Then follows a series of empiric reports with the remark of the author: “The master Serapio states that to rub gold to powder and eat it, leprosy is consumed and all members of man become strong. A wound in which gold has been placed will not become foul. The great master Halyx states that gold filings strengthens the heart more than all other drugs and allows no decomposition in the body. Gold scrapings remove the trembling of the heart which prevails from the earthy moisture, called melancholia. Avicenna states that gold removes the melancholia of man and likewise evil dreams and phantasies from sleep. The wounds in which gold is placed heal without harm and no foul flesh grows therein. Those who carry gold in the mouth have good breathing. Platearius: gold helps heart trembling and removes the sandess and is good for those who speak to themselves and make phantasies. Avicenna (in the book de viribus cordis) states that gold more than all other drugs makes the heart strong and makes good rejoicing blood.”
In these empiric reports we have already the chief indications of the homoeopathic school (melancholia and cardio-vascular action) and the most recent of school medicine (lepra, bacteriocidal action) before us. Also the fine division by trituration, even if not yet in another vehicle, was obviously known as necessary for the effectiveness. Pre-scientific empiricism remains valuable so far as the above directions are correct and give the newer observations the historical background.
Let us now go to the current stand of experimental clinical investigation on the action of gold. It appeared as parenteral therapy without any connection with earlier epochs of gold therapy. For a long time under theoretical conceptions, men have tried to kill the tubercle bacillus in the body by gold (and copper) or at least severely injure them. The task was to synthesize a compound of gold which had the highest possible therapeutic index, that is, a great distance between the dose injurious to the host and that which is healing (the therapeutic quotient = t:c = dosis toxica to dosis curativa).
In the original investigative field of tuberculosis (Moellgaard) the hopes set upon gold preparations (such as sanocrysin) have not been fulfilled. On the other hand in spirocheta (organ syphilis and recurrens) and streptococcus infections, gold preparations (as solganal and solganal B of Feldt, organic compounds of gold with sulphur) have proven curative in animal experiments. The exciter was destroyed. But not in the sense of a direct therapia sterilisans magna, that is, by a direct chemical influence of the agent on the exciter, but indirectly through an increase of the defense power of the host. This mechanism has been adopted today for all other chemotherapeutics with the exception of salvarsan. For gold preparations in particular it may be concluded from this, that their depressing or even lethal influence on the exciter in a test tube requires concentrations which are much larger than are necessary for the cure of an infected animal. Also an intravital alteration of the preparation permits a strong bacteriocidal compound to be excluded. From animal investigation alone it can be seen that the healing effect which goes up to the destruction of the exciter rests upon an influence, an activation, of the natural defense process of the host.
One postulates the chief site of organismal defense in the mesenchyme, in the vascular connective tissue, in particular in the reticulo-endothelial system. This holds on the one side as the site of natural defense actions, as the formation of antibodies, on the other side the storage also of the chemotherapeutic agent. Thus it may be assumed that particularly in this system the metallic catalysors, such as gold, activate the natural defense process.
The comparison of the knowledge of gold preparations obtained from homoeopathy to the newer gold therapy is difficult because today there are almost no simple gold preparations used, but mos- tly organic sulphur compounds. However it is reported of the 0.1 Percent gold chloride solution that it works exactly as good as the many organic preparations, indeed, that it is better born. Moreover it is cheap. The principle of optimal dose has not been worked out in parenteral gold therapy but nevertheless one knows that this therapy involves a stimulation of the defense function, particularly in the reticulo-endothelial system. In spite of the therapeutic animal investigation the indication the indications in sick mankind remain uncertain; almost all infections were occasionally found suitable for gold therapy; but the results are extremely variable without one being able to demonstrate in detail why the result lack of result occurred.
Chronic infectious arthritis, chronic septic states, lipus erythematosis, psoriasis, multiple sclerosis, tuberculosis, lepra, vaccinia recurrens (in the treatment of progressive paralysis) and syphilis are at present the field of application of gold preparations.
For the situation of the spirochetal diseases the already mentioned animal investigations still furnish the best point of view. Since the external manifestations of syphilis at first react with an increase of inflammatory manifestations after the injection of gold preparations, there can be little doubt of the stimulating character of this treatment. But it may be questioned whether the great doses (for example 0.25-0.5 grams solganal) of organic gold preparations are optimal. If they are proven as necessary then there may be weakening of the specific stimulative action as the result of the organic gold compound. In favor of this is the fact that only 1-10 mg. of gold chloride is necessary. But the height of the dose can also lie in the slight degree of relationship of gold to syphilis in man. Only then when the stimulative index, that is, the relation of the stimulus does for the exciter to the stimulus dose for the defensive function is considered, can one say anything about the degree of specificity. Because the grade of specificity and the dose optimum always stand in opposed dependence. In human tuberculosis many small doses (0.0001 grams, that is D 4) of the gold preparation have yielded favorable results. But the school does in general still stands under the old maxim of going up to the limit of tolerance on the basis of the still existing conception of a direct damage to the exciter.
The so-called untoward actions of the organic gold preparations show a special connection to the skin. Universal erythema with fever, measles-like and scarletini-form exanthems, isolated keratosis and desquamating infiltrating eczema and-by overdoses of the preparation called aurophos-an eruption like that of pityriasis rosea is observed. It is doubtful whether these skin manifestations are due to the chemical compounds, for example with sulphur. These “untoward” manifestations are so diverse that the usefulness of gold preparations in many diseases which are preferably manifested in the skin (in lupus erythematodes, leprosy, psoriasis, erythema nodosa, erythema exudativum, multiforme, erysipelas, lues II) can be considered as organotrophic from the homoeopathic viewpoint. Also within school medicine the conception gains ever more basis than the exanthems provoked incidentally are exactly as important for the skin. If the irritant treatment of the skin organ today is considered as an essential factor in the therapy of lues (for example by Buschke), then this is covered by the laic conception that the good appearance and the promotion of eruptions are favorable for healing.
FROM THE HISTORY OF GOLD THERAPY
The gold therapy of syphilis is by no means a production of modern medicine nor of homoeopathy. Paracelsus employed it in syphilis and leprosy. With the decline of the alchemists and the iatrochemists, gold again diminished in therapy, obviously because the art of preparation of useful forms was lost. Indeed a remedy always become obsolete when the suitable form or suitable domain of use is forgotten. However gold therapy had a brief period of blossoming from 1810-1830, particularly in France. Then this old drug again fell without notice into the grave of obsolete remedies and only in most recent times was again discovered as something entirely new, according to new methods, with many new compounds and names.
In contrast to the fashion of the school at least homoeopathy has acted differently since the continuity of gold therapy has persisted there during the last 100 years. This is not to be understood as mere conservatism on the part of homoeopathic physicians but it lies grounded in the method; when the basic lines for the domain of employment in the sick have once been es- tablished on the healthy man and removed from the up and down of empiric recommendation, then the fate of a drug no longer depends upon the praising or rejecting opinions; then the domain of action can be most precisely fixed and the possibilities and the limits of agents are ensured so far that the failure in a single case is to be ascribed more to erroneous indications or errors in the dose rather than the correctness of earlier observations on the healthy and their (obtained on the basis of symptom similarity) confirmation in patients, can be drawn into doubt.
As Hahnemann introduced gold into his materia medica after a proving on himself and other pupils about 1818, the curve of the medicinal use of gold was also on the increase in the remainder of medicine. In his apothecaries lexicon of 1795 (p. 368) Hahnemann held the medicine powers of gold in the sense of the prevailing opinion of the time, as very slight because of its in- solubility and suggested that apparent actions might be ascribed to the international or accidental admixture of copper. Also the apparent cardiac strengthening power of the old esteemed aurum potabile (etheral extract of gold 16:1 dissolved in aqua regia)he did not ascribe to gold.
In 1811 Chretien 649 again brought gold into fashion especially for the treatment of syphilis although since Paracelsus and Glauber 650 it was recommended now and then for this purpose. At first Chretien employed gold oxide (Au2O), gold chloride (H.AuCl4) and aurum muriaticum natron (NaCl. AuCl3) later he reported that finely dividend gold had the same action only milder. He permitted the patient to rub the gold into his tongue with the finger and from this perlingual application (likewise this has been rediscovered anew from time to time!) saw good results. There formed a correct party that gold results. There formed a correct party that gold was the remedy for syphilis and they held that mercury was ineffective and dangerous. 651 In 1825 Hahnemann 652 still mentioned nothing of the reappearance of gold therapy but cited only the Arabian and ancient authors. As he made his first attempt withfinely dividend gold (after an initial trial with a gold solution) (that is, before 1818), perhaps Chretien’s work was unknown to him.
When one compares purely clinically the indications for gold from the diagnosis of a century before with the homoeopathic, then there is scarcely any difference. Thereby one need not depend upon the animated gold therapeutists as Legrand, Niel, Percy, Gozzi, Destouches, who places gold far above mercury, but in the text books of that time, such as Vogt’s 653 one finds a great number of gold indications which later again have fallen into oblivion.
The old indications in melancholia, hypochondriasis, imbecility and chronic spasms were well known and also through observations of the stimulating actions of gold on the entire nervous system, and explained particularly on the brain (Niel, Percy). But still Vogt states that there are no observations of recent times, “if one will omit Hahnemann’s exaggerations.”
Gold was recommended as slowly working in syphilis where mercury has already been given without result or was poorly tolerated. “It often initially increased the symptoms which it later heals” reports Vogt and he cites examples of this.
Chretien and his followers also used gold with results in scrofula when the patient was not too old. Also in this respect gold is similar to mercury, even if not so active. With many folks carrying of gold rings in the ears is considered a defensive agent and curative remedy against scrofulosis and other maladies.
In uterine cancer, especially scirrhus (Grotzner), resuots have been reported with gold and this indication also has been incorporated in homoeopathy.
Furthermore in glandular tumors and indurations, even if not of a syphilitic or scrofulous nature, but particularly inflammatory induration and nodules in the tongue, then, in the various chronic maladies of the skin gold was reported as yielding results.
Also the ancient indication, mentioned even by Pliny, of gold for “dropsy” was again introduced a century ago with success, especially in hepatic cirrhosis in drinkers. Finally general “chronic” persistent inflammations, even phthisis, were reported, and this corresponds to the newest reports.
In this enumeration one misses the very ancient indication of cardiac weakness and, if one adds the homoeopathic use, the connection to the arteries, in particular to sclerotic processes. That this most important affinity for the understanding of gold action did not remain lost from the frequent use, even if it was not clinically utilized, proceeds from the numerous descriptions of that time.
The excitation of the arterial system which increases fever after excessive use, Chretien held as a pre-condition for the healing. At first gold increases the secretions especially of the urine and sweat; on the other side Gozzi has observed suppression of the urine and sweat from the misuse of gold. Chretien reports general erethism, inflammation of this or that organ, indeed according to the disposition, from too long continued use.
The homoeopathic provings of aurum and aurum preparations are found:
1. Hahnemann: Reine Arzneimittellehre, Aufl. Bd. 4, Chronische Krankheiten, Bd. 2 (Aurum met. and aur. mur.).
2. Molin: Bull. de la soc. med. hom. de Paris Bd. 1, Seit, 19, 1845 (Aurum mur. and aur. sulf.).
3. Buchner: Neue Ztschr. f. hom. Klinik, Bd. 4, S. 208 and Bd. 8, Nr. 24 (aur. mur.).
4. Eberle: ibid. (Aurum mur.).
5. Lembke: Neue Ztschr. f. hom. Klink, Bd. 11, S. 17 (Aurum met., aur. mur., aur. mur. natr.).
6. Hering: Metcalf’s Hom. Provings, p. 215 (aur. met.).
7. Burnett: Gold as a remedy in disease, 1879 (aur. met.).
8. Robinson: Brit. Journ. of Hom., vol. 25, p. 321 (aur. met.).
9. Shelton: N.A.J. of Hom., vol. 34, p. 485 (aur. met.).
10. Assmann: Deut. Ztschr. f. Hom., 1929, S. 245 (aur. colloid).
BLOOD VESSEL ACTION
For the comprehension of the drug picture of aurum one proceeds best from the action on the arterial vascular system. This is distinctly evident from all provings, also from the newest by Assmann which were performed with the 30, 15, and 6th decimal potencies. A sensation of heat with rush of blood, waves to the head, pressure sensation, heaviness, dullness and sensation of vertigo in the head, rushing and weaving in the head (as if one sat in rushing water), noises, rushing and swishing in the ears with diminution of heating, thereby variable cold and hot sensation: sensation of cold over the entire body, later increased sensation of heat, striking waves in the blood, just as if it boiled in the arteries, facial heat with cold hands and feet; chill at evening and in bed; the leg up to the knee is cold as ice; sensation of numbness in the arms and legs, soon after awakening, more apparent on lying still. The improvement of symp- toms by walking in the open air, the general aggravation by cold as well as through mental effort is easily understood on the basis of these vasomotor symptoms. To these are added the cardiac and pulse symptoms: severe palpitation and extraordinary dread, desire for sleep and fatigue in all extremities; at times a single very marked heart beat, oppression of the heart which compels deep breathing which relieves (aur. mur., D 4, Buchner), sensation as though the heart ceased beating 2-3 seconds and then suddenly began with a strong beat; oppression on the chest with feeling of anxiety; irregular heart beat with anxiety and dyspnoea; severely irregular heart; in one prover with aur. colloid. D 6, immediately after ingestion, slowing of the pulse which readily became irregular, at times the beat ceased and thereby the blood pressure fell from 112 to 95, a demonstration which must be tested further.
This great unrest and irregularity in the arterial system the older observers had described as arterial erethism and which on the re-introduction of gold therapy led to febrile states with transient chills. It is clear that in homoeopathy gold and its salts are important agents for such reactions in the heart and vascular system which have their origin in vasomotor disturbances as well as organic factors. Particularly arterial hypertension, the sclerosis of the coronary and cerebral vessels are important indications. But also there is a marked influence on the secretion of urine-at first increased, but later even suppressed, which forms an indication for nephrosclerosis. In this respect aurum is, in general, more suitable for the larger arteries and those of the upper part of the body while plumbum involves the arterioles especially of the kidneys (nephrosclerosis).
In the cerebral sclerosis the still to be mentioned mental and intellectual symptoms complete the picture. If the sclerosis whether of the aorta, the coronary or the cerebral vessels, is of luetic origin, then there is even more basis for the selection of a gold preparation (perhaps aur. iodat). Alcohol and nicotine are also important etiologic moments for aurum. In particular for the damages from nicotine in the cardiac manifestations, vertigo, diplopia and aurum is to be recalled in those from alcohol and the old indication of liver cirrhosis with ascites. Not rarely the flashes in the climacterium with high blood pressure and the corresponding mental symptoms form a good field for aurum, especially when it is concerned with a pre-sclerotic stage. Naturally other remedies are often indicated in the climacteric circulatory disturbances.
The vascular panel prevails in the aurum picture even in the type; it is the habitus apoplecticus, full blooded, corpulent man with red face, with the tendency to take everything hard, to look upon the dark side; in general people of advanced age are suitable for gold and moreover especially for those who have suffered from syphilis or mercury. A Stiegele has characterized the type in the following manner: “the aurum patient is heavy blooded, heavy mentally and heavy in motion and habit.” This does not suggest that gold is a remedy in the constitutional sense but it is determined distinctly by the organotrophy to the vascular system.
Mixed with the vascular diseases and luetic affections are the gold indications on the sense organs. The differentiation from the neighboring and related mercury is not easy here. Often one will give preference more subjectively to the slowly acting aurum when the process tends to have a more chronic evolution.
On the eyes many symptoms refer to congestion: a marked feeling of tension with lessening of visual power, spasmodic pressure in the orbit, sensation of pressing together, redness, burning pain and itching of the lids, a feeling in the eyes on looking as if from marked heat. Transient loss of vision, fiery spots before the eyes, veil before the eyes, double vision, have led to the use of aurum in internal diseases of the eye as glaucoma, and chorio- retinitis. An observation of darkening of the upper half of the visual field (from Hermann in Hahnemann’s proving, as with most other internal ocular symptoms) has given special occasion for use in detachment of the retina. Especially in luetic eye diseases, keratitis interstitialis, iritis with severe cutting pains in and around the orbit, diplopia from cerebral lues can furnish the link with aurum. But this does not state that scrofulous eye diseases such as are aided by mercury, cannot be favorably influenced by aurum. Also the pannus of trachoma with marked development of the vessels is reported. Still all these clinical diagnostic indications must be considered with the usual reservations.
On the ears the vasomotor symptoms with the diminution of heating have already been mentioned. The syphilitic processes are also included here whether the auditory nerve or the middle ear bones (with foetid suppuration) come under consideration. The same holds for the ozaena and the caries of the nasal bones with nocturnal pains, when mercury is without result or has been previously misused. Foul odor in the nose is a proving symptom of gold. A vasomotor early symptom may be the increased sensitivity of smell. A special site of predilection seems to be the nasal orifices and the tip of the nose. Redness and swelling of the nose, red nodular nose, has been observed many times since Hahne- mann; among others it occasioned the unbelieving student Hering to take gold trituration. A few days later he was compelled to aviod the room because he had a frightfully swollwn red nose. Acnerosaces, rhinophyma, copper nose, has given occasion for the use of gold.
MUCOUS MEMBRANES, GLANDS, TUMORS
Mercury-like oral inflammations were observed more than a century ago from the gold inunctions into the tongue. Offensive breath or foul offensive odor of the mouth and saliva are present. For luetic affections of the palate gold may come into question under certain conditions. Here we recall that even Avicenna used gold against bad breath. For the luetic bone affections, so far as they are suitable for aurum, the nocturnal aggravation is decisive.
In any case a slighter role is played in the aurum picture in hardened lymph glands than with mercury. The tumors of the uterus, myoma and scirrhus, also ovarian tumors, are also indications borrowed from old empiric use. Redness, heat, swelling of the vulva and vagina, thick white leucorrhoea pains pressing downwards are lesser points of departure from the provings which have given occasion for the use in enlarged and prolapsed uteri and in chronic metritis.