND
This is important for the choice of the mercury preparation. Univalent mercurius compounds basically are not derived from a univalent mercury ion but probably a complex combination of divalent mercury salts with a mercurius atom itself, for example, Hg.HgCl2 = calomel, mercurius dulcis. The slight dissociation of the so-called mercurius compounds is associated with this. They have a less acute local action but a longer stay by virtue of which they can exert other types of action than the easily dissociable pure salts. For this reason a complex compound as mercurius solubis Hahnemanni, chiefly mercurius amido nitrate, NH2Hg2NO3, is in no way superfluous. Because of its admixture of free mercury this preparation stands very close to mercurius vivus
If even the solubility and absorption factors of mercury establishes a guide for mercury in the organism, then this is still more evident in the compound in which mercury is employed; thus HgI2 or Hg (CN)2 approaches the halogens in its easily dissociable halogen ion in respect to a special affinity for the throat. The organic complex compounds of mercury are prepared with the intent of lessening toxicity and they make possible a more prolonged stay then the inorganic compounds and thereby a more chronic but at the same time a different type of action of mercury; thus with novasurol and salyrgan the inflammatory irritant effect of mercury on the kidney and perhaps also on the tissues is weakened in favor of the diuresis. Formerly calomel was also employed in cardiac oedema.
Also especially distinct in mercury is the alteration of affinity of the site of attack, in the chronic action of small doses. As with all heavy metals the action of the central nervous system then comes to expression most strongly. The excretion into the cerebrospinal fluid is thereby determining.
MANNER OF ACTION
Whether and to what extent mercury is active in the organism in ionic form and how far as soluble complex compounds is still entirely unknown. But even if it came to action in the most active ion form, the dilution in the organism at which for example therapeutic actions are observed from the usual inunction therapy could not possibly be sufficient for disinfection, for the killing of spirochetes. Because this dilution is estimated at most as 1:1,000,000 (D 6), 683 which would be insufficient for disinfection even under the most favorable conditions of a watery solution. But in the simultaneous presence of other protein substances this cannot even be considered. Schade therefore considers that mercury acts as a catalysor or as an activator of a catalysor already present, perhaps of a ferment or with still less presumption, defense mechanism, then we obtain the conception which is now universal for all chemotherapeutic substances, namely, that the cooperation of the organism is indispensable for their antibacterial action. The increase of defense activity lies primarily in the reticulo-endothelial system in which all poisons like mercury are stored.
Now the use of the same defense system insufficiently explains the etiotrophy which must be assumed to have a certain degree of specificity between mercury and spirochetes. A non-specific action or an increased defense mechanism to the spirochetes must still be awakened by the mercury. It is certainly no accident that (similarly as with arsenic) as a catalysor mercury is able to excite the defense mechanisms exactly against those bacteria, which are especially susceptible to mercury ions in the test tube. One can explain this grade of specificity so that mercury, like an opsonin, prepares the spirochete catalytically for the attack, without destroying them by its own power. In any case mercury is a suitable intermediator between the defense mechanism of the reticulo-endothelial system (perhaps as lysins) and the spirochetes. Such catalytic intermediary reactions finally are also physico-chemical reactions, only on another plane. They also presume a physico-chemical affinity between the bacterium and the chemical poison. The property of a chemical substance to serve as such a intermediating catalysor cannot however br determined in the test tube, that is, under such infinitely simplified conditions for it also requires the conditions, the medium of the organism. To the further and more exact indications for the suitability of such materials also belongs the fact that they act on the same defense system and with the greatest possible similarity of defense phenomena-as signs of the defense mechanism-as the damaging bacteria. Presumptions from this angle lead to the simile rule. And indeed in lues and mercury with great distinctiveness. The similarity of mercury symptoms with those of lues, primarily on the skin, mucous membranes and the glands dependent upon them is notorious. But the same “way” also holds for scrofula and therefore mercury frequently comes into question here as a healing remedy.
Outside of the enrichment in definite tissues, particularly in the reticulo-endothelial system, the chief site of defense against the toxins of micro-organisms, the sites of excretion are essential for the course of mercury actions. All the sites mentioned can come into considerations for excretion. But which one will be preferred and which produce toxic manifestations after mercury enrichment, amongst other things depends on the preparation; thus calomel especially affects the biliary passages and the intestine, biniodide and cyanide of mercury, particularly the throat, the stormy sublimate very rapidly inflames the oral mucosa, the kidneys and the large intestine. In the more protractedly acting metallic mercury, as in inunction cures and in mixtures of metallic mercury with complex compounds, for example mercurius solublis, excretion in the saliva and sweat obtains significance. In mercurius praecipitatus ruber, HgO, the ocular mucous membrane are preferred and cinnabar, HgS, usually considered non-toxic because of its insolubility, in sufficient subdivision shows a special affinity for the eyes and their vicinity.
Another pace is set with mercury vapors, the molecular from of mercury, if it is frequently inhaled. It provokes chronic poisoning preferably in the nervous system. This depends probably on the entrance of firm organic mercury compounds which are eliminated with relative difficulty. For it is also known that many organic mercury compounds cause early disturbances in the nervous system, for example, the methyl and ethyl compounds.
In spite of the great improbability of a direct mass action of mercury on the spirochete still the usual mercury treatment of syphilis must be extended over months and years to obtain an extensive saturation of the body with mercury up to the threshold of intoxication. In actuality it is probable that the difference from a homoeopathic mercurial treatment with the lower potencies, as is common, is not very great. Because in an inunction treatment we do not know how much of the mercury rubbed into the skin and the fraction inhaled (daily about 1 gram Hg) actually gains absorption. Moreover it may be assumed that much of the absorbed mercury is stored in an inactive form. Finally the excretory situation of mercury through the urine, bile, faeces, saliva, sweat, under certain conditions also in the milk and seminal fluid, is so variable and unpredictable that the extremely irregular curve of excretion in the urine permits no conclusions on the amount of active mercury. These relations are just as uncertain with the injection of mercury, in which one also never knows when and how much of the inactive depot becomes active and because of this uncertainty Lewin has urgently warned against the creation of such depots. If the stimulation of the defense mechanism, perhaps antibody formation, and sensitizing the microorganism was the essential, then the choice of the most easily and perfectly absorbable preparation in the state remaining most active and sufficiently frequent repetition would be most advantageous.