Triturations of Gold Leaf or Precipitated Metallic Gold, or Dilution of Gold Salts.
IN the following account the effects and uses of metallic gold are not differentiated from those of the chloride (aurum muriaticum) and double chloride of gold and sodium (aurum muriaticum natronatum).
Experiments and poisonings show that multiple ulcerations of the stomach and intestines are caused, with vomiting, diarrhoea, anorexia and rapid emaciation. There may also be dyspnoea and suffocation leading to death (dogs) from hepatised patches of lung, which are non-crepitant and sink in water.
In chronic poisoning the stress of the drug falls upon bony, cartilaginous and glandular tissues and on fibrous membranes and stroma.
Ulceration, caries and necrosis develop in advanced cases, but suppuration is unusual.
Mental symptoms are very conspicuous. A man taking pills of gold leaf complained that he was “going crazy,” “becoming imbecile,” was “in utter despair and melancholy,” and “felt like committing suicide.” He had loss of self-control and memory and was irritable from the slightest cause or if disturbed from his melancholy.
The drug is well known to cause great depression and a longing for death because of a feeling of inability to succeed in anything, and a general presentiment of coming misfortune: also alternations of hilarity and weeping; aversion to noise is another aurum effect. These symptoms are all useful as therapeutic indications for the drug.
Restlessness, with a hurried feeling like that produced by argent. nit., is not less marked- “can’t do things fast enough.”
General over-sensitiveness is present, not only to pain and touch, but of the special senses-hearing, taste, vision and smell, unless indeed the last named has been lessened or lost through damage to the tissues of the nose by the drug or by disease.
Nose- In the patient above referred to with mental depression, there were also induced offensive watery discharge from the nose and posterior nares, and gnawing pain in the bridge of the nose.
In another case severe coryza and violent croupy cough were present.
This coryza with offensive discharge and pain in the bones have led to its use in syphilitic ozaena, with excellent results. The nostrils are painful and are stopped up with crusts of dried discharge; itching, smarting and soreness are present. It is believed that aurum will arrest the progress of caries of the bones of the nose (especially the spongy bones), with its accompanying, foetid discharge. If due to abuse of mercury the result is equally good, and any symptoms of hydrargyrosis are amenable to the remedy.
To save repetition the pathogenetic and curative powers will be considered together.
Alimentary System.- The ulcerations produced in the lower animals are paralleled in the human subject by dry tongue, red throat, gastritis, colic and diarrhoea, accompanied by cramps and pains in the limbs, heat of skin and sleeplessness. These powers have been little utilized therapeutically, but there is no reason why, if occurring in a patient with the mental and general symptoms of gold, they should not be made use of with confidence of success.
One or two other symptoms are worth recording and may be found in connection with affections of some other areas-cardiac, hepatic, &c. They then become confirmatory indications. These are “excessive hunger” and sometimes considerable thirst, associated with slight faintish nausea; flatulence with rumbling, or with pain in the hypochondria, especially the right, and offensive taste in the mouth and odour of the breath. The bowels are most commonly constipated (except in acute intestinal conditions) and the stools are hard, large and lumpy.
The urine will be turbid on standing.
Mind.-All the mental symptoms already mentioned can be utilized as therapeutic indications, where there was a tendency to suicide, and in puerperal melancholy, where the patient wanders about speechless and with a countenance devoid of expression.
A despondent weeping condition due to grief or disappointment may likewise require aurum; or fears of evil or of nothing definite, or irritability and annoyance at contradiction or opposition equally suggest it. Hypersensitiveness to noises is part of a general hyperaesthesia, but it has the local peculiarity that music relieves or soothes.
In men a form of hypochondriasis associated with disease or atrophy of the testicles has been benefited by aurum, and a puny immature state of boys with undescended testicles or small undeveloped testes has been quite by it. The depression and despair of adults may be associated with manifestations of syphilis, for which disease gold in pill form has long been used empirically. It is chiefly suited to the tertiary stages and especially to bone affections.
The bone pains of gold are of a boring character and are worse at night and from the warmth of bed (merc.) The bones are sensitive to touch and the patient is hypersensitive generally.
Though the caries and ostitis amenable to gold are often syphilitic they may be of tuberculous origin. In periostitis and tertiary periosteal nodes it is a leading remedy.
The genital, lymphatic, salivary and some of the endocrine glands are all liable to be affected by gold, which appears to induce a chronic cirrhosis of them, especially of the testes, uterus, submaxillary and parotid glands.
The drug has been used to clear up swelling at the angle of the jaw after mumps. In men, swelling and hardness of the testes following gonorrhoea, associated with excessive sexual desire, seems amenable to aurum. The right testis is more commonly influenced by it. In women, redness, heat, swelling and smarting of the vulva, of subacute intensity, and with thick, white or yellowish leucorrhoea, are caused by aurum- and correspondingly may be cured when the other symptoms agree. This occurred in workers and was worse when walking. Menstruation is liable to be early and profuse and the flow acrid; leucorrhoea may be present and it is also acrid and offensive. Aurum has been used for chronic metritis with menorrhagia and bearing-down like prolapsus. Uterine fibrosis may be benefited by it or by platinum, which has features of resemblance to gold.
Sterility and vaginismus have been treated with success by a aurum, the general and mental state of the patient being the chief guides to the choice of the remedy.
Head.-Vertigo worse on stooping, walking in the open air and sometimes on the slightest movement, with tendency to fall to the left associated with double vision and sparks before the eyes, indicates aurum in cases of high blood-pressure, whether due to temporary conditions or to arterio-sclerosis and interstitial nephritis. The headaches of aurum are of a throbbing character worse from mental exertion; or there may be heat of the vertex or severe pain on the left side which seems to pass from the left side at the back through the head to the forehead; movement aggravates. The scalp and even the skull are tender to touch. Pains extend to the left side of the face. Some head pains are relieved by local warmth.
Eyes.-A slight degree of conjunctivitis is induced-shown by heat, feeling of sand in the eye, burning in lids and canthi, and sticking together of lids.
Deeper symptoms are pain in the eyeball, worse from moving the eyes; pain definitely described as tension. This led Hughes to suggest its possible use in glaucoma. There are disturbances of vision-such as part of an object appearing to be covered as if by a dark veil, lower half only of objects being visible; or weakness of extrinsic muscles causing double vision. These symptoms together with the cardiac symptoms have led to its use with benefit in nicotine (tobacco) poisoning. It has also gained a reputation in alcohol poisoning and may meet some of the functional disturbances due to that drug. It seems more likely to be of value in the last two conditions than in glaucoma.
Protrusion of the eyeball is a symptom which has attracted attention in aurum cases, and this, together with the cardiac symptoms and thyroid involvement due to the drug, commends its use in some cases of exophthalmic goitre.
In tuberculous subjects, with keratitis and ulcerations of the cornea with some photophobia and pain in the bones of the orbit, aurum has a considerable reputation. Its curative virtues extend to corneal opacities in youth subjects who are weakly or of a tuberculous tenderness and to syphilitic iritis. This should not prevent the ulcer of atropine as a mydriatic.
Circulatory System.- A good deal of use has been made of aurum as a remedy in erethistic conditions of the circulation. There are flushes of heat, followed by perspirations, hot face, quick and forceful beating of the heart (palpitation), which may be irregular and is easily quickened by noises, excitement or opposition; intermission and extra systoles are common-a beat is missed and the heart next “gives a sudden hard thump.” Local pulsations, ex. gr., in head and neck, palpable and visible, are prominent. The patient is restless and feels hurried (argent. nit). Cases of endocarditis or myocarditis may require aurum.
A valuable general symptom in aurum cases is great desire for fresh air and to be out in open spaces.
This is often very marked in the erethistic cases under consideration. The patient, however, dislike and suffers from the cold, and in particular likes his head to be warmly covered when aching-even if it already feels hot. Asthma, however, is worse from warm air, and the bone pains from the warmth of the bed. It is by attention to minute such as these that an accurate and successful prescription is made.
Such conditions of “erethism” are not uncommon at the menopause or from anxiety or mental strain. Over dozing with mercury (in bygone days) produced a broken down condition of health (see mercurial poisoning), physical and mental, resembling gold-poisoning,m for which in minute doses gold has been used as a remedy. It has been recommended for fatty heart and though it cannot be denied that, given a close similarly of symptoms, it might benefit patients with that condition, it is more likely to help those with hypertrophy, with fibrotic interstitial changes, due to syphilis or associated with nephritis and cirrhosis of the liver and in gouty subjects. Angina pectoris is another condition for which gold has been recommended, it is more likely to be useful for the underlying condition than for the paroxysms. For cardiac asthma it may be useful but less so far bronchial.
In these cases of circulatory disturbance the mental condition is one of depression in some form, suicidal, religious or some state which may be called by that apt modern term an “inferiority complex.” When organic changes are present the double salt-aurum mur. nat.- has chiefly been used.
Kidneys.- Hughes quotes Bartholow, an (orthodox) English therapeutist of last century, as recommending the chloride for granular and waxy kidney. There are not many indications for it- diuresis, apparently passing more urine than the fluid consumed, and swelling of feet being the chief. It associated with headaches and symptoms suggesting chronic liver or heart disease, aurum must come in for consideration.
Respiratory Symptoms.- The dyspnoea of aurum cases is cardiac rather than pulmonary; it is a more of less permanent condition, with suffocative attacks at irregular intervals, brought on by excitement, slight exertion or flatulent distension, worse at night and when walking. Restlessness and “fidgets,” irritability, depression, even to desire to die, characterize the patients.
Movement.- On the whole the symptoms of aurum patients are aggravated by movement, especially bone, joint and chest symptoms. Occasionally the motion modality may conflict with the temperature modality or with the craving for open air, and sometimes one and sometimes the other may predominate, e.g., movement may relieve because it generates warmth or takes a patient into the open air: or the desire for open air may predominate and bring relief in spite of general tendency to aggravation from movement or cold.
Sleep.- The nights are restless and disturbed by anxious dreams, the patient sobs during sleep. The pains (bones) may be so great as to prevent sleep and drive to despair.
The dreams are vivid but may not be remembered; or they may be of robbers, causing the patient to cry out, of falling from a height, of people who are dead and of dead bodies, or of an erotic nature. There is drowsiness in daytime, with yawning after eating.
Alternatively there may be an excited condition-no sleep, no pain, and yet no sleepiness or tiredness the following day.
Subjects most amenable to the therapeutic influence of aurum:-
(1) It is valuable especially for the ailments of old people with a tendency top stoutness.
(2) Also for restless people, with apprehensive disposition, always in a hurry.
(3) For ailments common in sanguine people with dark complexions.
(1) The mental state- a marked “inferiority complex” from a feeling of apprehension and inability to cope with daily duties up to desire to die; suicidal and religious melancholy.
(2) Combined with or alternating with above, irritability and peevish outbursts; opposition excites anger.
(3) A restless, hurried, nervous, fidgety condition of mind and body.
(4) General craving for open air, but aversion to cold; walking in open air, however, may cause giddiness.
(5) Hyperaesthesia of special senses and common sensation.
(6) Ailments from grief, disappointment, fright and mental strain.
(7) Pains worse at night (“from sunset to sunrise”) on the left side (except right testis and right hypochondrium); from warmth of bed and by lying still.
(8) Affections of bone and periosteum, especially those due to tertiary syphilis or mercurial overdosing.
(9) Nasal discharges: offensive, dry up and block nostrils: ozaena; caries.
(10) Excited circulation, palpitation and pulsations local and general,” organs ” of blood to head and other parts; menopausic flushes.
(11) Cardiac irregularity; cardiac asthma;cardiac myoses.
(12) Glandular indurations; lymphatic, reproductive, salivary, alimentary, thyroid.
Movement (bone and chest pains), but see p.218; night (bone pains); cold air (except asthma), but also warmth of bed;lying down; at menstrual periods (melancholia).
From getting warm (except bone pains in warm bed): in the morning.