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).
Worse on change to damp, cold weather. Better from lying down.
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.
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.
Moreover the therapeutic use for decades has shaped the selection among the many symptoms and evaluated them by the test of clinical use. (The probings with high potencies of Berridge 619 are not yet evaluated.)
The animal experiments cited in the Austrian journal of homoeopathy give us the best confirmation for the crude symptoms known from toxicology. Convulsions and paralysis have been observed repeatedly in the severe intoxications of animals.
In the industrial poisoning (according to Drysdale) that fat and light haired people are especially susceptible to kali bichromicum, which can serve as a constitutional sign. Likewise in these workers in chrome factories the modality of aggravation of many symptoms in hot weather was observed.
MUCOUS MEMBRANES: UPPER RESPIRATORY PASSAGES
Very distinctly developed, both from the intentional as well as accidental poisonings with kali bichromicum, is the chief trend on the mucous membranes of the upper respiratory passages. The tenacious stringy mucous is especially characteristic. The exuda- tes at times seem to be pseudo-membranous and even purulent- bloody discharges are observed. At first the nose is the chief point of attack. Even Arneth correctly stressed that one cannot arrive at an explanation of this affinity with the conception of a local action of chrome dust or vapors on the nasal mucous membrane, because the inflammatory manifestations also develop after the internal administration of the substance. The first stage is a coryza with considerable clear water and much sneezing a coryza which is said to be aggravated from cold air. Moreover the watery discharge also appeared in the proving in hot weather. (In this regard the catarrhal symptoms of the upper air passages with aggravation from hot weather, which is particularly characteristic for the gastro-intestinal symptoms, seem to be exception.)
The further course of the mucous membrane inflammation yields still better indications. Next come the most diverse sensations of dryness, tickling and burning in the nose, then pain and sensitivity of the nose, often nose bleed, outpouring of thick mucus, then, in the chronic industrial poisonings, tenacious, elastic, gummy plugs whose removal is painful. This refers to the lesion on the mucous membrane which is degenerating into the perforating ulcer of the septum. The perforation itself seems to progress fairly painlessly. SImilar circumscribed ulcers “as if punched out” also arise in the course of inflammation of the palate and throat. Their similarity with syphilis should be stressed. The already mentioned skin and mucous membrane affections and certain pains which one refers to the bones, especially on the head and the tibia, increase the similarity on the head and the tibia, increase the similarity. But without connection with this similarity and from the non-homoeopathic side, in France about 1850 kali bichromicum was used in secondary syphilis by Robin and in Germany as well, though today the chromate preparations in syphilis is again considered obsolete therapy. Recently again in homoeopathic literature a mercury com- pound of the chromate (merc. oxydulat. chromate.) has been suggested as a remedy in syphilis. It is to be considered in the cases where a differential diagnosis between mercury and kali bichromicum cannot be made and has repeatedly proven valuable to me in severe ulcerative processes of syphilis in the throat. The chronic kali bichromicum poisoning of the nose does not happen exactly as in syphilis for only the upper part of the cartilaginous septum is destroyed.
Also when ulcer formation occurs the nasal mucous membrane is persistently involved. This is signified by the loss of smell which seems to outlast the usual coryza; but the soreness of the nose is associated with an offensive odor of which the patient himself is aware. This degenerative mucous membrane symptom is
the occasion for the use of kali bichromicum in rhinitis atrophicans, the ozena of syphilitic as well as scrofulous origin.
The coryza with a thick tenacious secretion (which is like that of hydrastis) can also cause symptoms of nasal occlusion, especially painful pressure at the root of the nose which can also be conditioned by involvement of the frontal sinus. Moreover the thick secretion, like that of hydrastis, may fall into the posterior pharynx. An occluding coryza in fat plump nurslings is said to be especially suitable for the remedy.
Many sensations of pain in and around the nose in the proving protocols refer to this site as one of predilection. Very similar are the inflammatory manifestations in the throat, which, with redness of the throat and soft palate, with difficulty in swallo- wing and oedema of the uvula may go on to the already mentioned ulcers. For the chronic catarrh, pharyngitis, the tenacious stringy mucus is characteristic. Indeed as the initial symptom of the chronic mucous membrane affection besides the often mentioned sensation of dryness, scratching and sticking of the provings, there is the ever repeated symptom “feeling of a hair at the root of the tongue and the soft palate.” It is, so far as I know, described only by one prover (Norton) as the early warning of an ulcer in the throat. In spite of the solitary nature of his report I do not see little value in such a detail but decisive in this respect is the question of whether or not it has proven a practical indication for kali bichromicum. And this seems to be the case.
Hoarseness, tickling and painfulness in the larynx and the trachea, especially in the region of the bifurcation, stitches under the sternum going to the back, irritative cough and oppression of the chest, labored breathing and chest pains are frequently observed, but particularly characteristic for the laryngitis, tracheitis and bronchitis is the repeatedly mentioned tenacious expectoration and moreover the morning aggravation of the cough. The pseudo-membranous deposits on the mucous membranes of the throat, the larynx and the trachea which has also been found in animals has led to the proven use of kali bichromicum in severe diphtheria. Here also the structural participation of the mucous membrane is essential.
In close connection with the inflammatory manifestations in the upper air passages stands the ocular inflammations of kali bichromicum. Here also then itching, burning, redness, swelling, lachrymation photophobia is the usual but not characteristic picture. The tenacious, yellow secretion or the pseudo-membranous deposit speaks first for a conjunctivitis in the direction of kali bichromicum. But also a torpid keratitis with ulcer of the cornea without great pain and photophobia (indeed on the industrial poisonings) is found in the drug picture of kali bichromicum; more-over iritis with punctiform deposits in Descemet’s membrane; here also the relatively slight pain with severe inflammation is guiding. However it is not apparent on what clinical observations these indications are supported.
If one proceeds according to the frequency of the symptoms observed under kali bichromicum, if the value of symptoms is to be statistically conceived, then the gastro-intestinal complaints must have precedence over those of the respiratory passages. But according to all experience this is not the case. That nausea and vomiting appeared in almost one half the provers is still not decisive for a special affinity of the remedy for the stomach. Because it is to be considered that this defense manifestation is something quite common, when, as it happens here, a different drug is administered in fairly massive doses. A preferential organotrophy would be made probable first in that such symptoms were not only locally conditioned and rapidly transient but also appeared as persistent actions after the absorption of smaller doses. In such cases the symptoms also have finer differentiatio- ns and characteristics become evident.
The gastric disturbances of kali bichromicum show all the steps from functional disturbances to inflammation to ulcer: poor appetite, especially in the morning, thick yellow coated tongue, aversion to food, especially against meat, acid eructations or eructations of air, after eating an uneasiness in the stomach, gastric activity seems suppressed, nausea and vomiting appear suddenly. Finally kali bichromicum is cited on the basis of pathologic-anatomic findings of a sharply circumscribed ulceration of the mucous membrane as a remedy for ulcer of the stomach and duodenum. For this are single observations of improvement of gastric complaints after eating included. For the gastric disturbances in the direction of kali bichromicum the morning aggravation between 2 and 5 in the morning (perhaps also the aggravation of the nausea on moving around) speaks, moreover the aggravation of the nausea from drinking water, though great thirst is often present. Moreover the desire for beer is stressed This was repeatedly noted by one prover (Prof.v.Zlatarovich). However one also finds it repeatedly stressed in the materia medica that beer is not well tolerated and from this association it has said that kali bichromicum is particularly suitable for the gastritis of beer drinkers But it was precisely the prover named who felt better after beer. 620 Riedlin 621 also reports an aggravation from beer, but he avoided it as it was “too cold.”
The acute and subacute intestinal actions are, as previously mentioned, like dysentery. The brown foamy diarrhoea with tenesmus, at times bloody, shows the morning aggravation. Likewise for the enteritis the tenacious, stringy mucus like gelatin is said to be guiding and is considered an indication for kali bichromicum in mucous colitis; because of the tendency to ulcer formation under certain circumstances kali bichromicum comes under consideration in the most diverse chronic ulcerative processes. Moreover also a persistent constipation is observed in chrome workers and in the proves. It is said to be characterized by periodic recurrence and is associated with pains cutting across the pelvis and the voiding of a brown urine. In addition to other sensations in the anus as burning and pressure, a sensation of a plug is also present.
OTHER ORGAN ACTIONS
From the frequent pains of different types in the liver region which were associated with pale clay colored stools, one has concluded that kali bichromicum has significance as a liver remedy. The above reported findings of Lewin and the newer animal investigations of Hinsdale which showed the fatty infiltration of the liver and an increase in the connective tissue support this suggestion. But clinical observation has not yet showed that this indication is sufficient to make a therapeutic indication from it. It is mistake in the meaning of the simile rule when one would make any organotrophic connection conclusively evident of a therapeutic action trend. In the evaluation of the total picture it appears that the possibility of a trend of action is not sufficient. The pathologic-anatomic findings on the organs are for this reason often entirely unsuitable for the emphasis of this value because they bear only the fixed precipitate of a functional event after the ended reciprocal play of powers.
The same also holds for the nephritis which also appears at times as a result of severe kali bichromicum poisoning. The frequently mentioned pains in the lumbar region can also support this indication. But without exact further guiding symptoms we could hardly select kali bichromicum from other renal poisons in a case of nephritis. It is certain that there are also diverse irritative manifestations in the urinary passages from kali bichromicum. Perhaps in pyelitis, cystitis, and urethritis it may lead to the secretion of tenacious mucus. White sediment is also reported. As a special indication “the sensation as if drops remained in the posterior part of the urethra and cannot be pressed out” is perhaps useful from the proving.
On the female genitalia a tenacious yellow leucorrhoea is worthy of note; moreover irritative manifestations, itching, swelling of the external parts, like those on the male external genitalia, can lead to pustules and finally ulcers. Such a pustular and ulcer formation generally appears on the skin with kali bichromicum. The type of pustules which should heal with scarring has given occasion for the remedy in smallpox, just as the type of reactionless ulcer penetrating into the deeper parts among other symptoms has linked it to syphilis.
The kali bichromicum picture is rich in pains of the most diverse type which are present in the muscles, joints and bones. According to the site and character they have been considered now as rheumatic, now as syphilitic. Two properties of the pains are particularly worthy of note; first, the sudden appearance and diminution and rapid wandering from one part to another and, second, that they are often limited to a small spot so that one can cover the painful site with the end of the thumb. Both characteristics refer to neuralgias. The modalities of these pains are not fixed with certainty. Perhaps the best is aggravation from cold. In isolated instances they are relieved by motion but usually (especially at the beginning of motion) are reported as aggravated. The wandering pain, worse from cold, may be ascribed to the potassium fraction, perhaps also the preferential site in the back (in the pelvis, sacrum and coccyx). Other modalities which agree with those of kali carbonicum are the general early morning aggravation and the aggravation after coitus.
Then also an alternations between the gastric complaints and the wandering pains in the extremities is described as a sign of kali bichromicum on the basis of the provings.
Extraordinarily numerous in the provings are headaches and sensation of vertigo. In order to evaluate these reports, one must differentiate. The vertigo and many pains are associated with gastric symptoms, nausea and vomiting. Often the pains are associated with catarrhal processes in the upper respiratory pas- sages. They were usually localized in the forehead and about the region of the nose. From all these headaches which cannot be more closely defined than secondary are separated several others resembling migraine or neuralgia. These pains again are limited to small areas, over one eye, unilateral pains about the orbit or in the frontal region which precede darkening of vision, cloudy vision, and vertigo. Here movement seems always to aggravate but the reaction to cold is not constant (once it states better in the open air, the other time worse from cold air), the time of aggravation is often in the morning but also an increase up to noon and decrease toward evening is reported. Since these modalities are not precise, the suitability of the remedy for the for the symptoms concerned is less certain. Unilateral headaches with preceding visual disturbances are found in many drugs and differential signs are necessary. These must be introduced from other fields if one is to attack migraine with kali bichromicum. Kali bichromicum is most frequently employed in the headache associated with disorders of the frontal sinuses.
If one takes the single provings of Arneth’s with the various steps of dilution, then one can read out of it that the wandering pains are evident in the highest dilutions (D 7) and here also the kali fraction comes into prominence while in the third dilution the symptoms in the upper respiratory passages stand in the foreground and in the third the gastro-intestinal symptoms begin, then in the first dilution the nose and the mouth symptoms appear in a very organic expression and thus the chromic acid fraction which differs from the potassium can always be distinctly recognized.
That severe chromic acid poisoning leads to anemic and cachetic states has already been mentioned. This is a sign that the remedy has the capacity to produce deep, subacute and chronic, general disturbances. Corresponding to this in the drug picture which has to be considered less in the end state is a great weakness. The occasional yellow discoloration of the cutaneous appendages by the colored chrome in the severe instances of poisoning naturally is not taken over into the therapeutic drug picture. This would mean to convert the meaning of the simile rule into nonsense.
Type: So far as determined at present, light haired, puffy.
Chief Trend: Mucous membranes of the upper air passages and the gastro- intestinal canal.
The tenacious mucous.
The formation of pseudomembranes and circumscribed ulcers.
Pains limited to small spots.
Rapid change of the site of pain.
Alternation between gastric symptoms and rheumatic complaints.
(Doubtful desire for beer but aggravation from it.)
Modalities: Morning aggravation throughout. Catarrhal and rheumatic pains worse from cold, while the gastric symptoms in particular are worse in hot weather.
In general worse from movement.
DOSE The middle potencies (about the 6 D) are preferred in general.
Neither the metal vanadium itself nor its compounds have been proven on the healthy up to the present. The sodium salt of metavanadinic acid, Na. VO3, in animal experiments yielded actions experiments yielded actions on the vasomotor and respiratory centers and the intracardiac ganglia. The severe toxic manifestations after injection are: motor paralysis, loss of reflex excitability, convulsions, stupor, irritation of the intestinal canal up to inflammation, lowering of body temperature, slowing of respiration and weakness of cardiac action. The blood pressure is reduced, the pulse weak, irregular, intermittent, the respiration initially accelerated, later slowed and fails 622; from such acute poisonings one can learn as good as nothing.
In industry the salts of the lower vanadium oxide are used as catalysors of oxidation because the change in valence, oxygen is easily given off and taken up. In single invertebrate sea stars (Ascidia) vanadium plays the role of iron in the blood. Lyonnet and others report vandates, in particular ammonium metavandate, NH4. VO4, in amounts of 2-5 mgs., is a “roberans” for the improvement of the appetite, strength and weight. Accordingly the technically employed catalyzing property could also be appreciated for the excitation of metabolism.
From the exposure with vanadinic acid salts in industry, irritative states of the mucous membranes, the respiratory passages and the gastro-intestinal canal as well as the kidney have been seen; as general effects, headaches, trembling as well as psychic disturbances.
The recommendations for vanadium preparations in homoeopathy are also merely clinical and very general; as a tonic for the stimulation of the appetite in early tuberculosis, in anorexia with states of irritation of the gastro-intestinal canal, anemia, emaciation. Moreover in homoeopathic materia medica a fortunate use has been obtained by Burnett in the indication: fatty degeneration of the liver and arteriosclerosis (with many pains in the course of the aorta, pressure in the cardiac region). Vanadium is also used in compound remedies for arteriosclerosis. The basis through the result in the case in which the diagnosis is by no means accepted without reservation does not exactly awaken confidence for such a grave indication.