METALLUM ALBUM. ARSENIOUS ACID
This substance is generally prepared by sublimation from the ores of cobalt, and is often found adulterating the ores of zinc. It is a white powder, completely soluble in boiling water. It has neither taste nor smell, but leaves a somewhat acrid sensation on the fauces; and when fused and thereby deoxidized, it emits the odor of garlic which characterizes the heated metal.
In medicine, the forms of Arsenicum chiefly used are the arsenious acid and the solution of the arsenite of potassa known as "Fowler's solution," or the "tasteless ague drop." The latter is prepared by dissolving equal parts of arsenious acid and carbonate of potassa in boiling distilled water. A very little compound spirit of lavender is added to give color and flavor. It contains four grains of arsenious acid to the fluid ounce.
Dose : Five to twenty drops; it may be repeated several times daily.
Arsenious acid has been known since the eighth century. In the fourteenth century, it was used as a medicine in the treatment of diseases of cattle. In the seventeenth and eighteenth centuries, it was used as a caustic application to malignant ulcers, but its use was condemned by regular physicians. Irregular practitioners, however, had learned its value in the treatment of skin diseases and of intermittent fever. How they found this out is more than we can say.
The same has been true of nearly every drug of the materia medica. It is certain, however, that while in irregular and domestic practice intermittents and skin diseases were being cured by Arsenicum every day, its use was condemned by the faculty; and Goeffroy said, "Though it may be a good remedy for the present, it will afterward prove a poison and bring on very dismal symptoms. Arsenic, therefore, is, in my opinion, worse than the fever!"
Not so, however, thought the patients who were glad to get rid of their fevers, and to run the risk of the dismal symptoms. The popularity of the remedy, and its extensive use, unsanctioned by the faculty, at length converted learned doctors; and Arsenic was received into the orthodox pharmacopoeia, and became forthwith "a safe remedy," and much better "than a fever itself."
Arsenic is a poison to plants as well as to animals.
Upon animals it acts in its well-known peculiar way, however it be introduced into the system, whether by the stomach or by the rectum, or through the external surface of the body by the endermic method. Cases of fatal poisoning are on record in which the arsenic was introduced in a wash applied to cutaneous eruptions or to ulcers.
The fumes of arsenious acid act very sensibly on the system. It is recorded that persons have been poisoned by inhaling the air of a room in which had been burned candles the wicks of which had been saturated with a solution of arsenious acid. The same result has followed the use of arsenious acid in candles to harden them. Clay tobacco pipes are glazed with a preparation of arsenious acid,—at least those having a superior finish, and designed for the use of the aristocracy. At the first smoking this glazing is volatilized, and the smoker inhales a dose of arsenic. Every new pipe involves a new dose. Some persons scorn to use any but a new pipe. Fatal poisonings have resulted from this fastidious extravagance.
A beautiful green wall-paper gets its color from the arsenite of copper, a pigment known as Scheele's green. The exhalations from this paper have caused illnesses and death. The same pigment is used in almost every form of ornamentation of dress and furniture and condiments, from the artificial flowers of the fine lady's head-dress, which give her the mysterious arsenical neuralgic headache, to the green candy toy of her spoiled child, which, when eaten, gives the child the equally mysterious arsenical stomachache.
The effects of small doses of arsenic frequently repeated, producing chronic arsenical poisoning, are thus described:
Loss of appetite, nausea, deranged digestion, diarrhoea, thirst, salivation, tenesmus, colic and intestinal cramps ; respiration labored and painful; a sense of oppression with pain in the breast; cough; extreme wasting of the flesh, and hectic fever; the limbs grow tremulous, and not unfrequently are paralyzed, especially the lower extremities ; pains in the whole body, but particularly in the hands and feet; stiffness and contraction of the extensor muscles succeed; numbness invades the extremities, and the mental faculties subside into insensibility and torpor; oedema of the face and extremities, and even general anasarca are not unusual; the hair falls out; epidermis scales off; pustular and other eruptions, ending in ulceration, attack the skin, which acquires a lifeless, earthy hue ; the countenance, if not oedematous, is sunken ; the conjunctiva is strongly injected, and a reddish circle surrounds the eyes.
The symptoms of acute poisoning are as follows:
Immediately after the poison is swallowed a metallic taste is perceived, with constriction of the fauces. A violent burning pain, which soon becomes excruciating, is felt in the stomach, and gradually extends itself over the whole abdomen, steadily increasing in severity until it becomes intolerable. Retching and vomiting and cramps of the bowels ensue, with spasms of the oesophagus and chest, which resemble those of hydrophobia. The thirst is insatiable, but even the mildest drinks cannot be retained. The tongue is generally fissured, hard and dry, although occasionally there is profuse salivation, and the voice is hoarse. There is also tenesmus, with bloody and offensive stools and retraction of the abdomen. The irritation extends to the urinary organs, producing strangury. Sometimes the urine is completely suppressed, and sometimes it is mixed with blood. Christison says that in women there is burning in the vagina and excoriation of the labia, but this does not happen unless life is prolonged beyond three days. Bachman had previously noticed the pain above alluded to, and also profuse menorrhagia among the symptoms in women.
The pulse is irregular, rapid and intermittent; the muscles are spasmodically affected; the skin presents a livid eruption, as already described. The sense of anguish is unutterable, and sometimes there is delirium. The breathing is oppressed. A consuming fire seems to prey upon the vitals, while the whole body is pale, cold, shivery and clammy. The features are sunken and sharp; if vomiting occurs it is convulsive and affords no relief. Exhaustion of mind and body; prostration and despair, with anxious restlessness, generally attend this stage of the attack. On the approach of death, spasm yields to general exhaustion, the pulse grows slow and feeble, and urine and faeces are passed involuntarily, but sensibility and consciousness are lost only in the last moments of life.
The duration of the symptoms is variable, and may be stated, in general, as from six to twelve hours, but occasionally they last several days.
But even when recovery from the acute symptoms takes place it is rarely complete. For months or even years, the joints remain stiff and swollen, rendering walking difficult and painful; the digestive organs continue irritable and feeble, and all the functions of the nervous system are impaired. In some cases paralysis of the upper or lower extremities occurs, and gangrenous ulcers attack the legs.
The quantity of arsenious acid sufficient to cause death will depends, says Oesterlein, on the condition of the stomach at the time the arsenic is swallowed. If the stomach be full of food at the time a large quantity may produce only a slight effect. Thus Oesterlein reports a case in which just after a hearty meal a man swallowed a quarter of an ounce. Emetics were given immediately and no evil followed.
On the other hand, very small doses may produce very violent and fatal symptoms. Four, three, and even two grains of arsenious acid have destroyed life.
A summary review of the effects of Arsenic leads us to conclude:
1. From the fact that, after death from poisoning by it, it is found in almost every tissue and secretion of the body, that it is universally diffused throughout the body and acts upon every part.
2. From the fact that its action and diffusion are uniform, however it be introduced into the body, whether through the skin or by the alimentary canal, that its action is specific and not local.
3. From its effects in chronic poisoning, producing anaemia, exhaustion, emaciation, etc., that it acts upon the blood composition, as well as directly on the tissues and on the nervous system.
We consider now the more intimate specific effects as gathered from provings on the healthy body, made by Hahnemann and his pupils.
A few words from Hahnemann's introduction to his proving may not be amiss, and especially since the use of Arsenic as a remedy has been denounced on the ground of its frequent abuse as a poison.
When I utter the name Arsenic, powerful recollections possess my soul.
In creating Iron, the All-Merciful left it free to His children to transform it at their pleasure, either into the murderous dagger or the blessed ploughshare, and to use it either for destruction or preservation.
It is not the fault of Him who loves us all that we abuse powerful medicinal agents, giving them either in too large doses or in cases for which they are not suitable, being merely guided by the caprice of miserable authorities, and without having taken the trouble to investigate the inherent curative virtues of the drug, and to make our selection depend on the knowledge thus obtained.
1. Arsenic exhausts the vital power of certain organs or systems or of the entire organism, produces symptoms of impeded activity in the functions of organs; indeed, in some cases, positive paralysis.
This asthenic condition characterizes the entire symptomatology of Arsenic. For this reason, the sensations of prostration, lassitude, weakness, etc., sinking of the forces, etc., are highly characteristic indications for Arsenic. They are so peculiar to Arsenic that Hahnemann says: "Even circumstances that are in themselves not very important and would otherwise produce but little effect, occasion in the Arsenic patient a sudden and complete sinking of the forces." This is a vital phenomenon and not a result of chemical or physical destruction of vital organs, as the stomach or intestine; for this sinking occurs when there is no such destruction.
2. The organic substance of the body is acted upon throughout. A cachectic dyscrasia and colliquative destruction of tissues is indicated by symptoms of the complexion, excretions, ulcers, eruption, and the skin generally.
Hence the use of Arsenic in persons of a cachectic habit, in leucophlegmatic persons.
3. The sphere of action embraces almost all the organs and systems of the body, but it acts especially on the mucous membranes and the external skin.
4. It is one of the most eminent periodics of our materia medica.
5. As characteristic peculiarities may be mentioned :
That the symptoms of Arsenic are almost always accompanied by great restlessness and anxiety, indeed sometimes by frantic desperation.
That they are sometimes relieved for a time by external warmth.
That they occur and are aggravated during repose, but are ameliorated by standing and by moving.
That the symptoms are almost always attended by concomitant symptoms; that is, by symptoms which stand in no pathological relation to the former.
That as regards the time of day at which the symptoms occur or are aggravated there is a great variety. Most of them occur at night after lying down, or about two A. M. ; some on rising, and after dinner.
The action on the head is not very striking. Pressing pain and semi-lateral headaches are mentioned by provers, but not graphically. It is probable that the general symptoms alone will suffice to guide the prescriber in selecting Arsenic for headache.
EYES. Upon the eyes and their appendages Arsenic produces: itching, drawing and pressure around the eyes, swelling of the lids, pains on moving the eyelids, as if they were dry and rubbed against the eyeball ; agglutination of the lids; increased lachrymation; drawing and pressure, but especially tickling, itching and BURNING (the characteristic sensation produced by Arsenic.) The conjunctiva is reddened, there is photophobia, the pupils are contracted; in fact there is every symptom of inflammation. As regards vision itself, it is obscured and weakened.
With regard to the ears, no symptom seems characteristic, except that, almost all the paroxysms of pain, wherever located, begin with roaring in the ears. But when it is remembered that great debility and exhaustion attend the pains of Arsenic, and that these in turn are apt to be attended by roaring in the ears, this symptom will not be regarded as indicative of a special affection of the ear.
Let me, however, caution you against supposing that because Arsenic has hitherto produced no definite ear affection it cannot nevertheless cure one. I shall have occasion to relate to you a severe case of otalgia, cured in a very short time by a single dose of Arsenic ; which was indicated by the GENERAL constitutional symptoms of the case.
The face is altered in complexion, which assumes a sunken, yellow, ghastly aspect; the skin around the mouth is livid, the face is cold and sunken.
Swelling and inflammation of the lips, bleeding of the lips, painful tumor in the lip, an ulcer, phagedenic, with a tearing, biting, burning pain, aggravated by touch, and in the air, and especially at night. These symptoms must be remembered in connection with the well-known and long-known use of Arsenic in ill-conditioned ulcers of the lip, lupus, and epithelial cancer.
The toothache of Arsenic is a pressing, tearing, jerking, not infrequently conjoined with swelling of the cheek, relieved by sitting up in bed, and by external warmth. Many other remedies produce the same effects. The indication for Arsenic must, therefore, be drawn rather from the constitutional than from the local symptoms.
Arsenic produces great dryness of the mouth and excessive thirst, yet at the same time the prover drinks but little at a time. The saliva is sometimes bloody. The tongue is dry as if burnt, deprived of sensibility, stitching pains in the root of the tongue, burning pain in the tongue.
The tongue is excoriated at the tip, which has a biting or burning pain.
In the throat, dryness and burning, a scraped, ulcerative sensation. Constrictive feeling in the oesophagus and throat. Gangrenous inflammation of the throat.
Action on the fauces is eminently exerted by Arsenic, however it be introduced into the system. The same may be said of its action upon the entire alimentary canal.
Arsenic alters the normal taste; sometimes this is extinguished. Again, the taste is bitter, sour, or putrid. Appetite is abnormal; there are cravings for acids, for coffee, etc., but especially loss of appetite; there is nausea at the idea of food.
The nausea which Arsenic produces is conjoined with a sensation of the greatest weakness, with anxiety; it recurs periodically. It is often conjoined with symptoms that seem to have no pathological connection with it; it is worse during repose, and is aggravated by motion.
Actual vomiting occurs, with great anxiety, with diarrhoea, with severe griping and burning pains in the stomach and abdomen.
The vomiting requires great effort; is scanty in quantity, as are all the excretions of Arsenic; and it is followed by extreme prostration.
The matters vomited may be first water, then thick, giairy or grass-green mucus, and then blood. The stomach becomes at times so irritable that it will not tolerate food.
Hahnemann says, Arsenic provokes in the stomach rather an irregular convulsive action than an ordinary peristaltic or anti-peristaltic motion; rather an anxious, fruitless retching than a copious vomiting.
In the stomach itself, pressing, gnawing, BURNING, and a feeling as though the stomach were distended.
The burning pains are the most constant. With them come violent thirst, lamentation, anguish. They may be continuous or periodic. If the latter, they occur most frequently at two A. M., or after eating.
INTESTINES. All the varieties of pains analogous to that which is so characteristic of Arsenic, viz. : burning, may be confined to single parts of the abdomen, or may be general,—generally in the hypogastric region,—accompanied by thirst, restlessness and the other conditions of Arsenic.
STOOL. Most important symptoms.
Arsenic produces diarrhoea; it is our most important remedy for diarrhoea. As all the excretions of Arsenic are scanty, so is the stool. The irritation is disproportionately great. The stool is preceded by restlessness, anguish, and pain in the abdomen. It is accompanied by vomiting, excessive pain in the abdomen, burning in the rectum, tenesmus. It is followed by burning in the anus, palpitation, trembling of the limbs, great weakness — out of all proportion to the amount of stool.
It is of great importance to note the concomitant symptoms that precede, accompany and follow the stool. They often indicate the remedy. Thus Nux vomica, Mercury, Aloes, Capsicum, Podophyllum, Veratrum and Phosphorus are distinguished.
The stool, as regards its character, is diarrhoeic. It consists of a pappy (not often watery), yellow, bloody or greenish, or more frequently a blackish, very offensive substance.
The characteristics may be said to be small quantity, dark color, offensive odor; great prostration following it.
No other drug combines all these characteristics. Phosphorus has some; but Phosphorus is never indicated where the loss of power, the prostration, is a striking symptom.
Veratrum has some, but the quantity of the excretion is as remarkably large, as, under Arsenic, it is notably small.
Secale cornutum has some, but the stool is watery, putrid, dark brown ; and there is not the restless anguish of Arsenic.
Graphites has some, but the stool is pasty, of a light brown color, and a most atrocious odor, with scarcely any pain, and no restlessness, nor weakness, etc., etc.
There is burning in the bladder and in the urethra. The urine is scanty. Three cases of chronic poisoning,— recorded in the "Edinburgh Medical and Surgical Journal,"— one from which the patient recovered, two in which death occurred, present us perfect pictures of Bright's disease, even to the pathological anatomy of the disease.
Arsenic produces a yellow, acrid leucorrhoea, and increases the menstrual flow.
During the menses, sharp sticking in the rectum, extending to the anus and pubes; cutting pains in the abdomen, with the conditions characteristic of Arsenic.
The menses are often followed by a discharge of bloody mucus.
It should be added, that, in cases of chronic poisoning, profuse metrorrhagia has occurred ; and this fact has led to the successful use of Arsenic in such cases, where the constitutional symptoms correspond.
Arsenic seems to produce in the mucous membrane of the respiratory organs a hyperaemic and inflammatory condition, the symptoms of which vary according to the locality.
Thus, in the nasal membrane, the irritation is shown by frequent sneezing, by obstruction alternating with fluent coryza, with hoarseness and drowsiness; the nares burn, and the discharge is watery and very acrid.
On the larynx, the action is not marked. But we have constant tickling in the entire trachea, which provokes a cough, a feeling of rawness, soreness and burning in the chest; scanty, tenacious mucus in the chest, hard to dislodge; and when dislodged it is blood-streaked.
The cough is dry, and very fatiguing. It is paroxysmal, worse at night; and is sometimes so violent that it seems as though suffocation would ensue. It is aggravated by drinking, by movements of the body, and by the open air.
But the cough symptoms, etc., are by no means so violent, nor indeed so significant, as those of several other remedies. On the other hand, Arsenic produces a series of chest symptoms very peculiar and significant, viz., the asthmatic series.
Constriction of the chest (here we meet the characteristic constriction, as in the oesophagus, the rectum and the bladder), dyspnoea, asthma, whistling respiration —indeed all degrees of difficult respiration, dyspnoea, orthopnoea, apnoea. They may be paroxysmal, intermittent, periodically recurring, worse at night.
Burning in the chest.
The heart is especially affected by Arsenic, and it is probable that some of the dyspnoea is thus explained.
We find anguish in the praecordia, stitching and sore pain there on coughing; pain under the praecordia restricting respiration ; palpitation; at night, about three A. M., an irregular but very violent palpitation, which seems to him audible, with great anguish; palpitation much worse when he lies on the back.
Pathologico-anatomical investigations show the heart to be " lax, not over-filled with blood, the muscular substance infiltrated with blood. The pericardium contains serum." It would appear that Arsenic affects the muscular substance of the heart.
In the trunk, Arsenic produces various pains of stiffness, lassitude and powerlessness.
Autopsies show that the spinal marrow is always affected, especially the lower part of it.
In the upper extremities (as might be supposed) the symptoms are few, chiefly those of loss of power.
In the lower extremities they are numerous, but may be reduced to three varieties: pain, spasm, paralysis.
The pains are stitching, boring and tearing. The spasms are generally tonic contractions. The paralysis occurs, generally, in fatal cases, not long before death, and is hardly a specific effect of Arsenic, but rather a forerunner of dissolution.
The skin is one of those organs on which the action of Arsenic is most powerfully exerted.
Thus Arsenic produces:
1. Pains, itching, biting, gnawing; but above all, burning.
2. Watery swellings; from puffiness of the feet or the face to general anasarca.
3. Eruptions. Inflamed spots on the face, head and neck; nettle-rash, yellow spots.
Whitish papules or elevated spots, itching and burning, like lepra, red pimples, pustules.
4. Soreness between the arms and trunk. Ulcers already existing and hitherto painful become very sensitive, as if red-hot coals were laid upon them; the margins become elevated, and they bleed, discharging black blood; the ulcers become offensive.
The sleep is disturbed; sleeplessness alternates with restlessness and tossing, twitching and jerking. There are vivid, anxious dreams. Sleep does not refresh.
The fever may be continued, or remitting, or distinctly intermittent; quotidian, or quartan.
The paroxysm is not complete. One stage is generally wanting.
The fever is most apt to occur at night.
The sweat occurs only at the end of the fever, or only at the beginning of sleep.
The pulse is small; quick, but weak.
Thirst never accompanies the chill, but comes after it. It does not accompany the night fever, but is very violent during the sweat.
The disposition is:
A. Depressed, melancholy, despairing, indifferent.
B. Fearful, restless, anxious, full of anguish.
C. Irritable, sensitive, peevish.
Masked ague. Otalgia. Neuralgia. Bright's disease. Dyspepsia. Diarrhoea. Metrorrhagia. Skin diseases (psoriasis). Intermittent. Coryza. Asthma. Chorea. Heart disease. Ulcers.
The fact cannot be too often called to mind, nor too strongly insisted upon, that our most characteristic indications for the use of a drug which presents well-defined general symptoms, as Arsenic does, and indeed as every well-proved drug does, are derived not from its local action upon any organ or system, not from a knowledge of the particular tissues it may affect, and how it affects them, but upon the general constitutional symptoms and their conditions and concomitants. If this were not so, in the presence of how many maladies, of the intimate nature of which we are wholly ignorant and which nevertheless we cure, should we be utterly powerless for good.
I mention and urge this, because the opposite is strongly presented by an author whose voluminous productions are evidence in themselves of the notorious fact that his life has been that of a student and compiler; that he entirely lacks the practical experience in the treatment of the sick, which serves as the test and corrective of any theoretical opinions we may form of the mode of selecting drugs, and of their mode of action.
A few cases will illustrate what I mean.
A lady of middle age suffered from intense pain in the inner ear. There were no indications of external inflammation. The pain had lasted several days. No remedy had given any relief. Morphine had only temporarily assuaged the pain, which afterward became worse again. Here was the case. What organ was affected ? Doubtful. What tissues ? Who could say ? Could Arsenic be the remedy ? Certainly Arsenic produces no such symptoms. What were the constitutional symptoms and the conditions ? Did the patient endure the pain patiently ? On the contrary, the pain was intolerable. Her whole demeanor indicated positive anguish. She could not retain one position for more than a few seconds, but tossed and moved about, and was constantly changing her posture. Then, the pain was not constant.
It intermitted, the intervals varying from ten to ninety minutes.
As regards character, the pain was described as a fine, burning pain.
The effects of the pain were very remarkable. Whereas during its continuance the patient's violent movements indicated the possession of no inconsiderable muscular vigor, no sooner had the paroxysm passed over than she fell into a state of really pitiable exhaustion and weakness. Moreover, she had burning thirst, though she cared to drink but little at a time.
Here, then, we have, though none of the local symptoms corresponded to Arsenic, yet a complete picture of the general or constitutional action of that drug. We have burning pain, intolerable paroxysmal pain, followed by disproportionate exhaustion, and attended by burning thirst, in which, however often the patient drinks, she takes but little at a time. A single dose of Arsenic 30, given at the commencement of a paroxysm of pain, caused the disappearance of the pain in the space of five minutes. The patient fell asleep. There was never any return of the pain. She was well.
A second case will serve to illustrate not merely this point but also another, viz. : the detection and treatment of what is sometimes called "masked intermittent;" by which is meant a disease clearly resulting from marsh-malaria, and which nevertheless does not manifest itself by the customary paroxysm of chill, heat and perspiration, which constitute intermittent fever.
A precocious child in Dutchess County, twelve years old, had complained for more than eighteen months of a severe pain in the left ear. She was brought to my office for treatment, with the statement that for this affection she had been treated, both locally and constitutionally, for an inflammation of the middle ear, by some of the most distinguished surgeons of the city of New York, but with no good result. I could discover no distinct signs of local lesion, but nevertheless supposed it to be a case of otalgia, and from a very close correspondence of the case, as described to me, with the symptoms of Chamomilla, gave that drug.
She got no better. I then learned that she had been under the care of a good homeopathic physician, who, if it had been simple otalgia, would surely have cured her. This fact induced me to scrutinize the case very carefully before I prescribed again. Visiting the patient repeatedly at her residence, at different times in the day, I found that the attacks of pain were regularly and distinctly paroxysmal; that they were attended by the peculiar thirst so characteristic of Arsenic, and by the restlessness and anguish, and followed by the prostration, equally characteristic. Furthermore, concomitant symptoms in the shape of an Arsenic gastralgia and an Arsenic diarrhoea were also present. It then occurred to me that this was probably a case of masked intermittent. The situation of the house, and the topography of the neighborhood favored the idea. On the strength of the symptoms recited, I gave Arsenicum 200. Within five days the pains had ceased to appear, but in their stead came a regular paroxysm of chill, fever and sweat, indicating the existence of quotidian intermittent fever. These paroxysms recurred for four days, gradually diminishing in intensity. They then ceased, leaving the patient well.
Instances almost without number might be adduced in corroboration of this statement, that cures are to be made in a multitude of instances which present local symptoms and lesions of tissue, to which the symptomatology of the drug presents no analogy; provided always the general and constitutional symptoms correspond closely to those which characterize the drug. And it may be added that perhaps no other drug is so often useful and available in this way as Arsenic, for the reason that hardly any other drug produces general symptoms so strongly marked, and so easily detected; I may add, so frequently met with in patients. Whatever, then, may be the local nature of the disease before, whatever pathological name it may bear, if the general symptoms correspond to those of Arsenic in the way that I have pointed out, do not hesitate a moment to give that drug. (How otherwise could we cure lupus, cancer, ulcers; for these do not occur in provings!)
The eminent periodic character of the action of Arsenic upon the healthy subject, would mark it at once as a drug likely to be very useful in the cure of intermittent fever. But long before systematic provings on the healthy body had made known to us this peculiarity, popular experience had discovered the value of Arsenic in such cases. It was found to be the sole ingredient of a nostrum, very famous in the last century under the name of "the tasteless ague-drop.
During the wars consequent on the French Revolution, and the Napoleonic wars on the continent of Europe, while England held control of the ocean and effectually blockaded the European seaports, thereby preventing the importation of foreign products, and among them of Peruvian bark, the recognized specific for intermittent fever (for, whatever opinion the English may now entertain of the barbarity of our withholding medicines from our enemies, they had then no doubt of the propriety of withholding them from theirs);—at this time attention was turned to the practicability of using Arsenic as a substitute for bark in treating intermittent ; and large rewards were offered for an effectual method of so using it, or for any efficient substitute for bark. It is amazing that this idea of using one specific as a substitute for another specific could ever be entertained; since the virtues of a specific reside in its peculiar, individual properties, which are never common to two different substances. Nevertheless, even at the present day and in our latest works on materia medica, we find the subject of the substitution of Arsenic for Quinine gravely discussed, and statistics referred to to show, as the case may be, its inferiority or superiority to Quinine. As might be supposed, the testimony of different physicians differs widely on this point. Some affirm that almost all the cases treated by them during a certain period, were promptly cured by Arsenic, while they proved rebellious to Quinine. Others succeeded with Arsenic in a smaller proportion of cases, and in a larger with Quinine; while others, again, found Arsenic of comparatively little use, Quinine curing nearly every case. Finally, others again failed with Arsenic and Quinine alike, but succeeded with other drugs less often used, as Ipecacuanha, or Eupatorium, or Nux vomica.
Now, it is a wonderful thing that medical men should still argue, in the face of these statistics, upon a question of the relative value of certain drugs in the treatment of a disease, regarded not in the light of the individuals affected by it, but solely with reference to its great pathological features. It seems to me the only sound deductions from these testimonies are these: That there are diversities in the form in which intermittent fever appears in different persons and in different epidemics ; that these forms require different remedies, and that thus there is a form which is capable of being cured by Arsenic, and by nothing else; a form capable of being cured by Quinine, and by nothing else; and so of other drugs. In this view, when a case of intermittent fever presents itself, the question can never be: Is Arsenic a better remedy for this disease than Quinine is ? Does it offer greater chances of a cure ? There can be no better or worse. The question is between right and wrong ; suitable and not suitable. The question would be always: Which remedy corresponds to this particular case, and is, therefore, indicated in it?
Attention should again be called to the fact which has been previously mentioned (see Bryonia), that in different epidemics the indications, though uniform, are often quite different; and that in the endemic fevers of certain malarious districts, the indications for remedies are often very uniform, and yet different for each locality. Thus it has been found, by experience, that the intermittents which are endemic near Rome (Italy), require Quinine or China; those of the head of the Adriatic require Arsenic ; those of the Maremma, along the Tuscan gulf, require Bryonia; those of Salonica, in Turkey, yield to Ammonium muriaticum; while those of the Dobrutscha require Rhus toxicodendron.
The special indications for Arsenic in intermittent are thus admirably stated by Dr. Wurmb ("Homeopathische Clinische Studien," i., 179):
Arsenic is one of those few drugs whose action is distinguished not alone by its intensity, but equally by its extent; it involves the entire organism. Every system, every organ of the body, every nervous filament, is so subjected to its powerful influence that we are not able to say which of its symptoms are primary, and which are secondary, and where the focus of its action chiefly lies.
We see the entire nerve-life attacked in all directions, from the slightest excitement to the most violent irritation ; from the mere sensation of weakness to actual paralysis; and then we see, likewise, another series of disturbances arise from its action, which advance in regular gradation from the most inconsiderable acceleration of the circulation to the most violent febrile storm; from the slightest irregularity in the vegetative sphere to a cachectic dyscrasia, yes, even to decomposition and destruction of the organic substance.
In addition, we remark the striking similarity between the symptoms of chronic, arsenical poison ing and those of the intermittent cachexy ; as well as the fact that Arsenic has the property of causing the periodical recurrence of symptoms in so high a degree as to surpass in this respect all other drugs; in a word, no other drug known to us has such a power of affecting so intimately and so variously those organs that are especially affected in intermittent fever ; and none corresponds so well as Arsenic does to all the requirements of a remedy for intermittent.
Arsenic is indicated in cases which are distinguished not only by weakness in the vital power and deterioration of the organic substance, but also and at the same time by symptoms of excitation of the circulation, or of the nervous system alone, or of both together.
Again, it seems to be the more especially indicated the more malignant the influence from which the disease has sprung. Marsh-miasm is the chief of these influences ; in this originate the most serious and most dangerous cases of fever; and in these, Arsenic is often the only remedy that will rescue the patient.
Again, the longer the disease has lasted, the more is Arsenic generally indicated; because the more deeply have the organs and tissues been affected, the more nearly has the patient's condition approached that known as the intermittent cachexia, and which so nearly resembles the arsenical cachexia. Especially is this the case when the liver and the spleen have become swollen.
The intermittents which find this homeopathic remedy in Arsenic present in their paroxysms the following peculiarities: the paroxysms are general, violent, and of long duration ; the stages are either distinctly developed, and equally proportioned to each other, or else, as is most frequently the case, the one or the other stage is absent, or is very feebly present; if the latter be the case, it is generally the cold stage which fails, and the hot stage, is all the more violent. The more intense the heat, the longer it continues, the higher the degree of development of the accompanying excitement in the vascular system, and the more burning and insatiable the thirst, the better is Arsenic indicated. The sweating stage may be altogether wanting; or the perspiration may be very copious ; it breaks out generally several hours after the end of the hot stage, and lasts a long time.
With the paroxysms are associated many distressing accessory symptoms, which are connected, some with the disturbances in the nervous system, some with those of the vascular system, E.G., spasms, pains, delirium, paralyses, and the anguish and restlessness that are so characteristic of Arsenic.
The apyrexia is not pure, but is disturbed by symptoms of the most various kinds; restlessness, sleeplessness, spasms, digestive disorders, feeling of weakness and general prostration; and it is especially characteristic for Arsenic, that, after every paroxysm, there is a notable increase of prostration.
Much of what has been said will serve to point out the indications for Arsenic in continued fever as well as in intermittent. A careful analysis of the symptoms of Arsenic shows them to be a mixture of prostration and of destruction in the vegetative system, with erethism and excitement in the animal system and in the circulation. In this respect it is related to Rhus toxicodendron, being more active and more penetrating in each respect than Rhus. As representing torpor and collapse without erethism, we have already (following Wurmb) mentioned Phosphoric acid as the less powerful and Carbo vegetabilis as the more powerful drug,—correlatives respectively of Rhus toxicodendron and Arsenic.
Wurmb thus describes the typhoid fever in which Arsenic is indicated:
The patients are very restless and anxious, and generally so weak that they move only the hands, feet and head, and not the trunk; and hence do not voluntarily change their posture in bed. The pulse is very frequent, small and irregular; the temperature greatly elevated, the cheeks burning hot and red, the thirst insatiable. With these symptoms of excitement those of decomposition of the blood hold equal pace, as is shown by the exanthema and ecchymoses, the often profuse haemorrhages from various organs, the character of the blood thus excreted, and the destruction of the tissues in the parts on which the patient lies.
The sensorial functions are withdrawn from the influence of the will; the delirium is always full of anguish and distress, and is sometimes violent, but more frequently is muttering. There are sudden startings and jerkings of muscles in the face and trunk.
The patients often perceive nothing, and complain of nothing; the excretions pass involuntarily, but the urine is frequently retained, and the bladder is often so distended as to threaten a rupture, which indeed really takes place if the urine be not drawn off. The lips and tongue are dry, the latter often hard and either clean and dark red, or else thickly coated, the coat being a dark-brown fur, which also covers lips and teeth; speech is often impossible.
The stool bears the marks of colliquation ; the stools are frequent, watery and bloody; the flatulent distention of the abdomen is enormous. There is rattling in the lungs. Emaciation is very rapid and very great. In such cases perforation of the intestine is a common occurrence.
The indications for Arsenic in neuralgia, in affections of the eyes and teeth, must be drawn from the character of the pain and from the general symptoms. In cholera morbus, in diarrhoea, and in malignant dysentery, it may be indicated, as the symptoms, both general and local, already described, clearlv show.