Metallic platinum and the chloride. Triturations from the precipitated metal, and solutions and tinctures from the chloride.
THERE is little new to be related concerning platinum from the toxicological or laboratory point of view. The toxic effects resemble those of gold, but it is more irritant. Small poisonous doses produce tremors, cramps and convulsions, originating in the spinal cord and medulla. Large poisonous doses produce death from paralysis of the central nervous system, mainly through the respiratory centres, preceded by impaired sensation and surface coldness.
The provings present the paralyses of the poisonings as paretic weakness, almost always associated with rigidity or cramp-like pains in many parts. These particular pains are described as constrictive, or as if parts were tightly bound, or bandaged, or laced. This feature is found in (a) the head, where the scalp feels too tight, and the two sides of the head feel as if they were pressed or “screwed” together; (b) at the level of the epigastrium, as if tightly laced; (c) the chest, interfering with respiration; (d) the neck, as if bound up; (e) the lumbar region; (f) the thighs, legs and arms, as if tightly bandaged. It will be unnecessary to repeat this statement in each section.
Another nerve symptom equally general is impaired cutaneous sensibility and numbness, often patchy, and associated with patches of surface coldness; there is “painful numbness.” Muscular weakness if fairly widely disturbed; it is accompanied with trembling, and is worse when at rest and in the evening.
Other points are shooting and pressing inwards in small areas, described as like a plug pressing in- recalling the once familiar “clavus” of hysteria, but not confined to the head.
To most, if not all, these pains of platinic origin is attached to the modality-gradual appearance and gradual disappearance. This forms an important guiding symptom, when present in a patient with other platinum symptoms, and recalls that of another metal-stannum.
Mind.-The mental symptoms of platinum poisoning and provings are definite, but not easy to classify.
(a) There is depression, anxiety and apprehensiveness, coupled with absent-mindedness and forgetfulness. (compare naja).
(b) Closely allied and quite conspicuous is fear: dread of death, although bored with and tired to life; fear of impending evil, of a husband or wife deserting his or her partner in life. Associated with (a) and (b) are palpitation, flushes (without perspiration), oppression of breathing and tremblings, all of nervous origin.
(c) Another class of mentality is rather one irritation and excitement-impatient, quarrelsome, discontented, annoyed if spoken to -hence becoming morose. In this the disposition merges again into depression.
(d) Most definite of all is what may be called a “superiority complex.” The patient is arrogant is possessed of large ideas of his or her own importance, and even of his greater bodily size and strength than other people’s. Consequently there is a delusion of other people’s unimportance and mental inferiority, and the illusion of objects and people smaller than they really are. It is more a mental than an ocular phenomenon. This contemptuous or superior feeling may be worse in the evening and indoors and modified in the open air. Physical and psychical symptoms may alternate in severity.
The pride and over-estimation of one’s self adumbrates the elation of the manic phase of manic depressive anxiety. Paraphrenia and mania and obsessional (sexual) states are mimicked if not produced, and for such states and for menopausic “confusion” and loss of self-control the drug must receive respectful consideration.
Head.-The headaches are worse in a warm room and in company.
The paulatim modality obtains here. A weight on the vertex is felt, and a tight feeling (temples); numbness, itching and crawling are experienced, and extend from the head to the lower jaw, with coldness of the parts. Vertigo-giddiness-is felt on descending, even on so slight a downward movement as sitting down. It is very characteristic.
Eyes.-Numbness is found here also-in the eyelids. There is intermittent cramp-like pain, especially in the right orbit, and twitching of the lids. Objects seem smaller than they are in reality.
Ears.-Numbness, coldness, crampy pain and twinges of pain in the right external ear extend to the cheek and lips. Various noises in the ears are reported by provers (and patients)- roaring, rumbling, “whizzing.”
Face.-Here again numbness is present, especially in the left malar bone; also coldness about the mouth. The face is usually pale and shrunken, but sometimes feels burning nevertheless.
Mouth.-Pain in the teeth, with numbness in the lower jaw, is felt, worse in the morning after rising. The tongue may feel burnt and has a crawling feeling.
Stomach.-Poisonous (experimental) doses given to rabbits have caused softening and exfoliation of mucous membrane, and in one instance perforation of the greater curvature of the stomach. Provers experienced ravenous hunger, with disposition to eat greedily and hastily. Nausea and anxiety are present, and fermentation and flatulence are associated with loud morning eructations.
Abdomen, &c.-There is a feeling of pressure downwards towards the pelvis and genitals, as during menstruation, accompanied with ill humour, also drawing pains in the groins from the loins. Drawing pains in the region of the navel, as from a string, causing a sensation of retraction of the abdomen (cf. plumbum). The action of the bowels is difficult in two ways. The motion is liable to be hard and dry, “as if burnt,” and there is little expulsive power-a great effort is needed to secure relief. There is another more characteristic form of stool, sometimes as like putty; this may be correct as regards consistence, but the stool has a sticky nature, adhering very disagreeably around the anus, and is more like soft clay (though not in colour). Not many drugs cause or cure this kind of constipation (compare alumina and anacardium). The dry constipation is brought on sometimes by travelling-irregular meal times and unusual diet-and resembles plumbum.
Sexual Organs.-There is hypersensitiveness to touch, with voluptuous crawling and tingling in the back and abdomen, and extending to the perineum and external genitalia, male and female. In the former excessive erections and sexual dreams may occur, with palpitation and oppression. In women there is a dragging, like prolapse- “bearing down.” Sexual desire is abnormally increased in both sexes, amounting to erotomania, especially in women.
A pressure felt in the mons veneris is experienced at the same time as chilliness and cold surface, except the face.
Menstruation is brought on early, is freer than usual, and the blood is dark and clotted. In the intervals there is a frequent sensation as if the menses would appear. Leucorrhoea like the white of egg precedes and follows the period. The Hyperesthesia of the pudendum may be so great as to prevent the wearing of suitable protection during menstruation, may cause vaginismus, prevent vaginal examination and entirely preclude coitus.
Chest.-Breathing is oppressed by the ubiquitous feeling on constriction-necessitating an effort which the patient feels too weak to accomplish; crampy pain is felt in the left shoulder. A dry, nervous cough with palpitation comes on.
Neck and Back.-Numb, tense, feeling in the nape of the neck, and weakness of the cervical muscles, so that the head falls forward, as if too heavy to be supported by its muscles. Lumbar pain is felt, especially on bending back and on pressure. The coccyx feels numb and bruised on sitting, as if from an injury.
Limbs.-A weak, paretic feeling is felt in upper and lower extremities, but rigidity (especially of the forearms) is mixed therewith. The hands and legs tremble.
Fever.-No definite pyrexia appears to be caused by platinum, but there are sudden flushes of heat, especially in the face. Local patches of coldness also exist, ex.gr., on the right side of the face and elsewhere.
The mental symptoms of paragraph (d) (Mind section, p. 739) have led to the use of platinum in definite insanity with admirable results. The state of mind strongly suggests that of a general paralysis patient with his grandiose ideas. Less characteristic are cases of another nature, namely, religious depression and melancholia. The irritability, depression and fears (especially fear of impending death and weariness of life) may be utilized in the selection of platinum wherever present in a patient. Many of the symptoms simulate hysteria. The excitibility, alternating with depression, even weeping, the anxiety over things not serious, the irritability at trifles, the moody, sulky phases are found in that condition. Fright, excitement, shock, disappointment, or prolonged haemorrhage may be causes of disorders of mind and body which require this remedy. The alternation of physical and psychical states or symptoms indicates it (compare actaea, lilium).
Constipation, with hard, dry stools or with adhesive, sticky faeces may be cured by platinum. The former often occurs when the patient is travelling. The latter is more characteristic.
Sexual System.-Exaggerated sexual excitement, after labour or at other times; in men less frequently than women, in young single women, or even girls, with the excessive pudenda sensitiveness may amount to erotomania. Local itching and tingling, extending from the vulva up towards the abdomen, sometimes seem to excite this sexual erethism. Profuse and premature menstruation of dark, clotted blood may accompany the mental symptoms.
Masturbation in young boys has been checked by the administration of platinum.
Convulsions of an hysterical nature may call for it; less likely, puerperal convulsions; it has been used for ovaritis and metritis, and it may certainly be indicated in what appears to be ovarian neuralgia, especially, if on the right side, with burning pain in paroxysms, sensitiveness to touch, &c. Prolapsus uteri, much like lilium or murex cases, may require platinum if its mental characteristics are prominent.
The headaches of platinum patients have been described. They may be definitely neuralgic, with the gradual onset and departure of the pain. Numbness of scalp is very frequent, spasms or twitchings of the eyelids, sparks before the eyes, oversensitiveness of the sense of smell and tinnitus aurium (one or more of them) may accompany the headaches. The main digestive symptom is ravenous hunger, often a pregnancy symptom. Flatulence upwards or downwards may be embarrassing. Definite colic, like lead colic, may require platinum, indeed it has been used to antidote plumbism.
(1) A sense of tightness, constriction, or of being tightly bound up in many regions.
(2) Numbness is often associated with the foregoing.
(3) Grandiose ideas-of a person’s own superiority and size, a delusion of steadily growing larger; consequent contempt of others who seem inferior; persons and objects seem smaller than in reality.
(4) Weakness nd trembling, or rigidity; pain like a “plug” pressing in (clavus hystericus).
(5) Alternation of mental and physical symptoms.
(6) Gradual onset and departure of pains.
(7) Sexual excitement and sensitiveness of genitalia to touch, may amount to mania, especially in women.
(8) Vertigo on descending, even slightly, ex.gr., on sitting down.
(9) Right side affected more than left.
(10) AEtiological factors; grief, fright, vexation, pride, masturbation.
(11) Used for Vaginismus, nymphomania, satyriasis: and Hyperesthesia of surface-genital and general or patchy. Insanity, especially general paralysis of the insane.
(12) Constipation, especially with sticky faeces.
(13) Dark, thin people, of sanguine temperament and rigid fibre, are especially susceptible to platinum.
Touch, pressure during menses, evening, warm room, in company, travelling (constipation).
Open air (headache), movement.