More distinctly the affinity to the male sexual glands is determined by the symptoms. The rejuvenating influence of gold, cited from antiquity, refers perhaps to the increase of sexual impulse, which proceeds also from the provings. Also a psychic excitation, improvement of humor with desire for conversations and self satisfaction, greater mental mobility and desire for work, improved power of thinking and better memory may be connected with this as the first action of gold. This general elevation and excitation also struck the auralists of the French school a century ago. As later actions in this respect are the inflammatory and degenerative alterations in the testes: painful swelling, chronic induration and finally atrophy. Also for the tuberculous inflammations of the epididymus aurum, particularly aurum iodat., is suitable. Swellings as hydrocele corresponding to ovarian enlargements may be included in the field of indications of gold.
With the degenerative phase of action in the sexual glands and on the arteries one may bring into association perhaps the depressive melancholic chief action of gold in the psychic life. Moreover an immediate action on the cerebro-spinal system is not improbable. Cerebral sclerosis, lues are often combined with severe depression. Coronary sclerosis more with anxious unrest. The depressive influence of degenerative processes on the sexual glands is sufficiently well known. But it is not to be understood that the melancholia with a tendency to suicide of the aurum picture is only a secondary manifestation of these organ alterations. Much more the disturbances of circulation and the sexual hormones are to be brought into parallel to a certain extent in the second phase of gold action and to the melancholic phase of mental life without one being able to say what is the primary and what the secondary site of involvement. The mental weakness, the irritability, impetuosity, anxiety and restlessness in any case are often accompanying symptoms of sclerotic diseases which in themselves are suitable for gold. The gold indication “melancholia” known since antiuity often comes to expression symptomatically in the proving picture: “he believes nothing is right in the world and therefore seeks for death on which he dwells with inner pleasure. Great increasing anxiety proceeding even to suicide, with spasmodic contraction of the lower abdomen, disgust for life, thoughts of suicide. He is downcast and seeks solitude. If one leaves him alone, he sits silently by himself, in melancholy in a corner; the slightest contradiction however brings him into violent rage, he responds at first with fight and many words but later says only a few broken words.” Thus and similarly read the reports of the provings.
In any case the presence of these deep melancholic behaviors has proven an important guiding symptom in homoeopathic use. When some report that music acts as a sedative, but fear increases the irritability, perhaps it may be useful for differentiating from other remedies in melancholia. When the severe melancholic, depressive mental symptoms appear in arteriosclerosis, in luetics, after the misuse of mercury, in women at the menopause and not perhaps in the mild pulsatilla type, but accompanied with excessive irritability and tendency to suicide, one will first think of aurum.
RARE ORGAN ACTIONS
The already mentioned association with the skin, which is more expressed in the organic preparations, combined with sulphur, has given occasion in homoeopathy for the use of gold outside of acne rosacea also in lupus, particularly in erythematodes, occasionally also in psoriasis.
The symptoms on the respiratory organs are not so marked as to make a special affinity of gold to them probable. If intravenous injections have had occasional favorable results in pulmonary tuberculosis, so this can involve a less specific treatment, perhaps even protein split products which can be obtained through copper as well as other metals. In any case it is not known that the oral use of gold has proven useful in lung tuberculosis.
The gastro-intestinal symptoms in the provings of gold are even less characteristic. Therefore they have not obtained any practical significance.
Mesenchyme, reticulo-endothelial system. Blood vessels, mucous membrane, skin, sexual glands, sense organs, central nervous system, and mind.
Cardiac and vascular diseases, vasomotor to sclerotic disturbances (coronary and cerebral sclerosis, red high blood pressure but also nephrosclerosis), lues, particularly tertiary, after the misuse of mercury (arterial disease, bone symptoms, ozaena, glandular indurations). Internal eye diseases (chorio-retinitis, detachment of the retina). Uterine and ovarian tumors, orchitis, melancholia.
Guiding: Depression with tendency to suicide; loss of courage but very irritable, hypersensitive toward noise; music quiets.
Apoplectiform-plethoric type; nocturnal aggravation, better from movement in the open air (worse from cold, from mental effort).
Essential differences have not become distinct up to the present between the various preparations of gold. In the recently proven aurum colloidale up to the present no mental symptoms were observed. With the gold salts of which aurum muriaticum (AuCl3. HCI + 4 H2O), its sodium salt, AuCl3. NaCl + 2 H2O) and aurum sulfurat. + gold sulphide (Au2S3) are proven, one has attempted to accelerate the slow metal actions and to link them to definite organs. Aurum muriaticum and aurum muriaticum natron are often preferred especially in arteriosclerotic and leutic affections.
The salts and aurum colloidale are usually given in the lower potencies up to the D 6, aurum met. especially with the presence of the mental symptoms also in D 30.
In the periodic system of elements zinc stands in a series related to cadmium and mercury. However the relationship to mercury is not very outspoken either chemically or pharmacologically. Even if one thinks that the working range of zinc is of a much slighter extent than that of mercury, nevertheless considerable similarity in the toxic manifestations is evident and should not be dismissed, particulary the part which we know as mercurial erethism and tremor mercury we find again in zinc, but still most of the organ symptoms which we know and especially use of mercury are either entirely misused or insignificant in zinc. On the other side zinc shows a close horizontal relationship with copper.
Zinc (as well as copper) is found in considerable amounts in molluscs 654 as a normal organically bound constituent. According to Javillier 655 it is also a regular constituent of plant protoplasm. In very slight concentrations in the soil it is said to promote the growth of oats and cereals. 656 Our common foods and the intestinal contents and excreta of man regularly contain zinc (as well as copper). The excretion of zinc takes place in the urine, faeces, milk, the gastro-intestinal mucosa and perhaps also through the sweat.
The soluble zinc salts, as all metal salts, precipitate protein. The zinc albuminates which form are soluble in dilute acids, alkalies and an excess of the precipitating agent. We need not say much about the external influences of zinc salts. They act astringent or corrosive, indeed according to the acid with which the metal is bound and according to the concentration of the solution. Chloride of zinc acts most strongly corrosive. The astringent action is used externally, particularly in the mildest zinc compound, zinc oxide, in the form of a white powder or zinc ointment. Zinc sulphate was used more as an emetic formerly than today. The treatment of conjunctivitis and gonorrhoea with zinc sulphate is well known.
After absorption, zinc compounds provoke initially central excitation and later reduction of the reflex excitability and muscle paralysis. The red blood cells are said to be destroyed rapidly and hemoglobin, albumin, and sugar should appear in the urine. The pathologico-anatomic findings correspond to the toxic actions since after the chronic poisoning (10-15 days) with zinc oxide in dogs can be demonstrated: anemia and fatty degeneration in the liver, kidney and pancreas, swelling and disorganization of the epithelia of the biliary passages, anemia in the brain and spinal cord as well as atrophy and cloudy swelling of the ganglia of the anterior horn cells. Here we can go from the acute symptoms of intoxication to the acute corrosive actions on the gastrointestinal mucosa. However among the symptoms of a more chronic poisoning remain: cramps in the extremities after several days and finally after four weeks general convulsions. 657 Kissel 658 reports that, according to Blandlet, workers who inhale zinc vapors have spasms, apprehension, headache and vomiting. In a case of poisoning by zinc vapors on the first day a sensation of constriction of the chest, headache and vertigo was noted, on the second day severe cough, vomiting, stiffness of the extremities, on the third day a coppery taste in the mouth, some flow of saliva, abdominal pains and an increase of vertigo so that the patient could not stand upright. 659 Whether the so-called casting fever of smelters and workers in zinc 660 is a special result of zinc has not been determined with certainty. It begins with pains especially in the back, then chills, followed by chilliness for several hours, an increase of pulse rate with a tormenting cough, a feeling of soreness in the chest, later expectoration and frontal headache, more rarely muscle twitching, salivation and vertigo. After this sweat and sleep follows. In a remarkable way the diarrhoea which is said to appear with severity soon after the smelting (gushing diarrhoea) is missing in this enumeration.
EARLIER EMPLOYMENT AS A NERVE REMEDY
Even from the crude manifestations of poisoning one can deduce that the chief trend of zinc absorbed in the organism is on the nervous system. Formerly zinc compounds were often employed purely empirically in nervous diseases, but today one considers the treatment of chorea, epilepsy, or other nerve diseases with zinc as obsolete and abandoned. However zinc oxide is still mentioned in single textbooks as a remedy for epilepsy. But in the older textbooks the nerve actions of zinc were extolled in all types of spasms, general twitching, epilepsy, chorea, spasmodic nervous affections of the chest (spasmodic asthma, spasmodic hiccough, spasmodic laughing and the like) and here the poorly soluble zinc oxide was preferred. Vogt 661 stresses that the general twitchings from mental affections, acid stomach, the eruption of teeth, the development of puberty, suppressed skin eruptions or those disturbed in the course of evolution in the outer skin, acute as well as chronic, from worms, etc., gave the indication for zinc oxide. The cause of the convulsions for which zinc was employed should not depend upon a weakness of the nervous system but a disorder and excitation in it, especially in delicate, sensitive, youthful, full blooded and irritable individuals, particularly children and women.
Zinc found extensive use with Rademacher and his school. Rademacher 662 called zinc mineral opium, since it had great similarity to opium in its sedative power, even if it shared the vascular exciting property only to a slight extent.
For him it was an organ remedy of the brain, particularly for the sphere of thinking, but he also gave it in melancholia with a desire to sleep much, and when depression began with the symptoms of fear and evil. In diarrhoeas and “in severe brain symptoms which may accompany infectious diseases in the form of delirium or impending somnolence,” particulary in erysipelas, the Rademacherian school held zinc as the healing remedy. Kissel 663 states: “Zinc is a direct curative remedy of a special type in brain affections which can be expressed in many ways, especially by delusions, desire for sleep, headache, neuralgias, spasms, diarrhoea, inflammations of the skin and mucous membranes.” Moreover Rademacher gave zinc in the affections of the organs supplied by the cranial nerves thus in nervous tooth-ache and pains in the internal ear. H.Schulz mentions that the clinician Bartels gave zinc acetate in cases of the nervous insomnia which did not react to morphine. Rademacher gave zinc acetate solution, five drops, three times daily, three times daily, to people who were compelled to work after insufficient sleep. Is he following homoeopathic thoughts here? In any case he introduced personal experiences to support this by virtue of which Kissel 664 and H. Schulz 665 report: “In the morning Rademacher took a large dose of zinc oxide of 15 grains (0.9 g.) fasting. The striking symptoms resulting were the bluish redness of the face and a great desire to sleep overcame him so that he could no longer collect his thoughts. On the other side the nausea which developed prevented sleep. This state was similar to that in which one finds himself when he has become highly fatigued from exertion and is stimulated at the same time. After some time he had two liquid stools and the apparent action of zinc gradually ceased.” Rademacher held it as plausible that zinc also acted curatively on the spinal cord which he concluded from the cures
of neuralgia such as sciatica and lumbago. Loffler, 666 a pupil of Rademacher, employed zinc successfully in delirium tremens and here placed it at the side of opium.
Zinc provings have been published.
1. Franz: Stapf’s Archiv. f. d. hom. Heilkunde, Bd. 6, Heft. 2, S. 152, 1827, with 8 provers (with the C1 and C3).
2. Hahnemann: Chr. Krankheiten, 1 Aufi., Bd. 3, S. 254, 1828; 2 Aufl., Bd. 5, S. 428, 1839, contains the provings of 1 and increased by the results in 4 more provers.
3. Hartlaub und Trinks: Reine Arzneimittellehre, 2 Bd., 1838.
4. Buchner: Hygea, Bd. 14, S. 481, 1841, 7 provers (zinc oxide).
5. Schreter: Neues Archiv., Bd. 3, 1846.
CHIEF TRENDS ———— H. Schulz collected the symptoms which one obtains by the proving on the healthy with small doses of zinc oxide given continuously over a period of time. It thereby appears that the drug picture is concerned not only with the chief trend upon the nervous system with influence in the brain, spinal cord and peripheral nerves, but also has a second trend upon the vascular system and finally shows manifestations u=in almost all organs. On the one side the vascular actions proceed with an increased pulse rate with attacks of palpitation, alternating showers of chills and febrile sensations, congestion to the head, on the other side, with manifestations of stasis in the venous system. It is precisely the latter which have gained some significance as homoeopathic indications and permits zinc to appear as one of the so- called venous remedies. A third trend, at the same time dependent upon the second, is the effect observed on the mucous membranes, salivary glands and skin, but it possesses slight significance. Of the organs the kidney seems to be subjected as the result of zinc poisoning.
The manifestations on the nervous system are in the foreground. Zinc actions do not consist of either “depression or stimulation.” The time factor and the dose are decisive in this respect. It is precisely an interweaving of excitation and weakness, which is characteristic. For the acute action of massive doses the above reported personal investigation of Rademacher is descriptive: great fatigue, but at the same time restlessness and excitement up to nausea. The employment in excessive fatigue as well as in diseases which tend to manifest a desire for sleep and delirium at the same time in spite of the massive dose in the school of Rademacher is entirely homoeopathic. The symptoms of weakness, lassitude, fatigue and disturbance of sleep which zinc has in common with so many other remedies is characterized primarily by the symptoms of excitement of the cerebro-spinal nervous system. Weakness, heaviness, lassitude, dullness, inability to think, difficult comprehension, aversion to work, vertigo, waves of faintness, great sleepiness during the day (worse after eating), depressed, dreary, and melancholic disposition (worse at evening) up to lethargy and stupor-these characterize the depressive state. The indication of Rademacher: “melancholia which has to do with fear and evil” in the proving with zinc oxide by Werneck 667 has the symptom: “mental unrest as though he had committed a crime,” as a mirror image. The simultaneous exciting action which in no way can be separated merely in primary and secondary action from the sedative without arbitrariness embraces trembling and twitching of single muscles or over the entire body and particularly characteristic is the restlessness of the feet, which is described in the urge to stretch and extend the legs. The extreme state which approaches a type of delirium is evident in the disturbances of sleep. The night sleep is unrefreshing with much twitching, dreams, and crying out; restlessness and nausea prevent sleep. For insomnia with great unrest in the extremities, zincum valerianicum is often preferred. As already mentioned the central irritative manifestations can increase to convulsions. The following symptoms obviously owe their details primarily to clinical observation: convulsive phenomena in children with pale face, when the eruption in infections diseases (scarlet fever) does not come out or when irritative cerebral manifestations appear as from worms or teething; the child rolls the head from one side to the other or bores the head into the pillow and grinds the teeth. Thereby one thinks of an irritative state like that of hydrocephalus or meningitis. The connection of exanthems which do not develop with the cerebral irritative manifestations has good observations underlying it. Taken together with Rademac- her’s observations (somnolence, delirium), the actions of zinc give a noteworthy indication in different potencies should be tried repeatedly. How far the old indication in chorea and epilepsy), particularly when the finer signs speak for zinc, has not been sufficiently elaborated. It must also be stressed on the grounds of clinical observation that the child with spasms or with the convulsive cough places the hands on the genitalia when zinc is indicated.
Headaches are present in every proving of zinc and are extraordinarily diverse. A characteristic from is the pain at the root of the nose as though the nose was pressed back into the head. But also pain in the occiput and at the side of the head, even severe migraine, perhaps trigeminal neurarable nausea and dimming of vision, vertigo with the tendency to fall to the left are reported. The headaches seem to be of a congestive type evidenced by the redness of the face after large doses of zinc. It seems particularly characteristic for the brain and the head symptoms that they are increased by the least use of wine. The concordance of two irritant remedies to the brain makes this plausible. This also holds for the aggravation from nux vomica which was given for the symptoms of zinc in the older provings.
To the irritant manifestations of the central nervous system we must also count the neuralgias. The pains are jerky. We learned about dental neuralgias and sciatica as Rademacherian indications. To this belongs the left sided ovarian neuralgia with boring pain before the menses so that the patient cannot remain at rest; the pain is relieved by pressure and ceases as soon as the blood flows. The symptoms of the female genitalia particularly should
be accompanied by restlessness, depression, coldness, spinal irrtation, restlessness of the feet. Here we are confronted by the picture of a nervous dysmenorrhoea. A spermatic cord neuralgia with painful retraction of the testes corresponds for the male organs. Furthermore a neuralgia after herpes zoster is reported. Perhaps as a symptom of old spinal irritation, in addition to burning along the spine, there is also a pain in the last thoracic or the first lumbar vertebra. This pain is worse on sitting. Moreover an increase in sexual iritability is noted.
But the cerebro-spinal zinc goes farther. The pathologico- anatomic affinity to the anterior horn cells of the spinal cord, which was mentioned above, gives a point of departure for the basis of other symptoms. We may mention trembling in the muscles as the first irritative manifestation, crawling and numbness in the hands, calves and feet, fingers soon go to sleep, these merging into weakness, paresis and stiffness and finally to para- lysis. This is noted particularly in the eyelids: eyelids heavy as paralyzed, ptosis of the bladder sphincter muscle is also mentioned: voiding of urine on walking, coughing or sneezing. A spasm in the pharynx or esophagus is also mentioned, furthermore hysterical laughing from zinc oxide. Trials with zinc in diseases as bulbar paralysis, paralysis agitans and multiple sclerosis are well founded in the symptomatic picture. Naturally the employment in milder disturbances as writer’s cramp is more successful.
With zinc there is also a spasmodic dyspnoea with a sense of constriction, which is worse after eating and which is said to be better after the expectoration appears. The bloody and blood streaked sputum in spasmodic cough is explained by the easy rupture of vessels which is frequently noted in zinc. The spasmodic dic symptoms can also invole the heart, a spasmodically irregular cardiac beat with impact in the heart, with single heavy beats, is reported. Moreover in the older textbooks of materia medica attacks of stenocardia are given as indications. A finer symptom “as though a cap rested on the heart” was considered by Hering
668 as an affection of the spine.
As far as nausea, vomiting and diarrhoea appear dependent upon cerebral irrtation, we encounter them in the actions of zinc. The gastric symptoms: nausea which is produced or aggravated by every movement, but again, especially after the least wine, vomiting of bitter mucus, vomiting immediately after the ingestion of any food, allow one to think of the crude action of zinc sulphate on the stomach which can be considered indicated when centrally conditioned.
For the present the bladder and urethral symptoms stand to one side and have been studied less: voiding of blood after painful urination, persistent urge to urinate, burning in the urethra, cutting pain in the orifice of the urethra, moreover frequent urge to urinate and marked pressure from the urine in the bladder. The report: “can urinate only in certain position, for example, bending back” refers to disturbances in innervation.