The process which lies between the acute poisoning and the endstage of the chronic poisoning, is to be conceived in the proving on the healthy; from this intermediate domain we shall best gain the healing indications of the remedy.
PROVINGS
The provings of manganese salts are found:
1. Hahnemann: Reine A.M.L., and 2 Aufl., Chron. Krankh. (of mang. acet. and mang. mur.).
2. Lembke: Neue Ztschr. f. hom. Klin., Bd. II, p. 28, and Bd. III p.4 (of mang. mur. and mang. oxid.).
3. H. C. Allen: Amer. Hom. Observer, Bd. III, p. 345 (of kal. permangan. with such great doses that almost only acute mucous membrane symptoms of the mouth were observed).
DRUG PICTURE
As a point of departure for the picture of manganese one may take its similarity with iron; but at the other end stands to some extent the nervous system actions which are very decisive in the nervous system actions which are very decisive in the heavy metals foreign to the body (as with almost all), but which we need not discuss from what has been said above. The similarity to iron is revealed: anemia, pale face, great fatigue and sensation of weakness, general improvement by lying (but especially as with ferrum and holding for the cough), congestion to the head, restless anxiety (also better from lying still), many headaches (as if too large and heavy) which become better in the fresh air if they have occurred inside a room and better in a room when they have occurred in the open air.
ANEMIC SYNDROME
The disturbances of the menses belong here: the periods come too early and frequent, but are weak; likewise intermenstrual bleeding occurs. But amenorrhoea is also reported from kali permanganatum, moreover marked pains at the period, in spite of the fact that the remedy has not been proven on healthy women. But Stauffer considers it as proven in the dysmenorrhoea of the anemic. Both forms of menstrual disturbances are found in iron. Also the accompanying digestive disturbances are similar to iron, but without special significance in manganese. Pressure burning and sensation of heat in the stomach and in the abdomen and especially in the hypochondria, acrid eructations and nausea are the signs. The relief of the abdominal pains by pressure is occasionally mentioned in the provings and by Lembke; there is also aggravation of the pressure in the stomach from external pressure.
Likewise the trend toward the liver and the spleen is to be recalled as they show patchy inflammations in acute poisoning. Lewin mentions icterus in acute poisoning. A clinical proof for the hepatic and splenic maladies as well as in the hemopoietic system is not available at present.
RESPIRATORY PASSAGES
Also the tendency to persistent catarrhs in chlorosis with the tendency to transition into tuberculosis is again found in manganese. The symptoms in the upper air passages are expressed even more distinctly with manganese than with iron. Common with iron here is the characteristic modality that the cough is better on lying down. Dryness, roughness and constrictive sensation in the larynx, a deep cough without expectoration, on the other hand, easy expectoration in the morning without much coughing, expectoration of small yellow green clumps of mucous or bloody sputum; the catarrh is described in this way and the tendency to tuberculosis is very distinct. These catarrhs are aggravated when the weather becomes damp and cold. The severe mucous membrane alterations in the throat with oedema and ulceration in the local action of kali permangan have given occasion for the use of this remedy in diphtheria.
Besides the catarrhal symptoms which involve the throat and larynx, there is still another trend of action on the larynx, in manganese, that of innervation of the vocal cords. The weak and monotonous voice of chronic poisoning has been mentioned. Therefore the use of manganese is worthy of note not only for the catarrhal huskiness in professional speakers but also for the voice disturbances conditioned more by nervous factors. The lary- nx also seems to be a site of elective action for manganese and disturbances here, from nervous to tuberculous, come in the therapeutic field of manganese.
SENSE ORGANS AND NERVOUS SYSTEM
The frequently observed symptoms in the ear, sensation of occlusion and difficulty in heating, ear noises, pains which radiate from other parts of the body, especially from the throat on speaking and swallowing, obviously stand in association with the catarrhal symptoms and are mediated through the eustachian tube. The changes in the weather are of great influence here.
Pains also go from the teeth into the ears; the toothache becomes unbearable on contact with cold. Asthenopic complaints appear as signs of nervous exhaustion from singly directed efforts: the eyes pain from near work and from looking into a bright light.
A great sensitivity of the skin sensory organs is expressed in the symptom: pains in the most diverse parts of the body on touch as if they were sore.
All these nervous symptoms then pass over into many types of neu- ralgias of various parts of the body from altered sensation and numbness to twitching, tension, stiffness, weakness and trembling in the muscles and tendons, especially in the legs which obviously introduce the central disturbances of motion as early irritative symptoms to the central spastic paralytic manifestations of chronic manganese poisoning. The region of the knuckles and heels is an especially frequent site for the appearance of the pressing site.
RARE INDICATIONS
Added to the above trends of the iron-like picture of the blood injuries and the special tendency in manganese to definite involvement of the central nervous system are certain single assertions in the symptom registers which lie entirely outside of the sketch up to the present. These are the swellings over the tibia apparently inflammatory, sensitive to touch, which have been viewed as periostitis and erythema nodosa and swelling and pains in the joints with transversely changeable sites. Manganese has no other indications for the bone and joint inflammations. Itching and burning of the skin, unhealthiness and tendency to suppuration have also been cited as indications in old eczema and psoriasis but without any clinical confirmation giving the right for this.
Chief Trends:
Anemic syndrome and menstrual disturbances. Catarrh: cough better from lying down. Disturbances of voice. Kali permangan. in diphtheria. Neuralgias, paraesthesia, great sensitivity of the skin, central disturbances of movement (end stage-parkinsonian syndrome).
Modalities:
Worse on change to damp, cold weather. Better from lying down.
DOSE
The dose of manganum aceticum is still very uncertain. Pot. permanganate has been recommended in the lower potencies.
CHROMIUM The picture of chromic acid poisoning is so plastic and peculiar that one can scarcely forget it as the basis for the therapeutic indications. It is well known from many industrial poisonings (dyeing, electric chrome batteries, use of chromates in photogra- phy, chrome tanning) but also from unsuitable medical use (for corrosion, for suppression of foot sweats, in syphilis, and for the conservation of anatomic specimens). A very instructive case of chrome poisoning is cited by Riedlin. 612
PICTURE OF INTOXICATION
The severe picture of acute poisoning shows accord with the other acid poisonings. The yellow to red yellow discoloration of the skin and mucous membrane or the vomitus from local or resorptive action indicates a special type of poison. The vomitus may be blue or greenish from the abdomen, early collapse, cramps in the calves and cyanosis is the severest, usually fatal, cholera-like picture. Thereby ulcers are found particularly in the large intestine. With a somewhat longer course an acute nephritis with hemoglobinuria or urinary retention occurs. Fever and single cerebral symptoms 613 as well as glycosuria and polyuria are also observed. 614
More distinct lines of action and thereby better points of departure for therapeutic indications are yielded from the chron- ic acid poisoning. The chief trend appears on the mucous membrane of the naso-pharyngeal space and the gastro-intestinal canal and in the second line the action of the skin.
The peculiarity of the catarrhal manifestation especially in the naso-pharynx will be presented first in the homoeopathic drug picture. On the skin various eczematous papular, vesicular and pustular eruptions are observed. On the skin and mucous membranes the progressive effect leads to deep syphilis-like ulcers. One of the first signs is a painless perforation of the septum of the nose. One sees moreover that a great similarity with syphilis exists.
The chronic gastro-intestinal actions go from dyspeptic to gastro-enteric and finally to outspoken dysenteric manifestations A longer course occurs with anemia, cachexia and finally the manifestations of a chronic nephritis. Lewin once saw at autopsy of a kali bichromicum poisoning, a nutmeg liver.
KALI BICHROMICUM
The chromic acid preparation which is employed almost exclusively in homoeopathy is kali bichromicum, K2 [ (CrO3) (CrO4)]. The homoeopathic school possesses an extensive elaboration of the remedy from the Austrian school: Arneth, Physiologischen Prufung, of the double potassium chromate. 615 In it the oldest animal investigations of Gmelin 616 cited by Wibmer 617 are introduced, moreover the animal experiments and drug provings of Drysdale (Liverpool) which introduced kali bichromicum into the homoeopathic materia medicine in 1844. 618 Likewise the Austrian proves society didnot satisfy themselves with numerous provings on the healthy but added animal experiments to those available. Thus this basic work performed in 1847 even today is not surpassed and is standard for the basis of our drug picture of kali bichromicum.
Leeser, a Consultant Physician at the Stuttgart Homeopathic Hospital and a member of the German Central Society of Homeopathic Physicians, fled Germany in 1933 after being expelled by the German Medical Association. In England Otto Leeser joined the staff of the Royal London Homeopathic Hospital. He returned to Germany in the 1950s to run the Robert Bosch Homeopathic Hospital in Stuttgart, but died shortly after.
Otto Leeser wrote Textbook of Homeopathic Materia Medica, Leesers Lehrbuch der Homöopathie, Actionsand Medicinal use of Snake Venoms, Solanaceae, The Contribution of Homeopathy to the Development of Medicine, Homeopathy and chemotherapy, and many articles submitted to The British Homeopathic Journal,