The field of mercury effects which come under consideration chiefly as the image of the medicinal indications are not the hyperacute local corrosive action of ionized mercury salts, nor on the other side the chronic poisonings with preference for central nervous system involvement and ultimate cachexia as they are quite common to the poorly soluble manifestations perhaps as they are known in untoward actions in medical use and as the first manifestation of intoxication from absorbed mercury compounds; the inflammatory manifestations primarily on the mucous membranes, the skin and lymph glands, then in the periosteum, synovia and the serous membranes and finally on the kidney, particularly in the tubules with the picture of nephrosis. Only at a certain distance from here the chronic heavy metal action on the nervous system of mercury comes into the domian of indications.
MERCURY AND MERCURY COMPOUNDS
Provings of mercury preparations are found:
Of mercurius solublis:
1. Hahnemann: Reine Arzneimittellehre, 3 Aufl., Bd. 1, S. 348, 1830 (of mercurius solublis whose actions Hahnemann sets equal to those of pure triturated mercury. There is included a short proving of mercurius dulcis, mercurius corrosivus, furthermore reports taken from the literature on various mercury preparations).
2. Knorre: Allg. Hom. Zeit., 1835, Bd. VI, S.35 with mercurius solublis 1st trituration (eczema and glandular swelling) one prover.
3. Robinson: Brit. Journ. of Hom., vol. 24, 517 (short proving of 5th potency).
4. Andrieu: Journ. de la. Soc. Gall., VIII, 143 (short proving of mercurius solublis D 3).
5. C.Wesselhoeft: Trans. Amer. Inst. of Hom., 1886 and 1888 (with mercurius solublis in various potencies in 20 student provers which gave useless results).
Of mercurius corrosivus
1. Buchner: Allg. hom. Zeit., 1897, Bd. 135, S. 92 (7 provers).
2. Masselot: Archiv. gen de Medorrhinum, ser. IV, vol. XI, 58.
Of mercurius iodatus
Amer. Provers Union Monogr., 1866.
New Provings (After Allen’s Encyclopaedia, vol. 6, p. 269).
Of mercurius biiodatus
1. Andrieu: Jour. de la. Soc. Gall., Bd. VIII, S.140.
2. Robinson: Brit. Jour. of Hom., vol. 24, p.517.
3. Hering: Mat. med., vol. 1, 1873.
Of mercurius praecipitatus ruber Eiselt: Frank’s Mag.,Bd., 1.S.772.
1. Andrieu: Jour. de la Soc. Gall., 1856, vol. VIII, S. 143.
2. Neidhard: New Amer. Jour. of Hom., vol II, Append. Nov. 1852 (after Cyclopaed. of Drug. Path.1890, vol. 2).
For the rest unintentional intoxications with mercury compounds are so numerous that they afford a good basis for the drug picture. The intentional provings serve only for securing of finer details.
One can characterize a universal mercury picture as that which appears as the subacute poisoning with all, but particularly the inorganic mercury compounds. It corresponds in general to the medicinal domain of mercurius solublis or mercurius vivus. From this nucleus the details and characteristics of the single preparations can be best derived.
The somewhat inconstant mercury preparation mercurius solublis (obtained from mercurous nitrate by ammonia) is preferred in homoeopathy because Hahnemann’s provings were originally made with this compound. At first all mucous membranes can beset into inflammations of various stages by mercury; predominately and most frequently the mouth and throat and then the large intestinal mucous membrane are affected. This obviously depends on the enrichment in the excretion of the saliva and in the faeces. The secretions appear increased and altered under mercury.
MOUTH, NOSE, EYE, EAR
Stomatitis mercurialis can appear in all grades: Lewin differentiates a stomatitis simplex, ulcerosa and gangrenosa. The symptoms in detail are: the offensive salivation, foetor ex ore, gingivit- is with involvement down to the periosteum of the alveoli, the teeth become loose with nocturnal aggravation of the toothache, worse from cold and warmth; glandular swelling in the region of the mouth and throat especially the salivary glands; swollen tongue showing imprints of the teeth, thickly coated white tongue; marked thirst in spite of moist mouth, ulcerative processes from aphtha to deep purulent or dark blue-grey coated ulcers and abscesses. All manifestations of angina are frequent in mercury poisoning and are described exactly in the provings. After belladonna mercury is most frequently prescribed in sore throat. The similarity of mercury poisoning to pharyngeal diphtheria can be very close. 684 Similar inflammatory symptoms appear in the nose, eyes and ears. A tendency to suppuration always exists. In the coryza there is yellow green, thick or copious and acrid secretion, with much sneezing (worse from sunshine) and also here the periosteum may become involved with green offensive ulcers; caries as occurs in lues, naturally did not appear in the provings but arise from poisonings. The nose is also externally inflamed and swollen. Sensations in the region of the root of the nose refer to inflammation of the frontal sinus.
The inflamed eyes, blepharitis, and conjunctivitis with copious acrid secretion are very sensitive to light and flames (conjunctivitis of stokers!). For blenorrhoea mercurius praecipitatus ruber is preferred. Also keratitis, not only the parenchymatosa luetica, but also scrofulous and ulcerative forms tending to hypopyon, episcleritis and ulcerative forms tending to hypopyon, episcleritis are important indications for mercury. The nocturnal aggravation, in the warmth from the provings as cloudy vision and dark spots before the eyes are naturally unsuitable. The inflammation of the ears involves the external auditory passages and the middle ear. The earache is worse at night in bed, the secretions are again offensive, thick and yellow. Tubal catarrh with deafness may also require mercury.
A further elective trend is the large intestine. Leading here for the employment of mercury are: the dysenteric, bloody, mucous, or green acrid stools with marked tenesmus and the “never get done” sensation (no relief from stool) with nocturnal aggravation, chilliness, anxiety and nausea, and cutting pains; the acrid stools make the anus very sensitive and sore; noteworthy results can be obtained in oxyuris with mercurius solublis D 3. The white-grey stool which was also observed in the proving belongs to the disturbances of biliary secretion; together with icterus and enlarged sensitive liver they frequently indicate mercurius dulcis in inflammations of the bile passages and in duodenal catarrh.
The patient should not be able to lie upon the right side.
There are also a number of symptoms from other parts of the gastro-intestinal canal but they are not characteristic for mercury. The alterations of taste (salty, sweet, foul, metallic, slimy, dirty, tasteless) are associated with the processes in the mouth. Gastric manifestations may be associated with aphtha, foetorex ore, thirst with a moist mouth when mercury is indicated. Non-characteristic and therefore less used are the symptoms from the deeper respiratory passages. An exhausting, dry, nocturnal cough with stitches in the chest on sneezing or coughing may be mentioned.
URINARY AND SEXUAL ORGANS
On the other hand the inflammations of the urogenital system offer frequent indications. The nephrotic albuminuria (especially for mercurius corrosivus) has already been mentioned. The initially increased amount of urine with later diminution is a renal effect. Frequent urge to urinate, voiding of turbid urine with burning, cutting and sticking refers to the eystopyelitis, the greenish secretion from the urethra with inflammatory swelling of the urethral orifice and the glands to gonorrhoea, an important and proven indication. Correspondingly on the female organs the greenish and muco-purulent leucorrhoea with itching, burning, inflammation of the vagina and vulva find a healing remedy in mercury in cases of gonorrhoeal as well as other genesis. Als in adnexal diseases, not only of gonorrhoeal origin, are frequently suitable for mercury, particularly mercurius iodatus. The inflammatory manifestations on the external genitalia with vesicles and ulcers, bartholinitis, balanitis should also be mentioned here. To this may be added the repeatedly observed inflammation of the inguinal glands in the provings though they are less well known from the poisonings and observations of untoward actions. Hard and soft chancre, just as non-specific inflammations and buboes are homoeopathic indications for mercury. The participation of the lymph glands is always an important indication for mercury, also scrofula when, for example, the glands swell after each exposure to cold.
SKIN AND LYMPHATIC SYSTEM
Less observed in crude poisonings than in the untoward actions are the skin manifestations which according to Lewin can take on all forms from erythema and urticaria to Lewin can take on all forms from erythema and urticaria to eczema and severe dermatitis. That papular exanthems also appear is to be noted especially in respect to secondary lues. The skin manifestations of mercury are often associated with fever. The eczemas are most important as indications: “eczema mercuriale,” marked itching pu- stular eruption, small vesicles with turbid milky secretion, especially on the head with falling out of hair, and on the face, stinking yellow crusts, marked purulent secretion; painful deep, bloody fissures and cracks on the fingers, desquamation of skin around the finger nails. In general the skin and also the eruptions of mercury are moist or weeping, the eruption goes from vesicles to pustules, to small suppurative nodules; it is the picture of severe itching “fatty itch,” as it was formerly called. But dry itching eczema which burns after scratching also appears in the mercury picture; this itching is worse from the warmth of the bed.
Even early it was noted that mercury acted intensively on men with “succulent” skin (Lewin). Therein lymphatism comes to expression with its broad lymph spaces and sluggish lymph stream. Likewise mercury is said to be better adapted to light haired individuals. If one adds the glandular swellings with the tendency to suppuration, furthermore all manifestations as eczema which appears easily after chilling and cold baths, and, as Lewin also cites, that there is a sensitivity to cold and dampness, then the picture of scrofula is completed from this side. Also in the inflammation of the sebaceous glands, the inflammatory acne I have often found mercurius solublis of value. When mercury is employed in ulcers it is in those with offensive acrid suppuration and undermined borders, indications which other agents also have as marked or stronger.
In regard to the question of mercury excretion through the milk the report of the materia medica notes: poor milk the report of the materia medica notes: poor milk which the nursling refuses. A useful sign for mercury is pain and swelling in the breasts as signs of inflammation before suppuration. This first stage of inflammation of glandular tissue is, in general, the most suitable for the use of mercury.
JOINTS AND SYNOVIA
Mercury is also excreted through the sweat and increases and alters it as all secretions and excretions. The sweat of mercury is offensive, oily, clammy, increased at night and brings no relief in the disturbances of well being nor in the local inflammatory pains. These good indications from the sweat are utilizable most frequently in acute and subacute rheumatic fever. The joint affection in the picture of mercury is naturally a subordinate trend of action but in acute rheumatism which is also metastatic and mostly from a sore throat, it is one of the elective sites of mercurial action.
But a transition to the mucous membrane inflammation locally is also not rare in mercury. This we saw above in the mouth and nose inflammation. Periodontitis is one of the surest indications for mercurius solublis (D 6) when heat as well as cold aggravate and the pain is worse at night. The nocturnal aggravation is characteristic in all of the pains arising in the bones and therein lies another similarity to the luetic bone pains. Also in the headaches of mercury, which consist chiefly in tension, pressing together and sensation of a band, one may consider a participation of the periosteum or the Galea aponeurotica as a cause primarily on account of the nocturnal aggravation.
NERVOUS SYSTEM AND GENERAL SYMPTOMS
The actions on the nervous system are rarely observed in acute or subacute poisoning with mercury, but are peculiar to the chronic intoxication. Therapeutic indications are occasionally given by the so called mercurial erethisms. The chronic actions express themselves as follows: insomnia, psychic irritability, restlessness, anxiety, ill humor, anger, depression, disconsolateness; exaltation finally replaced by depression, weakening of memory, judgment and will power diminished, responses are slow, disturbances of movement vary from tremor, stuttering, trembling of the tongue, vertigo to forced movements with propulsion and finally to clonic convulsions, which are chorieform or epileptic. The similarity with mercury in this difficult malady. End actions of mercury poisoning, such as complete psychosis and blindness or hallucinations, with a picture that is similar to delirium tremens are just as little therapeutic indications as the cachexia mercurialis and the alterations of the blood and bone marrow. However exhaustion, emaciation, pale face are frequently accompanying manifestations. The report of Stock that a series of nervous complaints originated from amalgam fillings of the teeth cannot be accepted by the demonstration that urine. The improvement of well being after the removal of such fillings however is frequently observed. Finally neuralgias and circumscribed paraesthesias and anesthesias are known from poisonings and in respect to therapy the nocturnal aggravation with other indications may guide the choice to mercury.
Skin, mucous membranes.
Especially mouth and large intestine, then urinary passages.
Increase and alteration of all secretions.
Lymphatic system (glands); impending suppuration. Joint surfaces and periosteum.
Nervous system (erethism, chronic action).
Scrofula, eczema, acne.
Syphilis II, ulcus molle.
Mouth and nasal inflammation with involvement of periosteum (periodontitis).
Large intestine inflammations (dysentery).
Infections jaundice (especially mercurius dulcis).
Nephrosis (esp. mercurius corrosivus).
Metastatic joint inflammations: polyarthritis.
Adnexal diseases (esp. mercurius iodatus).
Lymphatism (light haired?).
Modalities and Leading Symptoms:
The nocturnal aggravation in the warmth of bed is the most general.
Neither cold nor heat is well tolerated, cold and damp weather and drafts often make the complaints acute.
The offensive, clammy sweat characteristically brings no relief.
The aggravation from fire and light refers to the eyes.
The aggravation from lying on the right side refers to the biliary passages (and perhaps to the dry cough with stitches in the chest).
Thirst with moist mouth and swollen thickly coated but moist tongue.
MOST COMMON PREPARATIONS ———————— Mercur. vivus = Hg.
Mercur. praec. ruber = HgO.
Mercurius dulcis = HgCl – calomel.
Mercur. corrosivus = HgCl2.
Mercur. iodat. flav = HgI.
Mercur. biiodat rub. = HgI2.
Mercur. cyant = Hg (CN)2.
Mercur. solub. Hahn = NH2 Hg2 NO3 + Hg + Hg2O (mercuroamidonitrate + Hg = mercurooxide).
Cinnabaris = HgS.
Mercurius corrosivus was preferred even by Hahnemann in severe dysentery (Spring dysentery). this preparation as well as the iodide (more frequently) is employed. Also in colitis and the participation of the peritoneum from the appendix or adnexa. Moreover mercurius corrosivus is the most marked renal preparation. The calcium infarct in sublimate poisoning is an anatomical end-product. Mercurius corrosivus is a most active preparation in which the inflammatory processes and ulceration extend rapidly and take on a phagedenic character.
Mercurius cyanatus is preferred particularly in diphtheria, in severe forms with great prostration and cyanosis. H. Schulz has dedicated a special monograph to this disease. But mercurius biiodatus also performs good service.
Mercurius iodatus and biiodatus increase the affinity of the mercury for the throat. Mercurius biiodatus is the more acute of the two; diphtheria, glandular swellings in sore throat with high fever are special clinical signs. Mercurius iodatus has subacute glandular swellings also post nasal catarrh; thick, dirty yellow coated base of the tongue. It has also proven useful in pelvic peritonitis.
Mercurius dulcis, the mildest preparation, is preferred for children. Duodenal and biliary affections are the chief trends.
Cinnabaris will be found useful in painful affections of the eye and in this region (orbit, sinusitis); pressure on the root of the nose; easily bleeding warts, condyloma about the genitalia and fiery red ulcers.
Mercurius solublis D 6 has proven valuable with me but in very acute inflammations the D 3 is better. The action of D 30 in the nervous affections remains uncertain. The other mercury salts in general are used in the lower and middle potencies, for example mercurius corrosivus in lues in D 3 -D 4.
Thallium discovered in 1861 spectroanalytically by Crookes has great kinship, chemically and pharmacologically, with lead, which immediately follows it in the periodic system. In its salts (the chloride, sulphate, nitrate, carbonate, and acetate) it appears chiefly univalent, although one should except from its relationship to the additional series IIIa, a preponderant trivalence. But the valences in the additional series are usually diverse and varying. Especially interesting would be a proving of the water soluble carbonate, Tl2 CO3, which has been little studied up to the present.
The similarity with lead shows itself first in the fact that thallium also causes a glandular degeneration of the red blood cells. 685 An eosinophilia and lymphocytosis has also been demonstrated in man. In dogs the manifestations of poisoning are: disturbances of coordination, trembling of the head, paralysis, disturbances of respiration, coma; furthermore especially rapid falling of hair, diarrhoea, lachrymation and albuminuria. 686 Curzi 687 reported increase of blood pressure in animals. The particularly noteworthy falling of hair was also observed in men, first as an unpleasant untoward action when thallium salts were employed in tuberculosis as an antihidrotic. Buschke has experimentally induced falling of hair in various animals with minimal scarcely demonstrable doses of thallium and also employed thallium salts for epilation in man by internal medication.
Since thallium-containing depilatories have been employed in large numbers, the reports of the untoward actions of thallium have increased. They agree with the actions which have been cited in the homoeopathic materia medica texts 688 of thallium and its salts. The older reports arise from Lamy: Gaz des Hop., 1863, p. 104 and Journ. de Chimie, 1863, vol. IX, p. 721, and Marme (according to Raue’s Ann. Records of Hom. Lit. 1870, p. 21).
One can present the gastro-intestinal syndrome first: nausea, vomiting, loss of appetite, abdominal pains with retraction of the abdomen, colic and diarrhoea, which soon passes into persistent constipation. Later disturbances appear in the nervous system: numb sensation in the feet, acroparaesthesia, reduced tactile sense but extraordinarily increased sensitivity to touch, especially of the lower extremities, painfulness of the muscles and joints, lancinating pains and weakness in the legs (depending upon multiple neuritis) trembling, incoordinated movement of a choreiform nature, visual disturbances from a retro-bulbar neuritis up to amaurosis, decrease in the psychic function up to dementia. To this may be added the vegetative-trophic disturbances complete falling of hair at the vertex; moreover conjunctivitis with marked secretion of mucus, blepharitis, acute suppurative dermatitis of the face and salivation. The night sweats of the tuberculous are said to be relieved.
Thallium poisoning leads to marked emaciation and general weakness finally also to cardiac, hepatic and renal degenerations.
The therapeutic use of thallium according to the simile rule is still unusual. It is said to have relieved the severe lancinating pains of tabes. A further testing of the action which resembles lead would be of great interest in view of the characteristic symptoms.
From the middle age analogy of lead to Saturn the designation of lead poisoning as saturnism still persists. Today the nature of lead and its position in the history of the material world has become significant in another respect. Lead is the inactive end- product of radio-active disintegration of uranium and thorium. The transformation of the elements by destruction of their nuclear structure filds a halting point in the ancient common heavy metal, lead.
In the course of regressive transformation of element with the highest ordinal numbers and atomic weights in lead for the first time one encounters the new problem of the riddle of “material element” which is only partly solved. It is shown that the chemi- cal identity of a substance as lead, which shows an identity in all respects to other substances, does not depend upon physical uniformity. Moreover that which always seems to appear as the same lead is a combination of various types of lead (up to the present 14 are known) which have their developmental histories according to structural and physical properties. Although possessing the same ordinal number, also determined in material relations by the same nuclear charge, they have various atomic weights. They are called isotopes, that is, belonging to the same place in the periodic system in spite of different atomic weights. The atomic weight of naturally appearing lead is the arithmetical mean of the atomic weight of these lead isotopes. All chemically pure lead still carries traces of its cosmic history in the composition of its isotopes.
Lead still possesses to some extent the physical forces out of which it arose or from whose point of departure it was; on the other side it also retains the inertia of a residue after the transformation of highest energies. When old physicians, particularly iatrochemists, employed lead preparations against cancer, perhaps there may have been some admixture of radioactive substances in the preparation of such lead. The insidious way in which lead leads to cachexia makes a comparison to cancer cachexia seem likely.
Later, perhaps a century ago, out of the obvious lead actions its drying, solidifying, contracting capacity were separated purely by assumption and it was recommended for states which seemed opposed to the normal by virtue of excessive secretion and dilatation The still current external use of lead water fomentations, ointments and plasters on discharging wounds and mucous membranes depends on the formation of a fine protein precipitate. For ages the internal use of lead preparations has been maintained, as a hemostatic, especially in pulmonary bleeding, but today as in general the internal use of lead has become completely abandoned.
With such extensive and common actions after absorption of lead at first it seems remarkable that so few experiences on its healing properties have been gained and retained. But it is comprehensible when one reflects how great a role the time factor has played in the appearance of the effects of the absorption of lead. Acute poisonings in lead are of slight significance. They require large amounts and then show almost only gastro-intestinal symptoms: salivation, bad taste, nausea, vomiting of masses of mucous, gastric cramps, and finally collapse with cold sweat, often Cheyne-Stokes breathing and convulsions.