The White Oxide of Metallic Arsenic. (As2 O3) Solution and Trituration.
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.
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.).
(i) Fluids easily transude form the blood-vessels, the skin becomes oedematous, and serous and synovial cavities dropsical.
(j) Most arsenic complaints are worse from midnight till 2 or 3 a.m. and to a less extent from noon till 2 p.m. Bearing these general characteristics in mind we may now proceed to consider the affections for which arsenic is remedial.
(1) Mental Conditions.- The provings and poisonings of arsenic suggest its usefulness: in melancholia, especially “agitated melancholia”; in restlessness of early dementia praecox; in anxiety neurosis; for delusions, e.g., of wickedness or of “being a lost soul,” of approaching calamity. Impulsive attempts at suicide at suicide may occur in arsenic cases. Korsakow’s disease (if not arsenical) may require it. Besides the great restlessness already noticed there is a state of anxiety, fear and despair, the sufferer thinks his illness terminate fatally and that it is of no use for anyone to try to do anything for him; he has despairing ideas and distressing thoughts. “Anxiety like one who has committed murder.” As a consequence he may commit suicide. He is afraid to be alone, especially in the dark, wants someone to be with him as he thinks he will die. He has spells of sudden fear at night that he is going to suffocate and jumps out of bed in alarm. A peculiarity of the arsenic patient is that he is very sensitive, all sensations affect him too much. He is very fastidious, ex. gr., every picture on the wall must be hung perfectly straight, no disorder or confusion can be tolerated.
(2) The headaches of the arsenic patient are of two kinds: (a) the congestive, in which the head feels bursting and throbs, is worse from light, noise and motion, any yet is attend with great restlessness; it is relieved by lying in a dark room with the head raised on two pillows. There is often vomiting with these headaches (sick headache), or retching, more than actual vomiting. Contrary to the usual modality of arsenic these congestive headaches are relieved by cold applications and cold air; the patient will fell cold himself and want to be wrapped up, but likes his head to be uncovered and cold air to blow upon it. (b) The neuralgic, which is often frontal or supra-orbital, and like the other pains of arsenic is better from warmth and worse from cold.
The scalp is so sore that he cannot bear it to be brushed or the hair to be combed.
(3) The eye complaints for which this drug is suitable are conjunctivitis with swollen lids, blood-stained acrid discharge, which excoriates the lids and reddens the canthi; there are granulations and burning pain and ulcers of the cornea with the same kind of thin, excoriating discharge.
(4) Arsenic affects profoundly the whole alimentary canal. The lips are dry and cracked and the patient often licks them. The tongue is red with indented edges, or in severe diseases like typhoid is dry and brown or black. Putrid ulceration and gangrene of the mouth (noma) call for the drug.
The thirst of arsenic is one of its peculiarities. In acute cases it is either for a little, just enough to moisten the mouth, and very frequent, or it is insatiable for large quantities, but the stomach is so irritable that it can retain only a sip at a time. In chronic cases there may be absence to thirst.
Inflammation of the throat and tonsils with burning is aggravated by cold and relieved by warm drinks. With these modalities it is indicated in diphtheria when the exudation presents a shrivelled appearance and covers the palate and fauces. The stomach irritation is serve, the pains are burning and aggravated by the least food or drink, especially if cold. External heat and warm drinks soothe. There is vomiting of watery fluid, bile or blood, with pain and much retching. The stomach is extremely sensitive to touch. In cases of gastritis or gastric ulceration with these symptoms, and in the chronic gastritis of drunkards, arsenic is a most valuable medicine (kali bich, especially for gastritis of beer drinkers).
The abdominal pains are intense and burning, and though the abdomen is so sensitive that the patient cannot bear examination, yet he is so restless that he is perpetually turning himself about. Hot applications relieve the abdominal pains.
Distension and tympanites, diarrhoea and dysentery are likely to follow. The stools vary from being simply watery to black, bloody and horribly offensive. Arsenic is therefore a useful remedy in many forms of gastro-enteritis and dysentery when there is much prostration and restless and painful, unbearable urging and distress in the rectum and anus. It is also a remedy for Asiatic cholera when the first stage has passed and the patient is exhausted and almost comatose. In cholera infantum it is of great value. It is one of the remedies for enteric fever, acting, as it does, specifically on the mucous membrane of Peyer’s patches.
Haemorrhoids which look like black grapes and feel like coals of fire call for it.
(5) Arsenic inflames the kidneys and in acute cases causes suppression of urine, and in chronic cases albuminuria and haematuria with burning in the urethra during micturition (canth). It has been found very useful in the large white kidney and in post-scarlatinal nephritis. Dropsical conditions are an indication for it in kidney disease (apis).
(6) In the sexual organs arsenic causes oedema of the penis and scrotum in the male and of the labia in the female, and ulceration and gangrene of the genitals of both sexes. It is a remedy for syphilitic ulcerations. Of late years it has been used largely in material doses of various of its organic compounds, such as salvarsan, injected intravenously or into the muscles, for the cure of syphilis. They have the power of destroying the Spirochete pallida and thereby rid the patient of the disease.
The haemorrhagic influence of arsenic makes it very suitable in many cases of menorrhagia and metrorrhagia, and its power over malignant ulceration indicates it for cancer of the uterus with its burning pain and foetid discharges.
(7) In the respiratory sphere the patients take cold easily and are sensitive to cold air, the nose becomes swollen and pours forth a watery, excoriating discharge which scalds the alae nasi and upper lip (aurum, allium; bland in the case of euphrasia).
Frequent sneezing occurs and also pain in the bone at the root of the nose. The discharge may be suddenly checked causing a dryness and burning in the nose with frontal headache. In chronic catarrh the discharge is thin, often blood-stained,or where there is a tendency to ulceration it may be thick. The catarrhal state goes down into the larynx causing hoarseness and an irritable cough from a sensation as if excited by smoke or vapor of sulphur. It is worse after drinking (Phos) and after midnight, when it is suffocating and the patient must sit up in bed (acon., antim. tart., samb).
When the inflammation proceeds down the trachea and bronchi there occurs wheezing with frothy expectoration looking like beaten-up white of egg;oppression of breathing is increased and it becomes asthmatic in character; there is a feeling of constriction, and lying down is impossible. When very bad the face becomes cyanotic and covered with cold sweat and there is great mental anxiety. A more serious condition still is when the urge are reached and become gangrenous with green ichorous sputum or prune-juice-like fluid, and horribly offensive odour. With these conditions there is a sense of burning in the chest as if one fire. In asthma, acute and chronic bronchitis and pneumonia, when the characteristic general symptoms were present, arsenic has saved many lives. An indicating symptom in some chronic lung troubles is acute, sharp, fixed or darting pain in the apex and through the upper third of the right lung. It is useful for pleurisy with effusion.
(8) The heart symptoms indicating arsenic correspond to a state of great weakness, with palpitation from the least exertion, worse lying on the back; attacks of palpitation at night; pulse quick, weak and irregular . Severe paroxysms of palpitation or attacks of syncope may supervene during endocarditis. Agonizing precordial pain (angina pectoris) is frequent. The power of arsenicum over dropsies is largely due to its favourable action on the heart.
(9) In nervous diseases it is useful in paralysis, chorea, epilepsy and various neuralgias. The paralysis is usually bilateral and neuralgia is an invariable concomitant. The pain may coexist with loss of sensibility to every thing but cold, which aggravates it. The paralysis is most complete in the hands and feet. There is a feeling of great restlessness in the limbs. In simple uncomplicated cases of chorea it is one or the best remedies . It is suitable for all kinds of pure neuralgias when the pain is burning and accompanied by great restlessness and anxiety, especially in states of debility such as post influenzal and malarial neuralgias, tic douloureux, the neuralgias of old age and those occurring in debilitated and anaemic persons and after herpes zoster..
(10) The blood-corpuscles are diminished in arsenic poisoning and the drug is a most valuable remedy in anaemias, even in pernicious anaemia. The symptoms indicating it are excessive weakness, considerable oedema, violent and irregular palpitations, extreme anxiety, and marked desire for stimulants, especially brandy, and for acids. It is the remedy par excellence for the anaemias of toxaemia.
(11) In fevers of a typhoid character where there is much prostration combined with restlessness and anxiety arsenic is indicated. The intermittent fevers that call for it are those in which there is violent chill, often a rigor, aching in the bones, restlessness, purple fingers and toes, headache, prostration, dry mouth with desire for hot drinks and to be covered warmly. The chill is irregular in its time of onset, occurring at no particular time and not twice at the same hour. With the sweat there is increased coldness, much prostration and unquenchable thirst for cold drinks.
(12) Since arsenic acts so profoundly on the skin we should expect to find it a good remedy in skin diseases, and we are not disappointed.
It has probably been more used by both schools in skin affections than any other remedy. Those for which it is most suitable have bran like, dry, scaly eruptions, or herpetic stops. The eruptions re burning, itching and painful after scratching. The ulcers on the skin are phagedaenic, burning, and may have a sloughing or gangrenous base. Arsenic has been found valuable in rodent ulcer and still more to cheek the growth and allay the pains of epithelioma. Burning pains and ichorous offensive discharges are the indications.
It will be seen how very extensive is the field for the administration of arsenic. It is impossible to treat of all the conditions and diseases for which it can be employed, but the prescriber may feel confident in using it in any disease whatsoever, provided there are present a sufficient number of the characteristic symptoms of the drug.
(1) Restlessness, mental and physical (acon., cham., rhus), irritability.
(2) Anxiety and fear of death or of being incurable (acon.). Anxious lined face (adults). Suspicions.
(3) Prostration, vomiting and purging (ptomaine poisoning).
(4) Periodic recurrence of complaints (cedron, china, ipec., nat. mur.).
(5) Burning pains (carb. veg., phos., secale, sulph.), (>) heat.
(6) Cachectic appearance.
(7) Aggravation of complaints after midnight (kali carb., nux v., rhus, sil.).
(8) Fear of being alone and of the dark (phos., hyoscy.), of robbers, of suicide.
(9) Thirst for little at the time and often.
(11) Acridity and offensiveness of secretions (bapt.).
(12) OEdematous swellings.
(13) Tendency to haemorrhages.
(14) Tendency for inflammations to run on to necrosis or gangrene.
From cold (except congestive head ache), midnight and after, 3 a.m., lying with head low, exertion, after food or drink, especially if cold.
From warmth (except congestive headache), movement (neuralgia); rapid movement (teething children).