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Chrysotherapy - the treatment of rheumatoid arthritis (RA) patients with monovalent gold drugs possessing anti-inflammatory and other properties - has been used with some success for more than 70 years; however, the metabolites generated from gold drugs have not been identified positively and the mechanisms of action are not known with certainty. This account selectively reviews recent available literature on the history of gold in medicine, with emphasis on RA; the role of Au(+) and Au(+) metabolites (Au(CN)(2)(-), Au(+3), Au(o)) and other mechanisms in chrysotherapy; current treatment regimes for RA using gold drugs; chrysotherapy case histories based on 2166 RA patients; and adverse effects of chrysotherapy, mainly various forms of dermatitis. More research seems needed on the role of gold metabolites in the treatment of RA, the use of more sensitive and uniform indicators of treatment success, improved routes of drug administration for maximum efficacy, and the development of gold drugs with minimal side effects.

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In acute toxicity bioassays with [Formula: see text] at 20 C and 20‰ salinity, the concentrations fatal to 50% of the organisms of various marine species in 96 hr ranged between 0.32 and 55.0 mg/liter Cd2+. The order of sensitivity was: sand shrimp, Crangon septemspinosa (0.32); hermit crab, Pagurus longicarpus (0.32); grass shrimp, Palaemonetes vulgaris (0.42); common starfish, Asterias forbesi (0.82); common soft-shell clam, Mya arenaria (2.2); green crab, Carcinus maenus (4.1); Atlantic oyster drill, Urosalpinx cinerea (6.6); eastern mud snail, Nassarius obsoletus (10.5); sandworm, Nereis virens (11.0); striped killifish, Fundulus majalis (21.0); blue mussel, Mytilus edulis (25.0); sheepshead minnow, Cyprinodon variegatus (50.0); and mummichog, Fundulus heteroclitus (55.0). Mummichogs were more susceptible to cadmium exposures at 20 C than at 5 C and at 5‰ salinity than at 15, 25, or 35‰. Additional studies with mummichogs clearly demonstrated that 96 hr was not sufficient to adequately evaluate cadmium toxicity to this species. Mummichog whole body cadmium residues determined by atomic absorption provided a useful index of cadmium body burden among fish surviving exposure. However, cadmium residue data from dead mummichogs were of limited worth owing to accumulation after death.

Health problems of gold miners who worked underground include decreased life expectancy; increased frequency of cancer of the trachea, bronchus, lung, stomach, and liver; increased frequency of pulmonary tuberculosis (PTB), silicosis, and pleural diseases; increased frequency of insect-borne diseases, such as malaria and dengue fever; noise-induced hearing loss; increased prevalence of certain bacterial and viral diseases; and diseases of the blood, skin, and musculoskeletal system. These problems are briefly documented in gold miners from Australia, North America, South America, and Africa. In general, HIV infection or excessive alcohol and tobacco consumption tended to exacerbate existing health problems. Miners who used elemental mercury to amalgamate and extract gold were heavily contaminated with mercury. Among individuals exposed occupationally, concentrations of mercury in their air, fish diet, hair, urine, blood, and other tissues significantly exceeded all criteria proposed by various national and international regulatory agencies for protection of human health. However, large-scale epidemiological evidence of severe mercury-associated health problems in this cohort was not demonstrable.

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