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of the indigestion, and depressed or deranged innervation of the stomach
existed: in diarrhoea from nerve-irritation, cerium was also successful;
" it seems to have the power of diminishing reflex excitability of the ali-
mentary tract; "in dysentery, gastric ulcer, cancer, gastro-enteritis, he
tried the medicine, but with less satisfactory result (Medical Record,
March, 1876).

11 Chronic Cough." Mr. Clark has recorded cases of chronic lung-
disorder with some partial consolidation, and accompanied with dyspnoea
on exertion and violent morning cough producing sickness, the symptoms
were much relieved by the (apparently) sedative effect of oxalate of
cerium, given in 5-gr. doses half an hour before rising (Practitioner,
April, 1878).

^Epilepsy. Dr. Ramskill has recorded two cases of epilepsy preceded
by a " gastric aura " I.e., " a sense of faintness, and of something turn-
ing upside down at the epigastrium " which were benefited by the
oxalate of cerium, when belladonna and bromides had failed to relieve.
Cases of epilepsy without this aura were not benefited, and Dr. Ramskill
suggests that in the gastric cases there was a primary failure of action in
the splanchnic nerves, that the medicine acted as a sedative and conser-
vator of their power, and that this influence being conveyed to the me-
dulla lessened its excitability (Medical Times, i., 1862). The cerium salt
has at least this advantage over nitrate of silver, that it will not darken
the skin.

PREPARATION AND DOSE. Cerii oxalas: dose, 1 to 5 gr. or more
according to Dr. Image, 10 gr. For an infant or child under two years,
i to gr.



116 MATEEIA MEDICA AND THERAPEUTICS.

[PREPARATION, U. S. P. Cerii oxalas.]

ADULTERATIONS. Mr. H. Greenish asserts that commercial oxalate of
cerium contains a large proportion of the oxalates of lanthanium and didy-
mium, and that the pharmacopceial test does not exclude their presence;
this may possibly account for failure in some cases (Medical Record, 1877).



CUPRUM COPPEK, Cu,=63.4.

This metal (which has its name from Cyprus) is now obtained chiefly
from the mines of Cornwall, of the Pyrenees, and of Fahlun in Sweden,
in the form of a double sulphide with iron (copper pyrites, Cu^Fe^S,):
an oxide, a sub- or red oxide (cuprite), and an oxycarbonate (malachite),
also occur, as well as arseniates, phosphates, etc.

The metal is extracted from the ores by a process of roasting and
fusion; a purer form by electrolytic decomposition of the pure sulphate.

Brass is a compound of copper with zinc (but often contains some
lead), and bronze is an alloy of copper, tin, and zinc: ordinary commer-
cial copper may contain arsenic.

CHARACTERS AND TESTS. Copper is the only red metal; it is lustrous,
malleable, and ductile, of sp. gr. 8.92; unaltered in dry and cool air, in
moist air it becomes coated with hydrated carbonate, and at a red heat is
oxidized. In contact with acids, alkalies, or fats, it is readily acted on,
with formation of various green compounds, acetates, or oxides, commonly
known as verdigris. It is soluble in nitric acid, in sulphuric acid with
heat, and in hydrochloric acid if air be present, also in ammonia. It
forms cuprous and cupric salts.

Tests may be remembered by their color, as (1) the red test, shown by
immersing clean iron in an acid solution of copper, when the red metal
will be deposited; (2) the blue test, shown by the coloration produced
with excess of ammonia; (3) the brown test, by the bulky reddish-brown
precipitate which occurs with ferrocyanide of potassium (R. W. Smith).

CUPR1 8ULPHA8 SULPHATE OF COPPER BLUE VITRIOL COP-
PERAS, OR BLUE STONE, CuSO<,5HoO,=249.4.

PREPARATION. By dissolving copper in sulphuric acid, with the aid
of heat,

Cu + 2H a SO 4 , = CuS0 4 , + 2H 2 O, + SO 3 ,

treating the product with hot water, filtering, and crystallizing.

CHARACTERS AND TESTS. Occurs in oblique prisms of deep blue
color, and metallic styptic taste; soluble in 4 parts of cold, and 2 of
boiling water, insoluble in alcohol, efflorescing slightly in dry air. The



COPPER. 117

anhydrous salt is white, but turns blue when moistened with water, and
hence serves as a test for the presence of water in absolute alcohol. The
sulphate answers to the tests for copper already given, and like other
sulphates, gives a white precipitate of sulphate of baryta with barium
chloride.

Ammonia- Sulphate of Copper in solution is used as a test for the
presence of sulphides in liq. ammonite fort., and also as a test for arse-
nious acid, with which it produces a light-green precipitate of arsenite of
copper (Scheele's green).

SUBACETATE OF COPPER VERDIGRIS AERUGO, Cu(C 2 H 3 2 ) 2 CuO.

PREPARATION. Manufactured by exposing copper plates to the action
of pyroligneous acid.

CHARACTERS. Occurs in powder, or lumps of small crystals, bluish-
green in color, of sour odor, and metallic taste. A solution is officinal
as a test for butyric acid in valerianate of zinc; the acid is precipitated
by it.

ABSORPTION AND ELIMINATION. Metallic copper, even when pow-
dered, is not usually absorbed. Drouard gave large doses to animals,
without any result (Paris, 1802), but when finely divided, some may be
rendered soluble by the gastric acids, and traces may be detected in
the urine and saliva (Mialhe, Mitscherlich, Portal). Copper coins have
often been swallowed with impunity, but profuse salivation is recorded
in the case of a child after swallowing a penny (Barton, quoted by Gub-
ler). That the sulphate can be absorbed from wounds has been both
affirmed and denied. Langenbeck and Stadeler have traced poisonous
symptoms to this cause only when fatty acids were present, but Blodig
reported vomiting from a single application of cupric caustic to the con-
junctiva: such absorption, though it may occur, is certainly not frequent
(Husemann). Workers with alloys or salts of copper absorb it, for their
secretions, hair, and teeth may be colored green by it during life; it has
been found in their urine, and after death in the bones, and even in the
earth in which they are buried (Millon: Bulletin de VAcad'emie de Mede-
cine, t. xii.). Soluble salts of copper combine with albuminous secre-
tions and form a bluish coagulum; this, when resulting from a salt of an
organic acid (as the acetate) is still soluble, but from a salt of a mineral
acid (as the sulphate) it is more resistent (Mitscherlich). In any case,
only a portion of even a moderate dose is absorbed into the blood, and
this probably as an albuminate the larger portion passes off by the
bowel, and appears in the dark brown faeces as sulphate.

Elimination occurs by the bile, the saliva, and bronchial secretion
(Flandrin and Danger: Annales de Therapeutique, vol. i.) : these ob-
servers did not detect it in the urine, but others have done so. Elimina-



118 MATERIA MED1CA AND THERAPEUTICS.

tion is slow, for Orfila found copper in the viscera seventy days after its
use had been omitted. It is apt to be deposited in the liver especially.

It must be recognized as a very usual constituent of the normal or-
ganism. Sargeaux detected it in the blood of many animals, and Odling
and Taylor in the liver, kidneys, and other organs, irrespective of poi-
soning ( Guy's Reports, 1866). In the bodies of domestic animals fed on
vegetable food Wackenroder found no perceptible amount of copper, but
in snails and shell-fish comparatively much; in man and carnivorous ani-
mals he found also a rather large proportion both of copper and lead, and
concluded that they were derived from the nutritive or medicinal sub-
stances taken (Abstract in British and Foreign Review, 1855). Odling
and Dupre found copper in bread, flour, shell-fish, etc., and in the human
liver and kidneys, not invariably, but usually (Guy^s Reports, 1858).
Stevenson remarked that copper might be derived in the course of an
analysis from a copper lamp used for incineration, so that the greatest
care is required in such investigations (Lancet, ii., 1872). Schwartz-
enbach found 0.004 gramme of copper and rather more lead in 2,100
grammes of liver (British and Foreign Review, January, 1857); Orfila
had reported ten times as much. More recently, the average amount
found in the entire liver and kidneys in fourteen bodies was 2 to 3
milligr. (- s to -fa gr.), and it was found also in the foatus. The speci-
mens used in the investigation were carefully chosen as not having been
exposed to absorption of copper, and the metal was excluded from all
apparatus employed. We may therefore conclude that any quantity
above 4 milligr. (^ gr.) found in these organs is abnormal, and results
from direct administration of the drug (Bergeron and 1'Hote, quoted
Lancet, i., 1875, p. 255). In the case of the two wives of Moreau, 120
milligr. and 80 milligr. were found respectively (British Medical Journal,
ii., 1874, and i., 1875). In a case where ammonio-sulphate of copper had
been taken three months before death, nearly 300 milligr. (4 gr.) were
obtained from the liver, a good instance of its slow elimination (Bourne-
vette and Yvon: Revue Scientiftque, 1874, p. 859). Rabuteau found 16
ctgr. (2 gr.) in 1,000 grammes liver also three months after the last dose
43 grammes in all of ammonio-sulphate had been taken ( Gazette Heb-
domadaire, March, 1877).

PHYSIOLOGICAL ACTION (EXTERNAL). The sulphate, which is the salt
most commonly used, has little action on the sound skin, but when applied
to wounds or mucous membranes, it coagulates the albumen, and forms a
thin film on the surface. The pure salt, or its concentrated solution, acts
as a caustic; weaker solutions act as stimulants and astringents, both
forms producing more or less condensation of the neighboring tissues.
They exert, also, some antiseptic power, partly by decomposing sulphu-
retted hydrogen, and partly by destroying low organisms, whether animal
or vegetable. Any conclusions drawn from the effects of the smoke and



COPPER. 119

vapors of copper foundries are rendered doubtful by the coexistence of
sulphurous acid, arsenic, etc. Vegetable life of all kinds is destroyed in
the immediate neighborhood of such works.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. In the lower
animals, salts of copper seem to be uncertain in their effects, at least
when given by the mouth. According to Orfila, vomiting is the earliest
and most marked symptom, and Drouard found that 12 gr. of sulphate
caused fatal gastric inflammation in dogs. On the other hand, Galippi
could not poison dogs with pure copper salts, for small doses were toler-
ated, and large ones were so nauseous that he could not get enough swal-
lowed or retained (Bulletin de Therapeutique^ 1875). Ducom and Burq
also report that dogs can take from 15 to 60 gr. daily of soluble salts of
copper for a varying time without ill-effect on the general condition, with
the exception of vomiting at first; long continuance of this medication
at length impaired appetite and digestion, and thus led to death from
exhaustion (Bulletin de Therapeutique, 1875).

In man, small doses (^ giv) of a soluble salt of copper exert a tonic
astringent action, but if continued for a long time impair appetite and
digestion, and cause diarrhoea from irritation. The effects of frequently
repeated minute doses have lately excited special attention, on account
of the adulteration with copper of many preserved vegetables. Thus, in
the French preserved green peas, 0.31 to 0.56 gr. has been found in each
tin, and by some chemists, and even medical men, this quantity has been
pronounced injurious (M. Pasteur and others: British Medical Journal,
1876-77). Vulpian, however, says that any copper compound contained
is insoluble and harmless, and that no evidence exists to the contrary; and
Galippi, after the crucial test of eating them freely for some time, found
no bad result (British Medical Journal, i., 1877). In a 4-lb. loaf of bread
.4 to 1.8 gr. has been found, and the latter amount might become serious
(Medical Times, i., 1871, p. 509). Doses of 1 to 3 gr. induce a sense of
constriction in the gullet, and vomiting occurs in a few minutes without
much nausea, and is commonly attended with diarrhoea; 5 to 15 gr. act
as a powerful irritant emetic.

Lauder Brunton and West have experimented to ascertain whether
cupric salts cause vomiting by irritation of the stomach or of the vomi-
tive centre in the medulla. Into the jugular vein of cats they injected
a neutral albuminate of copper (which would not cause coagulation of
blood), and retching and vomiting followed. Previous section of the
vagi did not prevent the retching, but it did prevent evacuation of the
stomach, and after section of the vagi and the splanchnic nerves neither
retching nor vomiting occurred: hence they conclude that these symp-
toms depend upon gastro-intestinal irritation, not upon a direct excite-
ment of the central organs (St. Bartholomew's Hospital Reports, 1S7G).

Toxic Action. Half an ounce given at one time by the mouth pro-



120 MATERIA 3IED1CA AND THERAPEUTICS.

duces severe symptoms of irritant poisoning, including metallic taste,
feeling of constriction, thirst, salivation, nausea, vomiting, purging, and
severe cramping pain with tenesrnus; the abdomen is distended and ten-
der, the evacuations greenish or containing blood; the face may be
flushed and swollen, the gums ulcerated, and sometimes jaundice occurs;
death may follow from enteritis or exhaustion within a few hours or
days. From 1 to 2 oz. of sulphate or acetate may be reckoned a fatal
dose, though recovery has occurred after 5 oz., when vomiting has been
free (Toussaint and others); in practice a fatal issue is rare.

Blandet asserts that enteritis, though commonly produced by carbon-
ate or acetate of copper, does not occur from the sulphate, and in one
case, where 300 gr. were taken, vomiting, suppression of urine, and sub-
sultus occurred, yet recovery took place without enteritis {Medical
Times, i., 1874); the danger of the drug has doubtless been exaggerated,
and Honerkopf gave in seventy-two cases, 5 grammes, and in eighteen
cases, nearly 3 grammes without injury, but in other cases enteritis has
been caused by it.

Acute copper -poisoning occurs most often from accidental contamina-
tion of food cooked in copper vessels, which, when perfectly clean and
pure, are not harmful, but under the influence of air and moisture, vine-
gar, salt, or hot fats, carbonate, acetate, and oxychlorides of copper are
formed, and the admixture of these salts (" verdigris ") with the food is
exceedingly injurious, causing severe colic, vomiting, headache, and py-
rexia; tympanitis is sometimes very marked, and numbness and tremor
of the limbs have been noted (Taylor, Armstrong: Medical Times, 1844).
Similar symptoms, with scanty urine and excoriations about the mouth,
followed the use of water boiled in a copper kettle, and of injections from
a brass syringe (Amyot: Medical Times, 1859; Boggs: Lancet, 18G9).
An epidemic, much resembling dysentery, occurred on board an Indian
emigrant ship from using copper for the cooking of rice with ghee or
butter (Moore: Lancet, 1846). If only one portion of the contaminated
food has been taken recovery is usually rapid and complete, in proportion
to the amount of vomiting; but if more be taken and not rejected, there
remains a tendency to colic, vomiting, or diarrhoea, with much debility.
Should death follow, there will be found intense redness of the intestinal
tract or actual ulceration, according to the stage of the poisoning; perfo-
ration is rare (Taylor).

Chronic Copper-Poisoning "Cuprismus Chronicus" While by
some observers this condition has been described as marked and frequent,
by others its existence has been denied, and the symptoms explained by
adulteration with lead, etc. The truth lies between extreme views
some amount of copper-poisoning may be traced among workers with
the metal, but it is not very serious. Working in pure metallic copper
without heat causes no bad symptoms (Ilirt, Maisonneuve), but particles



COPPEK. 121

of oxide and cupric salts in the air of heated rooms may induce dyspnoea
and laryngeal spasm. " Gold-printers," working with brass-alloy in fine
powder, sometimes get vomiting, gastric pain, and anaemia; the hair be-
comes green-colored (Taylor). Dr. G. Harley has described a case of
.sudden colic with nausea, but neither diarrhoea nor constipation, in a
copper-plate printer after cleaning plates coated with verdigris: there
was a purple line on the gums (Lancet, 1863). Blandet was the first to
describe a more serious chronic cuprismus as existent in Paris workshops,
and marked, besides the green coloration, by colic with remissions, fever,
lassitude, nausea, bilious vomiting, and diarrhoea, alternating with con-
stipation ( Gazette Medicate, 1845). Sir D. Corrigan recorded seven in-
stances in brass-founders and engineers with similar symptoms, also
emaciation, cough, and night-sweats; but two of these had organic lung
disease, and the cases are not conclusive (Dublin Hospital Gazette, 1854).
A band of light or reddish-purple on the gum-margin is described as
characteristic, but really indicates an inflammatory condition which may
arise from other causes (Bucquoy: Union M'edicale, i., 1874). Bailly
describes the true copper bluish-green or blue line as on the teeth only,
not on the gum, which, however, was commonly inflamed: by analysis he
detected copper in the blue line. Perron reported the prevalence of dys-
pepsia, " enteritis," and phthisis, among Swiss watchmakers working
with an alloy of gold and copper; they had green coloration of the teeth,
but mal-hygiene was a more likely explanation of their impaired health
(Medical Times, 1861). Dr. Clapton brought before the Clinical Society
cases of irritative dyspepsia in a flower-girl and a copper-smith, but his
inquiries about copper-workers verified the absence of any special dis-
ease among them (" Transactions," vol. iii.). Chevallier, after an exhaust-
ive inquiry, concluded Blandet's statement to be exaggerated, and failed
to verify a true "copper colic " (Annales de Hygiene, 1859); any severe
cases were found complicated by the presence of lead in the material
used. Christison and Chomel reached the same conclusion. Hirt, while
allowing that verdigris-makers may suffer from intestinal catarrh, and
even from some amount of paralysis, blames rather lead, zinc, or arsenic
in observed cases of severe " colic." I have known brass-founders get
periodic attacks of colic and vomiting followed by rigors a condition
known in the workshops as " brass-founders' ague," and induced when
the alloy is malted, and they are much exposed to its vapor but have
connected it rather with zinc or arsenic than copper. Pecholier and Pie-
tra Santa, reporting on the health of verdigris-workers, describe local
irritation of mucous membranes, but otherwise good health: they note
especially the absence of colic and of chlorosis (Medical Times, 18G4); and
Maisonneuve concluded that though gastro-intestinal disorder may be
induced by such work, the symptoms are neither severe nor persistent
(Ranking, i., 1865).



122 MATERIA MEDICA AND THERAPEUTICS.

Pathological Changes. In animals that had taken copper for a long
time Mair observed softening and degeneration of the liver, and in one
case of poisoning by the sulphate Maschka attributed the jaundice to fatty
degeneration. The kidneys were similarly affected (Sydenham Society's
Year Book, 1873).

Nervo-Muscular System. If f gr. of oxide of copper be injected
under the skin of a rabbit, there will quickly follow unsteadiness in walk-
ing-, which will gradually pass into complete motor paralysis: the respira-
tions and pulse become feeble, and muscular irritability becomes less, till
finally death occurs from paralysis of respiratory muscles (Harnack :
Schmidt's Jahrb., 1874). Falck noted very similar effects, with fall of
temperature and progressive general paresis, ending in death from car-
diac palsy, after hypodermic injection of sulphate, nitrate, and chlorate
of copper (Deutsche Klinik, 1859) ; sensation was unimpaired, and the
paralysis was limited to striped muscular tissue.

It has been remarked that many emetic medicines, e.g., antimony and
apomorphia, produce also muscular paralysis, and there may be some di-
rect connection between it and severe vomiting: in Falck's experiments,
however (with hypodermic injections), vomiting was not produced. In
cases of acute copper-poisoning in men the nerve-symptoms are such as
headache, giddiness, prostration, restlessness, tremor, subsultus tendi-
num, convulsion alternating with stupor or comparative clearness of
mind, and sometimes a motor or sensory palsy, partial and temporary in
character: such symptoms are mainly secondary to the gastric irritation.

Respiratory and other Systems. There is not much to be safid about
the special action of copper on other parts of the body, but in the course
of acute poisoning, respiration becomes hurried and labored, the pulse
small and usually quickened, and the extremities cold; suppression of
urine has been recorded, but among workers in copper, absorbing slight
amounts daily, diuresis was a usual symptom (Clapton).

SYNEEGISTS. Salts of lead and zinc, silver and gold, are allied in ac-
tion to those of copper. Depressing vital conditions favor the develop-
ment of its irritant properties.

ANTAGONISTS INCOMPATIBLES. Metallic sulphides, alkalies, and alka-
line earths, iodides, and vegetable infusions containing tannin, are chemi-
cally incompatible with salts of copper: sugar also reduces them. In
cases of poisoning, the action of sugar is too slow to be effective, and
magnesia, though it may retard bad effects, does not wholly prevent them,
since the hydrated oxide of copper is soluble. Sulphide of iron decom-
poses copper salts, forming an insoluble cupric sulphide, and may be
used, but the best antidote is said to be ferrocyanide of potassium (yellow
prussiate of potash), which should be given freely: the resulting copper
salt is insoluble (Medical Times, ii., 1854). Albumen, which may be given
in the form of egg and milk, forms an albuminate of copper, but this is



COPPER. 123

not inert and should be removed afterward by the stomach-pump (Schros-
der). In phosphorus-poisoning, copper, though praised by Bamberger,
is not so good as turpentine (v. pp. 43-44).

THERAPEUTICAL ACTION" (EXTERNAL). Applied in lotion, ointment,
powder, or crystal, sulphate of copper, " blue-stone," or " blue-vitriol,"
acts as a stimulating astringent, or a moderately severe caustic. It unites
with albuminous secretions to form an insoluble albuminate of copper,
which, acting like a new cuticle, protects the injured part from the at-
mosphere, and promotes the healing process. Equal parts of sulphate of
copper, alum, and nitre, fused with four parts of camphor, form a caustic
of some celebrity known as " lapis divinus," or green-stone.

Tinea Tarsi Trachoma. In these chronic, recurrent disorders of
the eye-lashes and lids, the crusts and muco-purulent discharge, and in
severe cases the lashes, should be carefully removed, and a crystal of cop-
per sulphate lightly applied to the affected parts. This treatment has
the recommendation of Sir W. "Wilde (Dublin Quarterly Journal, No.
10), of Galezowski, and other authorities, and Mr. Williams (Boston) has
published good practical instructions concerning it (Ranking, ii., 1870).
I myself commonly prefer this remedy to either zinc or silver, since it is
milder, and causes less, pain; I generally combine with it the use of a
dilute mercurial ointment.

Aphthous Stomatitis. Sulphate of copper, either applied lightly in
substance, or brushed over the affected part in strong solution, removes
the white curdy deposit and induces healing of abrasions and ulcerations
about the gums: 10 gr. mixed with about 1 oz. of honey is a good form
for its use in children. Sir James Paget recommends a gargle contain-
ing 1 to 2 gr. of sulphate in 1 oz. of water, as useful in salivation, free
purging being secured at the same time (Medical Times, i., 1858). A
similar lotion will destroy diphtheritic membrane.

Indolent Ulcer Rectal Ulceration. The solid crystal of the sulphate
is a good stimulant to indolent ulcers, and a good caustic for exuberant
granulations. Dissolved and used as an injection it is of service in vari-
ous forms of ulceration affecting the rectum, especially, according to Mr.
C. Heath's experience, in the later syphilitic forms, when the dorsal sur-
face, or sometimes the whole circumference of the bowel within two



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