The White Oxide of Metallic Arsenic. (As2 O3) Solution and Trituration.
PATHOGENESIS
ARSENIC in one of the best known poisons and has been used for criminal purpose from the Middle Ages till the present day. It is also often the cause of accidental poisoning and of poisoning from food contaminated with it, as is illustrated by the poisoning of contaminated with it, as is illustrated by the poisoning of several thousands of persons in 1900 in the Manchester district, from beer in the manufacture of which glucose containing arsenic was used.
In acute poisoning when large quantities of arsenic are taken by the mouth, the patient in about half an hour complains of a feeling of constriction in the throat, difficulty in swallowing and discomfort in the stomach which soon increases to violent pain, with vomiting and later, watery diarrhoea which becomes of “rice water” character like the stools of cholera. There may be blood in the vomited matter and in the stools. Urine is diminished or suppressed. These symptoms are accompanied by headache, giddiness, cramps in the muscles, and soon by collapse with cold damp skin, pallor, feeble pulse sighing respiration, passing into coma and death, with or without convulsions. (see Cushny, sub. voce)
Chronic poisoning may occur after recovery from acute poisoning, but it is more commonly caused by the effects of the ingestion for weeks or months, of small quantities absorbed unawares, as from dust from wall papers containing arsenic, from dyes, from its presence in water, milk or preserved food, or from the handling of pigments impregnated with arsenic used in various arts and manufactures.
The symptoms of chronic poisoning are first, weakness and languor, m loss of appetite, nausea and occasional vomiting, with heaviness and discomfort in the stomach. Diarrhoea may be present. Then the conjunctiva become red and inflamed, coryza comes on with sneezing, hoarseness and coughing from catarrh of the nose and larynx. Swelling of the liver and jaundice may occur. Skin eruptions of various forms arise, papular, vesicular or erythematous; the epidermis falls off in small scales, or from the hands and feet in large flakes (keratosis and desquamation). Pigmentation of the skin of a dark metallic colour takes place, or in fair people it resembles freckles. Later, symptoms of involvement of the nervous system supervene-peripheral neuritis. In the hands and feet are disturbances of motion and sensation, acute pains more or less localized around the knee, ankle and foot, less frequently in the wrist and hand, formication and increased sensitiveness to touch. The palms of the hands and the soles are often red, swollen and very sensitive to touch. Pressure on the muscles causes intense pain. Sensory paralysis may set in, especially in the extremities, and may cause symptoms resembling locomotor ataxia. The sensitiveness to heat and cold may be altered. Following sensory paralysis motor paralysis comes on, which generally appears in the extensors of the toes and the peronei, but any muscle of the limbs may be affected. The paralysis is tendon reflexes are absent. In very prolonged arsenic poisoning the patient may become apathetic, semi-idiotic “epileptic; or cutaneous epithelioma may develop.
In the alimentary canal the mucous membrane of the stomach is red and swollen either in patches or throughout its whole extent; the epithelial lining is in a state of fatty degeneration. Erosion and ulceration may occur. The intestines present a similar appearance, especially around Peyer’s patches; they contain a think fluid with flakes of membrane resembling the “rice-water” stools of cholera.
The blood-pressure is increased at first but soon falls from loss of control of the vasomotor centre and after wards of the splanchnic nerves. The capillaries seem to permit the passage of fluid into the tissues more readily than normally.
In arsenic poisoning all kinds of eruptions are common. It causes proliferation of the epidermis which is increased in thickness, and arsenic has been found in appreciable amount in the hair, nails, epidermis scales and in the fluid of blisters in patients taking it. The pigmentation is not due to an arsenic compound but to the formation of an organic product in the deeper layers of the skin.
The bone-marrow seems to be unusually active, as witnessed by its increased vascularity, the greater number of young red corpuscles and lessened fat cells. The red corpuscles and leucocytes of the blood are decreased in numbers.
The metabolism of the body is affected by a poisonous dose of arsenic, glycogen disappears from the livers which seems incapable of forming it from the food. There is fatty degeneration not only of the epithelium of the stomach and intestines but also of the liver and kidneys, the muscles of the heart, the striated muscles, the blood-vessels and the lining of the alveoli of the lungs.
The prolonged administration of arsenic in doses insufficient to cause chronic poisoning is reputed to stimulate growth and nutrition and when small doses are taken habitually tolerance is established. This is illustrated by the arsenic eaters of Styria and the Tyrol who take it because they think it enables them to work better and to climb mountains with less fatigue and respiratory distress, and also to improve their complexions live to a good age and exhibit no symptoms of poisoning.
Arsenic is excreted for the most part in the urine, but also in the stomach and intestines and through the respiratory mucous membrane; traces are eliminated in the secretions of the skin, and are found in the hair and the milk.
THERAPEUTICS.
The pathological symptoms related above provide a broad indication for the use of arsenic as a medicine, but they give only the main outlines and need to be supplemented by fuller detail. They are obtained from the symptoms of acute and chronic poisonings and are the gross effects. The fine symptoms which distinguish the role of arsenic from other drugs that act somewhat similarly, have been elicited by homoeopathic provings and by the use of the drug in diseased conditions. By these means there have been found to be certain general characteristics which serve as distinguishing marks for its use in illness, and one or more of these should be present to warrant its employment. Arsenic is such a universally acting substance, attacking, as it does, nearly every organ and tissue of the body, and therefore suitable for some cases of nearly every disease, that it is very necessary to be well acquainted with the general characteristics that will reveal it as the similimum in any given case.
(a) In the first place arsenic cases have a tendency rapidly to proceed to what may be called a condition of malignancy. By this is not meant a cancerous condition, though the drug is often indicated in that state, but a tendency for diseases to assume a grave form, to destruction of tissue to a general lowering of the vital forces, and haemolysis, ending, if it be not checked, in death.
(b) This leads us to another characteristic-prostration, a prostration that is out of proportion to the severity of the complaint from which the patient is suffering. He is exhausted after the slightest exertion.
(c) Though there is this prostration the patient is nevertheless exceedingly restless. He is restless with the pains, must walk about with them and grains some relief by doing so. He is also restless independently of pain, a mental more than a bodily restlessness, he feels impelled to move and when too prostrate to be able to do so, wants others to move him, to lift him out of bed, or from one bed or room to another.
(d) Pains have a burning character in whatever part of the body they are situated; in the mucous membranes this can be accounted for the acridity of the secretions of arsenic, but the same burning character distinguishes the neuralgia; there are also burning pains in the glands, and there is often a sensation of hot fluid coursing through the blood-vessels.
(e) though the pains are burning yet the arsenic patient himself is a very chilly person, feels the cold much, has cold hands and feet, and shrunken skin and wants to sit by the fire well wrapped up. He cannot bear a draught of cold air (compare hepar, kali carb., rhus, silica, &c.). All the pains are relieved by warmth, except the congestive headaches which are better from cold.
(f) Periodicity is a feature of arsenic. It is one of the few medicines capable of producing a true recurrent fever. Remissions and intermissions are common. For this reason it has been much used in malaria affections. The periodicity is every other day, every fourth, seventh, or fourteenth day: the more chronic the complaint the longer the cycle.
(g) This is an accompaniment of its ulcerations whether internal or external, and of the tendency of its ulcerations to go on to necrosis and its inflammations to become gangrenous.
(h) Allied with this is bleeding. Inflamed and ulcerated parts bleed readily. Haemorrhages occur from the lungs, bowls, kidneys and uterus (compare arnica, china, crot. h., Ipecac., nit. ac., phos., secale, &c.).
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,