Today we take up for study the last of the acid remedies. I refer to Arsenious acid, or ARSENICUM ALBUM. It has quite a number of concordant remedies and quite a string of antidotes. Its complementary remedies are PHOSPHORUS and ALLIUMSATIVA.
Arsenicum album comes to us quite thoroughly studied, both as a poison and as a remedy. It has long been known as a speedy means of destroying life, hence it has been frequently used for suicidal and homicidal purposes. It has the property of uniting with animal tissues, probably with the albuminous portions of the tissues, hardening them and causing them to resist the usual process of decay, so that these tissues are long preserved. This fact is taken advantage of by taxidermists in stuffing birds and animals. Cases of accidental poisoning with Arsenic are quite common, and this is all the more so because of the use of Arsenic in the arts. In the form of Scheele's green, or arsenite of copper, it enters into the composition of certain paints. It is used frequently in the manufacture of certain green wall-papers, and also in artificial flowers. It is also introduced into pastes to be used in sealing packages, which are to protect goods from insects. All these uses of Arsenic render poisoning, especially chronic poisoning, by it not at all uncommon.
In certain districts Arsenicum is indulged in as an article of diet. The women take it for the purpose of beautifying the complexion, and the men indulge in it because it enables them to work hard with little or no fatigue. The drug acts on muscular tissue so as to increase its power of endurance. We may make use of this fact when some disease has resulted, from climbing mountains or a long journey, as a provoking or modifying cause. The "Arsenic vice" is very objectionable, and certainly very injurious. After awhile these persons will suffer from Arsenic poisoning, especially if they move away from the region where they are living. The symptoms of slow arsenical poisoning are these: Oedematous eyelids; the patient suffers from slight conjunctivitis; the eyes are always red and injected, and smart and burn. Associated with these symptoms is dim sight. Whether this comes from the inflammation externally, or from any internal ocular trouble, I am unable to say. The mucous membrane of the mouth, nose, and throat is unnaturally red and dry. The sufferer complains of almost constant thirst. Digestion is most certainly deranged. The patient will tell you that he is dyspeptic. The skin assumes rather a dry dirty look ; it is only exceptionally clear and transparent. The patient suffers frequently from nettlerash. Long wheals appear, and these itch and burn intolerably. Still later, eczema makes its appearance. The patient also suffers from stubborn neuralgia in different parts of the body. These are the most common, and the most certain symptoms indicating arsenical poisoning. In addition to these there will be some acute symptoms. For instance, there will be times when the patient has attacks of vomiting, with deathly nausea. He will vomit every thing he drinks. At other times he has symptoms indicating cholera morbus, E.G., vomiting and purging, and coldness of the surface of the body.
You may frequently be called upon to antidote arsenical poisoning. If it is an acute case you should excite vomiting and administer the sesquioxide of iron as an antidote. Dialyzed iron has also been recommended. It has the advantage of being more stable than the sesquioxide. For the nausea occurring during chronic poisoning, IPECAC. acts very nicely. In the acute attacks simulating those of cholera morbus, VERATRUM ALBUM relieves.
CINCHONA also suits many of the symptoms, particularly the debility, dropsy, and neuralgia.
GRAPHITES is one of the best remedies to cure the skin symptoms of chronic arsenical poisoning.
Now we will consider the symptoms of Arsenicum in their totality. Quite a universal symptom of the drug, and that, too, whether the result of poisoning or of proving, is what I have already mentioned, an irritability of fibre. This is present and prominent in the worst cases in which Arsenicum may be used. Death may be almost certain, and yet there is this irritability of fibre showing the universal characteristic of the drug. Even when the patient lies in a stupor, this stupor is broken by anxious moans and restlessness. Consistently with this quality of the drug, we find Arsenic indicated in patients who are anxious and restless, frequently changing their position, full of fear of death; hence they do not wish to be left alone for fear they will die. Delirium is violent, more violent than in any other of the acids except NITRIC ACID. It is worse at night, particularly after midnight. The patient has visions of ghosts and other fanciful figures, with trembling of the whole body. You cannot here fail to recognize the similarity to delirium tremens or mania a potu. Arsenicum here is of great use, particularly in old offenders who are seriously diseased by the use of alcohol, and who, from some cause or other, cannot get their usual drink.
The pains which the Arsenicum patient experiences, whether neuralgic or otherwise, make him desperate and angry, almost furious, in fact. When falling asleep, he jerks and starts. During sleep his dreams are frightful and fantastic. Before going any farther, I want to introduce a caution in regard to Arsenic. Arsenic is not a remedy usually called for in the beginning of diseases. The tendency of the symptoms is deathward. If you give the drug too soon, in a disease which in itself tends deathward, you may precipitate the result which you are anxious to avoid. I have myself several times made the mistake despite great caution. Do not give Arsenicum early in typhoid fever unless the symptoms call for it unmistakably. Here it is especially dangerous to give it too soon. Often RHUS TOX. precedes its use. I will say the same thing in regard to tuberculosis. In the last stages of this disease this restless tossing about.is not an Arsenic symptom, and Arsenicum will not relieve it. That is only a precursor of death. You must be certain that the mental state is indisputably that of Arsenic, or you will do harm instead of good to your patient. There is one exception to this word of caution, and that is in inflammations of the gastro-enteric system. I may say that Arsenicum may here be given quite early in the case without doing any harm, on the contrary, with much benefit.
Now for the inflammations and fevers of Arsenicum. Arsenicum alters the blood. It is useful, as we shall learn, in low types of disease, when the blood-changes are serious. The inflammations of this remedy are characterized by their intensity, and by the tendency to the destruction of the tissue which is inflamed. In these local inflammations of Arsenic you will find burning lancinating pains the characteristic sensations. This is described by the patient as though hot coals were burning the part. It is often accompanied with throbbing. Now this burning when Arsenicum is the remedy indicates destruction of tissue, hence it calls for this remedy in gangrene, in sloughing, in carbuncles, and in that dreadful disease, cancer. And it does not call for Arsenic when this burning is a mere sensation. Patients occasionally complain of burning pains, here and there, which arise from nervous causes only. Arsenicum does no good then. I have often seen physicians give Arsenic when women complained of burning pain in the ovaries. There was no evidence whatever of active inflammation, but there was this burning from ovaralgia. Arsenicum could do no good here. If, however, there is ovaritis with this pain, Arsenic becomes an invaluable remedy. All these cases in which Arsenic is called for are relieved by hot applications, and greatly aggravated by cold.
The most important sites for the Arsenicum inflammations are the stomach and bowels primarily, and next to these the heart. This inflammation in the stomach and bowels may vary from slight irritation to the most destructive gastritis. The mouth is dry, the tongue white as if whitewashed, or, in some other cases of irritable stomach, thetongue is red with raised papillae. Thirst is intense, but the patient drinks but little at a time because water hurts the stomach. An ordinary amount of food causes a feeling of fulness or repletion. In this symptom it is similar to LYCOPODIUM. The least food or drink is vomited as soon as taken. But we may have another group of symptoms ; weak, sinking sensation at the pit of the stomach, relieved by eating, but so soon as he begins to eat, he has urging to stool with diarrhoea. Here the drug is similar to CINCHONA and FERRUM.
There is very distressing heartburn. Sometimes, burning in the stomach like coals of fire is associated with the diarrhoea. The stools are undigested, slimy, and bloody, and are attended with violent tenesmus and burning in the rectum. If this goes on, the stools become brownish or blackish, and horribly offensive, showing that it is indicated in most serious cases of enteritis and dysentery. The exciting causes for these various sets of symptoms are sudden chilling of the stomach with ice-water or ice-cream, alcoholic drinks in excess, certain poisons, as sausage meat that has spoiled, rancid fat, spoiled butter or fat that has undergone decomposition, and lobster salad at certain seasons of the year.
Arsenicum also excites intestinal disease which is almost identical with cholera Asiatica. Even the organic growths of cholera are found in the discharges from the Arsenic proving. Do not conclude from this that Arsenic must be THE remedy for cholera Asiatica. It is only the remedy when we have the following symptoms: Intense vomiting and purging, the stools being not so much like rice-water as they are brownish-yellow, profuse, and offensive. The vomited matters are green, yellow, and bilious. There is burning thirst, with the intense agony which belongs to Arsenicum. The surface of the body is as cold as ice, but internally, the patient feels as if full of fire.
Arsenicum is also useful in cholera Infantum, and in atrophy of infants. It is indicated by many of the symptoms that have already been enumerated. The symptoms of the bowels are, undigested stool, diarrhoea which is provoked just as soon as the child begins to eat or drink, aggravation after midnight (particularly the restlessness and the diarrhoea), and rapid emaciation. The child's skin is apt to be harsh and dry, and often yellowish and tawny. The little patient is restless, evidently being in constant distress. Here, too, we often have to give Arsenic quite early in the case, because here the symptoms have been going on before your arrival. It stands in close relation with NUX VOMICA and SULPHUR in atrophy of infants. For instance, early in the case of marasmus, you may give Arsenicum, providing diarrhoea is present in a case which would call for NUX VOMICA or SULPHUR were constipation present. The same dried-up mummy which you find in the Sulphur case, with the peculiar gastric symptoms of Arsenic, would call for the Arsenic. In far advanced cases, the resemblance is not to these remedies, but to CINCHONA, or China, and to ARGENTUM NITRICURN.
Now let us study some of the related remedies of Arsenicum in gastrointestinal troubles.
ARGENTUM NITRICURN has slimy, greenish stools, with excessive flatulence, worse at night. Although both remedies have restlessness, it is not the same in each case. Arsenicum has a restless desire to change place, now sitting, now standing. The restlessness of Nitrate of Silver is purely nervous. The patient has difficulty in breathing, with long sighs.
Much more frequently will you be called upon to differentiate between Arsenicum and CARBO VEG. Carbo veg. is somewhat similar to Arsenicum in abdominal affections arising from chilling the stomach, as with ice-water. It has, perhaps, less of the distinctive restless tossing about, but at the same time it may have a nervous, irritable, anxious state, without tossing about. Carbo veg. is also a similar remedy to Arsenicum when rancid fat has excited gastro-enteric symptoms.
SECALE CORNUTUM is very similar to Arsenicum in many of its symptoms. The two drugs are complementary. They agree well one with the other. In the abdominal symptoms both drugs meet in cholera Asiatica. Arsenicum may be distinguished from Secale by these few symptoms: The movements in Secale are copious and come in spurts; Secale has not the same restlessness that belongs to Arsenicum. Now, when there are any spasmodic symptoms present, as is often the case, you will find under Secale, fingers spread asunder, with tingling in the hands and feet.
VERATRUM ALBUM is somewhat similar to Arsenicum in cholera morbus. The latter has not so copious a stool as the former. Cold sweat on the forehead is more marked in the Veratrum.
Do not forget that CADMIUM SULPHURICUM is similar to Arsenicum in black vomit, whether that symptom occur in yellow fever or in any other disease.
We find Arsenicum often indicated in intermitting types of fever. We all know how often Arsenic succeeds Cinchona in the treatment of chills and fever. It often cures. If is especially indicated after the failure of quinine, or after the abuse of that drug; also when the fever has been contracted in salt marshes along the seashore. The chill is not well defined; in fact, it is rather irregular, but the heat is unmistakable. It is intense, with burning thirst, especially for hot drinks; cold drinks make the patient feel chilly. Sweat does not always relieve. Sometimes it appears very tardily. The apyrexia is marked by severe symptoms, dropsy showing itself as the result of enlarged spleen or liver. The patient is scarcely able to sit up. He is often annoyed by neuralgia; this neuralgia being typical in its appearance. The pain usually affects one side of the face, and seems to be almost maddening, driving the patient from place to place. At the height of the attack there are nausea and vomiting, and buzzing in the ears. Arsenicum may be also used in intermittent, semilateral headache of malarial origin, especially after the abuse of quinine.
There are several drugs similar to Arsenicum in these malarial neuralgias. CEDRON, has neuralgia, returning at precisely the same hour each day.
CACTUS GRANDIFLORUS has neuralgic and other forms of pains, which are sure to appear when the patient misses an accustomed meal.
KALMIA and KREOSOTE are useful in neuralgia, especially when there are burning pains.
MAGNESIA PHOS. is called for in neuralgia which occurs regularly each night.
MEZEREUM has neuralgia in the cheek-bone, or over the left eye. The pains leave numbness. They are worse from warmth. It is especially useful when there have been herpetic eruptions after the abuse of mercury. It is one of the remedies we use for the neuralgia of zona.
ROBINIA has, jaw bone feels as if disarticulated. With this, there is intensely sour taste or vomiting.
In typhoid fever, Arsenicum is indicated late in the disease when the blood changes have so far progressed that you have a picture of complete exhaustion. The patient thinks himself still able to move about until he finds out how weak he is. He has fainting attacks which are very alarming; he faints dead away, with cold sweat on the body. The delirium is worse after twelve P.M., and is attended with great restlessness. He is sleepless at three A.M. on account of the great heat. The mouth and tongue are covered with sordes, and with a dark brownish coating. Sometimes the tongue is very red. Around the dorsum and tip of the tongue, you will find the papillae red and raised as under Belladonna, but the concomitant symptoms enable you to differentiate it from that remedy at once. The mouth is full of blisters and aphthous ulcers which bleed readily. In other cases, the tongue is bluish with ulcerated edges. Sometimes, in severe cases, water can not be swallowed because of partial paralysis of the oesophagus. You do not often find much tympany in the Arsenic case. The bowels are very much disturbed. Diarrhoea is almost always present, and seems to be provoked by every attempt to eat or drink. Sometimes stool and urine are involuntary. The stool is yellowish and watery in character, horribly offensive and worse after midnight. At other times, the stools contain blood, slime and pus. In some cases, the urine is retained from atony of the muscular fibres of the bladder. The fever is intense, being almost sufficient to consume the patient. Sometimes, you have the haemorrhagic diathesis to deal with, and there is oozing of blood from various parts of the body, from the eyes, nose, etc. This is a dangerous symptom.
COLCHICUM is a remedy which we are very apt to neglect in typhoid fever. It seems to stand in typhoid conditions between Arsenic and Cinchona, having the excessive weakness of the former remedy and the marked tympany of the latter. The chief symptoms of Colchicum are abdominal. They are, this great tympany, involuntary forcible watery stools, accompanied with nausea and frequent vomiting of bile. The body is hot and the limbs are cold, just as in PHOSPHORUS. The nose is dry and blackish. The teeth and tongue are both brown. The mind is somewhat cloudy. He answers questions correctly, but otherwise says nothing. He seems not to know the danger he is in.
The relation of Arsenic to other remedies in typhoid fever have been described to you when speaking of other remedies. I need not therefore, repeat them here.
Arsenicum may also be useful in a continuous fever, which in its early stages so closely resembles that of ACONITE, that you may not be able to distinguish between the two drugs. There are hot skin, full bounding pulse, restlessness and anxiety. Thus far it is exactly like Aconite. But it does not end here. It goes on to a continuous type of fever without any intermissions, and with only slight remissions. The heat increases, the patient grows more restless and yet weaker, the tongue becomes brown and typhoid symptoms develop.
Now the distinction between Arsenic and Sulphur is easily made. SULPHUR is also useful in continuous fever. Arsenic is indicated when the great restlessness and burning show you that the case has gone beyond simple continuous fever.
Now the action of Arsenicum on the mucous membranes. We find it an excellent remedy in winter colds. The nose discharges a thin, watery fluid, which excoriates the upper lip, and yet the nasal passages feel stuffed up all the time. This is accompanied by dull throbbing frontal headache. Repeated attacks of this kind of catarrh or coryza, result in the discharge of thick, yellowish, muco-purulent matter. Ulcers and scabs form in the nose. Sneezing is a prominent symptom. Now this sneezing in the Arsenic case is no joke. It does not give the relief which one usually gets from a good sneeze. It is a sneeze which starts from irritation in one spot in the nose as from tickling with a feather. After the sneeze, this irritation is just as annoying as it was before. As the cold creeps downwards, you find the case complicated with catarrhal asthma. Dyspnoea appears. The patient cannot lie down, particularly after midnight. He is greatly relieved by cough with expectoration of mucus.
You will at once recognize the similarity between the symptoms of Arsenic and those of hay fever. Other remedies which you may remember for this condition are: AILANTHUS, SILICEA (which has itching or irritation in the posterior nares or at the orifices of the Eustachian tubes), LOBELIA INFLATA, and a remedy introduced by the late Dr. Jeanes, ROSA DAMASCENA.
This Rosa damascena is useful in the beginning of rose-cold when the Eustachian tube is involved and there is some little hardness of hearing, and tinnitus aurium.
SINAPIS NIGRA is indicated when the mucous membrane of the nose is dry and hot. There is no discharge. The symptoms are worse in the afternoon and evening. Either nostril may be affected alone or alternately with the other.
In diphtheria, Arsenicum comes into use as a most valuable drug. It kills the microscopic growths which produce the disease. In its potentized state it is a most valuable assistant. It is particularly indicated when the breathing is foetid. There is adynamic fever with a great deal of somnolence. This sleepiness is broken by starts, crying out and by jerking of the limbs. The membrane looks dark and is gangrenous. The pulse is rapid and weak. I would advise you to substitute ARSENICUM IODATUM, if in addition to the usual Arsenicum symptoms, there is marked enlargement of the lymphatic glands.
I have stated that Arsenic acts on the heart. It gives us a list of cardiac symptoms which are in brief, these: The heart-beat is too strong, it is visible to the person standing by and is audible to the patient himself. It is worse at night and is particularly aggravated when the patient is lying on his back. There may be palpitation with great irregularity of the heart's action. Or the pulse may be accelerated and weak. In cardiac inflammations, endocarditis or pericarditis, we find Arsenic indicated after the suppression of measles or scarlatina. You then find present the characteristic restlessness and agony of the drug, tingling in the fingers especially those of the left hand. Oedema is more or less general, beginning with puffiness of the eyes and swelling of the feet and ending with general anasarca. There is great dyspnoea. Now there are two varieties of dyspnoea which belong to heart disease, one which depends upon the defective carrying of the blood through the lungs and the system generally, and the other which is due to accumulation of water in the chest, hydrothorax and hydropericardium. There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally, the patients are burning hot. Now if this condition calling for Arsenic goes on uncured, Bright's disease of the kidneys develops. The urine is highly albuminous and contains waxy and fatty casts. Dropsy appears. Little blisters appear on the legs and these burst, and serum oozes from the ©edematous limbs. The skin itself is rather tense and has a palish-waxen hue. Exhausting diarrhoea seems to accompany these symptoms. There is very apt to be also a burning thirst with intolerance of water.
I wish you now to recall the comparison that I have already given you between Arsenicum and Apocynum, and Acetic acid, which stands midway between Arsenicum and Apis. I would also have you recall the similarity between Arsenicum and MERCURIUS SULPHURICUS in hydro-thorax.
In kidney affections you may compare Arsenicum with APIS, HELLEBORUS, PHOSPHORUS, AURUM, TEREBINTHINA, and DIGITALIS.
Now the DIGITALIS symptoms are these: There is venous hyperaemia of the kidneys. You are to study it, therefore, in renal affections when there are present dropsy, feeble or slow pulse, scanty dark turbid urine, which will, of course, be albuminous. It is exactly like Arsenic, without the restlessness and irritability of that remedy.
Again, we find Arsenicum indicated in that dreadful disease, angina pectoris. The patient is obliged to sit upright; he cannot move the muscles of his body without great suffering. He holds his breath, so painful is it for him to breathe. Pain seems to radiate from the heart all over the chest and down the left arm. In extreme cases there is cold sweat on the forehead, the pulse becomes scarcely perceptible, and, with all this, there is apt to be burning around the heart.
I would now like to refer to the action of Arsenic on the skin. You have already seen that it tends to produce induration or hardening of the skin. This renders it a valuable remedy in eczema, in fact, in every variety of the skin in which there is thickening of that structure, with copious scaling. Arsenicum is also useful in eczema proper, when vesicles appear which turn into pustules and form scabs. Arsenicum is specifically indicated for bran-colored scales on the head, coming down over the forehead. It may also be indicated when there is a thick scabby eruption on the scalp, oozing pus, and very offensive.
Arsenicum compares with SEPIA, RHUS TOX., and GRAPHITES. Like Sepia there is dry scaly desquamation, but in Sepia this "peeling" follows vesicles, which were not surrounded by very red skin, or it follows a fine rash, worse about the joints, or a circular eruption like herpes circinatus.
RHUS TOX. has vesicles on a red erysipelatous surface.
GRAPHITES looks very much like Arsenicum, but with oozing of a glutinous fluid.
CLEMATIS is similar to Arsenicum, but has more rawness, aggravation from washing and moist, alternating with dry scabs.
In the exanthematous diseases we find Arsenicum indicated first of all in urticaria. Here it is a valuable drug when the wheals are attended with burning, itching, and restlessness. Particularly may it be indicated for the bad effects of repercussion of hives. Even croup may be cured by Arsenic if it follows the retrocession of nettle-rash.
In scarlatina Arsenic is to be used in some of the worst cases when the rash does not come out properly. The child is thrown into convulsions, and lies pale and in a sort of stupor. It is very restless, moaning during the stupor. Suddenly it seems to arouse, and immediately goes into convulsions, and then relapses again into this stupor. It is also useful when, during the course of scarlatina, the parotid glands swell and suppurate, after the failure of Rhus.
Arsenicum is useful in gangrene, particularly in the dry gangrene of old people, with great soreness and burning in the affected part, with relief from warm or hot applications. This modality furnishes you with a sufficient distinction between Arsenic and another great gangrene remedy, SECALE, which is useful in gangrene, with relief from cold applications.
We may use Arsenicum in carbuncles or in boils with pepper-box openings in them, and dipping deeply into the cellular tissues. It is indicated by the character of the pains, which you know run all through the Arsenicum symptoms, cutting lancinating pains, with aggravation after midnight, and irritability of mind and body.
Arsenicum sometimes fails in carbuncles. Then we have to resort to ANTHRACINUM, chiefly in the thirtieth potency. It has precisely the same symptoms as Arsenicum, but to a more intense degree.
CARBO VEG. and LACHESIS are remedies that we neglect in this disease. If we use Carbo veg. it is well also to use a charcoal poultice over the carbuncle.
Arsenicum may be used in cancer. I am not going to propose that this drug will cure cancer. Epithelioma has been cured by CONIUM, HYDRASTIS, ARSENIC, CLEMATIS, and a few other remedies. But in cases of genuine open cancer I have not seen any cases cured; but even if these cases cannot be cured, it is still possible to give them some relief. The pains of cancer you know to be torture. They are of a sharp lancinating character, a red-hot knife thrust into the part could not be worse. Arsenic sometimes relieves these, sometimes it does not.
Sometimes BELLADONNA brings relief. In some eases ARSENICUM IOD. relieves when Arsenicum album fails.
The ulcers for which Arsenicum may be given are not usually very deep. They are rather superficial. The pains are of the character already described, burning and lancinating. The discharge is apt to be excoriating, dark, and sanious. They are apt to bleed very readily.
Lastly we will consider Arsenicum as a remedy in nervous affections. It is indicated in hemicrania when the pains are worse over one eye, and are of a severe lancinating character. They often alternate with colic or aifections of the liver. They are worse from any motion and are temporarily relieved by cold applications.
It may also be used in epilepsy. The patient falls down unconscious and then writhes in convulsions. Before the attack he has spells of vertigo and intense aching in the occiput. The convulsions are followed by stupor, which, however, is not complete, but is broken by restlessness.