That on the central nervous system initially excitation and increase of irritability and then paralysis is observed means but little since this is observed in animal experimentation from nearly all metals. In the frog there is an excitation of the centers in the medulla and which extends from above downward over the entire cord so that reflex tetanus on touch appears.
The similarity of bismuth poisoning with that of mercury (oral and intestinal inflammation and nephrosis) has given occasion for mercury poisoning which has also been elaborated for mercury poisoning by Almkvist. It involves precipitation of the metallic oxide by hydrogen sulphide in the cells and vessels. An occlusion of the vessels will be occasioned through the precipitation in the finest capillaries of the intestinal wall. In any case the presence of H2S markedly influences the excretion of bismuth. If sulphur is administered to a bismuth poisoned animal, then the stomach and intestinal wall show a dark discoloration and ulcers appear. On the other hand after formation of H2S in the intestinal canal, the introduction of bismuth compounds by mouth cause only slight discoloration and no formation of ulcers. This close connection of sulphur to heavy metals is certainly not without significance for the site and grade of effectiveness. In this respect however one observes bismuth damages without the appearance of H2S. The epithelial cells of the small intestine, liver and kidney cells where hydrogen sulphide is not known to play a role may be damaged by the excretion of the metal.
Let us now consider the explanation for the therapeutic manner of action of bismuth with the standard indications: gastralgia, gastric ulcer, sour stomach (in former times also acute and chronic diarrhoea as well as ulceration of the intestine). Then bismuth was valued as an astringent which formed a firmly adherent coating to the mucosa and limited secretions, acting defensively and protectively. But in actuality epithelial damages up to hemorrhagic-ulcerative processes have been observed from bismuth in the intestinal canal. One can well underline the discussion of H.Schulz on the theory of astringent action and scab formation. We retain the similarity of the subjective and objective gastro-intestinal phenomena and assume that the favorable results obtained by large doses are due to the slight absorption. In the simile relationship we do not as yet see an explanation of the favorable action and we would rather await the possession of better knowledge of actual process. If we would form a picture of the healing of a gastric ulcer by small doses of bismuth, then we may best assume the production of an early state of inflammation which has much in agreement with the healing process of an ulcer. For this the enrichment of the intestinal wall with bismuth containing leucocytes may be taken as the first point of departure.
The bismuth treatment of syphilis can arise from the similarity with the parasitotropic arsenic and antimony compounds as well as with mercury.
The report on bismuth of Hahnemann contains few personal observations and other symptoms are drawn from the reports of Hermann, Hartmann, Langhammar. Even Hahnemann considered the proving as unsuitable but it has not been enriched in the interval. Hahnemann calls his preparation bismuth oxide but according to the preparation cited it is bismuth subnitrate. But apparently in his preparation the the bismuthyl hydrate (BiO)OH or Bi(OH)3 are probably constant admixtures to bismuth subnitrate and even increased in that the second washing of bismuth subnitrate precipitate was performed with water containing some drops of potassium (perhaps potassium hydroxide?)
Apart from these reports of Hahnemann of the actions on healthy humans, those cited by Wibmer may be included. The difference between the preparations employed is not made distinct, so that one can discuss the symptoms without hesitation under bismuth subnitrate which is not a uniform preparation.
If one proceeds according to diagnosis then the homoeopathic indications in general agree with those known to school therapy, gastralgia, gastritis, gastric ulcer, more rarely diarrhoea and ulceration of the intestinal processes. If one closely studies the now known, but still the ever necessary symptoms, then the agreement with antimony is striking. But in the center with bismuth subnitrate stands severe gastric pains: pressure as
if from a weight, burning, cramp-like pain. The pains go through to the vertebra and pressure on the vertebra necessitates bending over which relieves (ulcer on the posterior wall?). But these signs do not arise out of the provings but are differential characteristics obtained and proven clinically. Nausea and spasmodic vomiting appear soon after eating; there is a desire for cold drinks; they relieve temporarily but then vomiting soon follows (as soon as the stomach becomes full or as soon as they enter the stomach), entirely the same as in arsenic, phosphorus and antimony. The tongue is coated white, the taste metallic or sweet as in antimony. However foul eructations are reported.
The mercury-like actions in more prolonged intoxications, the oral and large intestine inflammation as well as the nephrosis have not obtained special therapeutic application up to the present. Salivation and oral inflammation were also observed in the provers. The diarrhoea is said to be painless, accompanied by marked thirst, frequent urination and vomiting. Cardio- vascular symptoms are also not entirely lacking in the intoxication, and are similar to arsenic and antimony only they have no clinical significance, for bismuth outside of the old indication “cholera” in which bismuth played a great role in the previous century. A pinching, pressing pain in the region of the diaphragm and extending diagonally across the chest is probably associated with meteorism. In the provings the pinching, pressing pains and rumbling in the abdomen signify flatulence.
Headache and facial neuralgia alternating with gastric pain is reported with bismuth entirely as with antimony. The cutting or pressing headache is said to pass especially from the right frontal region to the occiput. Neuralgic, pinching facial and tooth pains are said to be worse from eating, better from cold, as long as cold water is held in the mouth.
The mental behavior is like antimony. Anxiety from being alone is present chiefly in the acute gastro-intestinal disturbances. Otherwise dissatisfaction and many complaints about the condition are cited as characteristic for the mental picture.
Chief trend: Stomach: Gastric pain cramp-like, pressing, penetrating toward the back, necessitating bending over. Nausea and spasmodic vomiting, worse from eating, temporary improvement from cold water; fluids are soon vomited again.
Alteration of headache and neuralgia with gastric pain. Dental neuralgia relieved by cold water in the mouth.
Disposition: Anxious, discontented.
DOSE: The lower potencies up to the 6th are customary. I have observed favorable effects from these.