More rarely, a manic, paranoid state may develop in the last stage, with suspicion being the dominant characteristic. He suspects that people are plotting to kill him. He stares with a wild suspicious look. The patient may suffer from a fear that he will kill people upon whom he depends. In this stage he may avoid talking to people and may become obstinate and withdrawn. Finally, he may enter a state of complete tranquility, yet in this state he is completely out of touch with reality and refuses to talk to anyone.
The stages that have been described clearly illustrate the steady progression of pathology into increasingly deep layers of the organism. The pathology initiates on the physical level, progresses to a state of anxiety and insecurity, then to fear of death, and finally to despair, loss of interest in life, suicidal disposition, and a paranoid, delusionary state. In the final stages one may encounter great difficulty in accurately prescribing Arsenicum without the knowledge of its stages of development. Many of the usual symptoms of Arsenicum may be missing – restlessness, fastidiousness, desire for company, fear of death, anxiety, thirst, etc. It may be difficult to separate Arsenicum from other remedies at this stage, but if the case is taken carefully, the full dynamic process of the disease will become clear.
Acutely, Arsenicum corresponds to fevers, sometimes very high, of all types, but mostly septic fevers. During fever Arsenicum can display several interesting symptoms. Delusions may arise: he sees thieves in the room and hides under the bed; he imagines that the house is full of thieves or that the bed is full of worms. He may pick at the bedclothes. He may moan and lament loudly, screaming with pain. In manic states or in fevers with delirium, the Arsenicum patient may demonstrate a strong desire to be held.
It is interesting to note here that patients who never experience fever (apyrexia, even in severe acute ailments), frequently require Arsenicum for their chronic or acute conditions.
In Arsenicum, acute diseases have the same anxiety, restlessness, and even despair which characterize the chronic state. The restlessness and anxiety can be tremendous, compelling the patient to get up and move about. He moves from chair to chair and then drops exhaustedly into the bed, only to rise yet once again until he finally lies, completely prostrated, in bed. He is exhausted, thirsty for sips of water, and chilly – yet with a hot face.