Charles D. F. (Charles Douglas Fergusson) Phillips.

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tula or numerous leech-bites, a silver probe, dipped as required in the
melted salt, is very convenient. The finely powdered nitrate, diluted (as
with sugar), has been used for the throat and larynx, and abroad, charpie,
dipped in a strong solution and dried, is used as a dressing for indolent
wounds, and known as the black or caustic charpie of Riboli (Husemann).

Of solutions, 40 gr. in the ounce will prove caustic to mucous mem-
branes, and from 80 gr. upward caustic to the skin; distilled water, gly-
cerin, or nitrous ether may be used as solvents (v. p. 14) ; opium may
be added to diminish pain, and after a strong application the part, espe-
cially if it be the eye, should be bathed with warm salt water to neutral-
ize any excess of caustic 20 gr. to the ounce is a useful strength for an
astringent solution, but a proportion of 10, 5, and even 1 gr. to the ounce
is suitable according to the condition of the affected part, and may be
used in lotion, injection, or collyrium, as already described, it being re-
membered that the weaker solutions require to be used the more fre-
quently : the disadvantage of the salt staining linen must be borne in
mind.

Both the nitrate and oxide have been used in stimulating and astrin-
gent ointments : thus, in the Hamburg Pharm., 15 gr. are ordered with
1 dr. of Peruvian balsam and oz. of zinc ointment (Ungt. Nigrum), and
Lane used the oxide in specific and other ulceration, but I do not think
ointments a good form of the remedy.

Since the salts of silver are readily decomposed, they should be mixed
as little as possible with organic or mineral substances, and haloids, sul-
phides, alkalies, soaps, tannin, and astringent extracts should be excluded
from prescriptions for silver compounds: it is important to mention, also,
the exclusion of creosote, for explosions have occurred from its trituration
with oxide of silver and organic substances. Solutions of the nitrate for
internal use should be kept as much as possible from air and light, and
are therefore commonly ordered in covered or dark-glass bottles: they
may be made with distilled water or with glycerin, and sometimes a few
drops of nitric acid are added to prevent reduction; syrup may be given
with it for children. Delioux prescribed it with an equal part of salt in
a weak, sweet, albuminous solution (white of egg), and Deniau added to
this a small proportion of bromide of potassium to redissolve the precip-
itate; but, in such combinations, the object of which is to secure solubility
and absorption, we are not giving the nitrate, but a complex chloro-albu-
minate. Discoloration of the lips and teeth, and nauseous taste, are,
however, drawbacks to the use of any solutions. A pill may be made
with crumb of bread according to an old and well-known formula (Bou-
din) : the decomposition into chloride that may occur is unimportant (v.



AESENIC. 25

p. 2). Argilla and silica and chocolate have been recommended as ve-
hicles.

The oxide is always given in pill or confection, and this form is to be
preferred for " constitutional " effects, or for an action on the lower parts
of the intestinal tract. It is usual to direct a patient taking these medi-
cines to abstain from much salted food before or after the dose, as likely
to hinder absorption into the blood.

[PREPARATIONS, U. S. P. Argenti cyanidum, used in preparing hy-
drocyanic acid; Argenti nitras ; Argenti nitras fusa ; Argenti oxidum.~]



AESENICUM AESENIC, As, =75.

The name arsenic is applied by common usage both to the element
and to its oxide, which is more correctly termed arsenious anhydride; it
it also called white arsenic, or arsenious acid.

The element, formerly classed with metals, now with metalloids, occurs
sometimes native, but generally in alloy with iron, copper, and other
metals, as oxide and sulphide. Nearly all sulphur contains some arsenic,
and from these different compounds it is liable to pass undesignedly into
many pharmaceutical preparations. Mineral waters also frequently con-
tain it; Tripier has noted its almost constant occurrence in chalybeate,
and Thenard in saline springs, though in minute proportion: those of
Plombieres contain but 0.0008 gr., Vichy 0.01 gr., and La Bourboule (the
largest amount) -fa gr. in 16 oz.

CHARACTERS. The metalloid is a steel-gray solid of metallic brilliancy,
readily oxidizing and tarnishing on exposure to air. It volatilizes at a
dull heat, the colorless vapor having a garlic-like odor. It burns when
heated in the air.



ACIDUM ARSENIOSUM ARSENIOUS ACID, OR ARSENIOUS ANHY-
DRIDE-WHITE ARSENIC, As a 3 ,=198.

PREPARATION AND CHARACTERS. Arsenious acid is prepared by sub-
limation from arsenical ores, and condenses in the cooler parts of the re-
tort as a heavy powder, fine and white, like flour; in the hotter parts, it
forms a vitreous mass, transparent and amorphous, which becomes, on
exposure to air, opaque and crystalline, and is usually seen in smooth
milk-white or yellowish pieces not unlike porcelain, and stratified in ap-
pearance according to the different opacity of its layers; the change from
the amorphous to the crystalline form is accompanied with phosphores-
cence (one of several of its analogies with phosphorus). The two forms



26 MATERIA MEDICA AND THERAPEUTICS.

differ in density and in solubility, the transparent acid dissolving in about
100, the opaque in about 80 parts of water at 15 C.

The powder is not readily wetted by water, so that it is apt to remain
floating on the surface, or adherent to the sides of a vessel. Organic
products, milk or mucus, render it less, acids and alkalies more, soluble;
oils and alcohol also dissolve it. It crystallizes from a saturated solution,
or after slow sublimation in minute shining octahedra, or in rhombic
prisms (like oxide of antimony, with which it is isomorphous): sprinkled
on a red-hot surface, it evolves scarcely visible vapors of metallic arsenic,
which have an odor like garlic, and, at a few inches from the hot surface,
change to dense white odorless smoke, being the acid re-formed by oxida-
tion. Arsenious acid itself has no smell: its taste is sharp and rather
nauseating (Hirtz), but, in such small quantities as may be taken for
trial, nothing more than a slight sweetness and grittiness will be de-
tected (Christison).



LIQUOR ARSENICAL1S ARSENICAL SOLUTION FOWLER'S SOLU-
TION.

PREPARATION. By boiling together arsenious acid and carbonate of
potash, and adding to the solution (when cold) tincture of lavender, and
sufficient water to preserve a proportion of 4 gr. in the ounce.

CHARACTERS. A reddish, alkaline liquid, with the odor of lavender:
it contains a mixture of arsenite and carbonate of potash.



LIQUOR ARSEN1C1 HYDROCHLOR1CUS HYDROCHLORIC SOLUTION

OF ARSENIC.

PREPARATION. By boiling arsenious acid with hydrochloric acid and
distilled water, preserving a proportion of 4 gr. to 1 oz. (This solution
corresponds in strength with liquor arsenicalis; it is nearly three times
the strength of liquor arsenici chloridi, London, and of the original acid
solution of De Valangin.)

CHARACTERS. A colorless liquid of acid reaction and sp. gr. 1.009.

SOD^E ARSENIASARSENIATE OF SODA.

PREPARATION. By heating together arsenious acid, nitrate and car-
bonate of soda, dissolving and crystallizing.

The liquor sodce arseniatis contains 4 gr. of the anhydrous salt in 1
oz. of distilled water.

CHARACTERS. The salt occurs in colorless transparent prisms soluble
in water and alkaline in reaction: the solution is also colorless and alka-
line.



AKSENIC. 27

Arsenic Acid, As 2 O 6 , the higher oxide of arsenic, is also white and
solid, but is so soluble as to be almost deliquescent, and it has a strong-
acid reaction. It is not employed in medicine in its free state, but in
combination with soda and iron. In the arts it is largely used in the print-
ing of cotton stuffs, and in the manufacture of aniline dyes.

Ferri Arsenias Arseniate of Iron, Fe 3 As 2 O 8 (v. p. 134).

Liquor Arsenici et Hydrargyri Ilydriodatis. A solution (not of-
ficinal) containing a double iodide of arsenic and mercury, has long been
in use under the name of its proposer Mr. Donovan, of Dublin (1839).
It is a pale-greenish colored liquid, having no odor, but a styptic taste;
it probably contains the red iodide of mercury and ter-iodide of arsenic.
In each fluid drachm there is about -fa gr. arsenic, ^ gr. mercury, gr.
iodine.

TESTS. 1. Sulphuretted hydrogen gives a bright yellow precipitate
of arsenious sulphide (As a S 3 ) in acid solutions of arsenious acid or the
arsenites.

2. Hume's Test. Ammonio-nitrate of silver gives a lemon-yellow
precipitate of arsenite of silver (Ag 3 AsO 3 ) in solution of arsenious acid,
or the arsenites. The same silver-salt gives a similar reaction with phos-
phoric acid, but with arsenic acid and the arseniates, a chocolate-colored
precipitate of arseniate of silver (Ag 3 AsO 4 ).

3. Ammonio-sulphate of copper gives with compounds either of ar-
senious or arsenic acid a light-green precipitate of arsenite of copper (Cu
HAsOJ, Scheele's green.

4. Marshes Test. Generate hydrogen by the action of a hot solution
of caustic potash or soda on zinc (Zn + 2KHO = K 2 ZnO 2 4-H 2 ). Fleit-
mann has shown that antimony will not combine with this form of hydro-
gen, but that arsenic will. Place the solution to be tested in a " Marsh's
apparatus," and if arsenic be present it will combine with the nascent
hydrogen to form arseniuretted hydrogen (As 2 O 3 -f 6H 3 = 3H 2 O + 2AsH 3 ).
On igniting the jet of gas (which burns with a bluish flame), and depres-
sing upon it a cold porcelain plate, an arsenical stain will be deposited,
while the hydrogen is burned off into water. The stain has the following
characters: (a) metallic brilliancy; (b) hair-brown color; (c) volatility;
(d) solubility in chloride of lime; (e) non-solubility in cold disulphide of
ammonium; (f) when evaporated with a drop of nitro-hydrochloric acid
it yields a residue of arsenic acid, which gives a brickdust-red turbidity
on the addition of nitrate of silver.

5. Reinscfi's Test. A piece of copper foil, when boiled in an acid
solution of an arsenical compound, will become slate-gray from the depo-
sition of a fine film of metallic arsenic. This test, to be complete, must
be verified by heating the coated copper in a narrow glass tube, when
metallic arsenic will sublime, and be deposited in a ring on the cooler
part.



28 MATERIA MEDICA AND THERAPEUTICS.

For the " reduction test " of white arsenic, it should be placed with
" black flux " in a similar tube perfectly dry, and, on heating first the
charcoal and then the arsenic, the latter sublimes and is deposited in a
metallic ring as above mentioned.

ABSORPTION AND ELIMINATION. Since the observations of Schmidt,
Mialhe, and others, metallic arsenic has been considered inert. Recently,
however, Schroff has shown that it may exert a strongly poisonous ac-
tion, and that doses of 8 to 15 gr. have caused gangrene of the stom-
ach and death in thirty to forty hours (Zeitschrift der Arzte, i., 1858). It
is probably oxidized before absorption.

Arsenious acid in all its combinations, and by whatever channel intro-
duced by mouth or by rectum, by the lungs or by the skin is readily
absorbed, and has been detected in the blood a few minutes after its ad-
ministration. It passes out by the skin and mucous membranes, by the
various glands, as the salivary and even the lachrymal, but mainly by the
kidneys.

The rapidity of elimination varies; in some cases, none of the sub-
stance could be detected in the secretions three days after the last dose,
but in Ludwig's observations on animals, if small quantities were given
for a fortnight and then omitted, the urine was not quite free till three
weeks afterward (Medical Record, 1877). Gubler gives six weeks as the
time during which it may continue to pass out, and when it has ceased
to do so it may reappear after administration of iodide of potassium;
hence it seems probable that elimination is not always complete, and
that of what is taken, a part may be deposited in the tissues and occa-
sion so-called " cumulative " effects. Recently, arsenic has been found
to be specially deposited in the nervous system; thus, if in fresh muscle
1 part is found, the proportion in liver is 10.8, in brain 36.5, and in spinal
cord 37.3 (Scolosuboff: Annales d'Hygiene, January, 1876). This be-
came a matter of great importance in a recent French trial (Danval),
when the experts were blamed for not examining the brain and cord
(British Medical Journal, ii., 1878, p. 73); these parts should henceforth
be analyzed as carefully as the abdominal viscera. Caillol (de Poncy)
offers some analyses to show that arsenic partly displaces phosphorus in
nerve-compounds (Medical Record, 1878). If any be contained in the
body at death, it may be detected after an almost indefinite period.

PHYSIOLOGICAL ACTION (EXTERNAL). Preparations containing arse-
nic produce local irritation, inflammation, or destruction of tissue, in vary-
ing degree, according to the strength and character of the application.
Dry white arsenic in mass may not injure the unbroken skin, but arseni-
cal powders are apt to produce eruptions of various kinds on exposed
surfaces, and especially irritative effects on the pudenda, in those who
are employed in the manufacture of green dresses, wall papers, artificial
flowers, etc. (Annales d 1 Hygiene ; Dr. Guy: British Medical Journal,



ARSENIC. 20

ii., 1863, etc.). Perforation of the septum nasi has been noted, and anal
ulceration has followed the local use of a green paper colored with arse-
nite of copper. Arsenic dissolved or moistened is still more irritating,
and those who use it, for instance, in sheep-washing, generally suffer
from eczema of the scrotum, etc. (Lancet, 1857). Those who work with
arsenical powders are liable also to various degrees of acute and chronic
arsenical poisoning; and green colors are not the only dangerous ones:
fuchsine, a red dye, contains much arsenic (Ludwig: Medical Record,
1877), and blue gloves have shown arsenic on analysis (British Medical
Journal, ii., 1878). The use of green-colored cards has caused a disease
of the nails resembling psoriasis, and green hat-lining has caused eczema
(Farquharson: British Medical Journal, ii., 1879). The external use of
a violet powder adulterated with arsenic proved fatal to thirteen chil-
dren out of twenty-nine subjected to it (British Medical Journal, ii.,
1878).

The continued application of a strong arsenical compound has a cau-
stic, destructive effect, which is not simply a chemical one, like that of
caustic acids or alkalies, and is not exerted on the dead subject (Hirtz),
but is produced by interference with nutritive processes in the part, caus-
ing rather a condensation and "mummifying" of tissue than an actual
destruction (Gubler). It is much more active in unhealthy, ill-nourished
tissue (e.g., that of lupus), than it is in normal tissues. Very strong ar-
senical applications produce much local inflammation, and so far interfere
with the action of absorbents that the effect remains local only; but un-
less in such strong concentrated form, arsenic is readily absorbed, es-
pecially from wounds and mucous surfaces; hence its surgical use has
led to serious constitutional symptoms, and even to death. Roux de-
scribes the application of an arsenical ointment 1 part in 32 over a
space of 1 square inches of a cancerous breast for one night only, and
death from poisoning on the second day. Sir Astley Cooper relates a
fatal case from the use of an arsenical solution to a " fungus of the eye "
(Lancet, i., 1837).

Arsenical paste applied to an inflamed tooth-pulp has also proved
fatal, and Graham has recorded vomiting, severe pain, convulsion, and
death from the use of a plaster containing half its weight of arsenic to a
cancerous breast (Glasgow Medical Journal, 18G9); the prescriber of the
plaster was tried for homicide, and many similar cases have been before
the law courts.

The antiseptic power of arsenic deserves mention: it is largely utilized
in the dissecting room, and seems to have retarded the process of post-
mortem decay in some cases of poisoning when large amounts have been
used. The recent researches of Johannsohn assign it, however, but a
limited power: he found that small quantities checked fermentation in
yeast and syrup, but only for a time: in lactic fermentation it diminished



30 MATERIA MEDICA AND THERAPEUTICS.

the growth of one fungus, but favored another. The same thing occurred
in urine: it exerted no influence on non-organized ferments, such as pep-
sin, amygdalin, etc. (Archiv fur Exper. Path., Bd. ii., p. 106).

PHYSIOLOGICAL ACTION (INTERNAL). The blood and the nutrition-
processes are altered by arsenious acid and its compounds, but the symp-
toms of its physiological action are mainly evidenced in the alimentary
canal, the mucous membranes, and the nervous system, and in different
cases these parts are affected in different degree, according to the dose,
the time and mode of its administration, and the constitution of the in-
dividual.

Digestive System.. Very small doses, such as -fa to -^ gr., may be
taken for some time without other effects than such as are of stimulant
and tonic character e.g., improvement of appetite, sense of warmth at
the stomach, and general invigoration; but usually, sooner or later, these
symptoms are replaced by those of irritation and malaise. Trousseau
quotes from Koepl the case of a servant who, desiring to get rid of a
severe mistress, mixed with her food for some time very small doses of
arsenic: the mistress, however, improved in appearance and in stoutness,
and the plot was only detected after the use of a large poisonous dose.
Doses of ^ to \ gr. are liable to produce soreness of mouth, with some
salivation and dysphagia, foetid or sour taste, thirst, heat and constriction
in pharynx, with nausea or vomiting, gastric pain, flatulence amounting
to tympanitis, and diarrhoea. Vaudrey found copious pultaceous stools
follow the medicinal use of arsenic without toxic symptoms. One of the
early symptoms of the physiological action of the drug is a slimy silvery
aspect of tongue, "as if nitrate of silver had been lightly applied" (Beg-
bie), an appearance produced by a thin coating of mucus secreted under
the influence of irritation. After continued doses, the tongue becomes
red or brown, cracked and tremulous, the gums bleed, and the buccal
membrane becomes covered with aphthous or even membranous patches
like a true diphtheritic condition (British Medical Journal, \., 1862).
Vomiting becomes so frequent that all food is rejected, and emaciation
sets in rapidly, an effect which has been termed " tabes arsenicalis."

After poisonous doses, which may be stated at 2 gr. and upward, the
symptoms already described become intensified; pain especially of most
severe burning, cramping, spasmodic character comes on within half
to one hour, in the region of the stomach and navel, spreading thence
over the whole abdomen, which becomes contracted and hard: the ejecta
are offensive, and yellowish or greenish in color, not unlike bile (unless,
as often occurs in cases of poisoning, soot or indigo has been mixed with
the arsenic); hiccough attends the vomiting and purging; the latter be-
comes involuntary, and is accompanied with severe tenesmus, and the
general symptoms may closely simulate those of cholera (Lancet, ii.,
1870).



ARSENIC. 31

On the other hand, in some exceptional cases, the vomiting 1 has been
only moderate, and there has been complaint of coldness rather than heat;
in others, there has been almost entire absence of pain, the patient re-
maining in a dull and semi-narcotized condition, and in several even se-
vere cases, a remission of symptoms has occurred for some days before
death (cf. Taylor: Guy's Reports, 1850).

In experimenting with frogs, Dr. A. Lesser found that intestinal peri-
stalsis was increased by arsenic, and local tetanic contractions occurred
from immediate irritation of ganglia in the intestinal coat (not indirectly
from influence of the central nervous system): gastro-enteritis was also
produced by the drug, but he did not, as Bohm did, find it more poison-
ous when given by the mouth than by a vein. It was eliminated by
the intestinal mucous membrane (Virchow's Archiv, 1878; Lancet, ii.),
and we may add here that by whatever channel toxic doses of the drug
are given to men or animals, gastric inflammation is commonly deter-
mined.

Nervous System. The early effects of very small doses are usually
tonic in character, there being a general sense of improved power. The
same fact was noted when describing effects on the digestive system, and
it is possibly not a primary nerve-tonic effect, but rather dependent on
improvement in appetite and assimilation of food.

Full medicinal doses, long-continued, give rise to numbness and prick-
ing sensations with tremor or stiffness of limbs.

Irritant doses cause gastric pain, as already described; sometimes
headache has been a marked symptom, as, for instance, in a large number
of children who each received about 1 gr. of white arsenic in milk ("Tay-
lor on Poisons," p. 295), and in many persons poisoned by the accidental
admixture of a small quantity of arsenic in bread: they suffered also from
a feeling of constriction over the forehead, vertigo, and tinnitus (Dr.
Feltz: Lancet, i., 1880), from visual sensations of light or flame, prostra-
tion, and feebleness of lower extremities, and in these, as well as in
other cases, pain in the back has been urgent (British Medical Journal,
i., 1873). Sometimes the extremities have been very sensitive. Restless-
ness, insomnia, grinding of teeth, giddiness, irritability, and depression
are frequent symptoms.

The effects of poisonous doses (6 to 8 gr.) are often ushered in with
rigor, profound depression, and extreme anxiety. Restless tossing of
arms is commonly noted, and later, numbness, cramps, and twitchings of
all muscles. The oesophageal spasms may simulate those of hydrophobia,
and the muscular cramps may amount to opisthotonos convulsions alter-
nate with delirium, the special senses become impaired or lost, the mental
faculties torpid (the stupor may suggest narcotic poisoning), and syncope
or collapse may close the scene. There may be local palsies, as of limbs
and sphincters in the course of arsenical poisoning, and, as the effect of



32 MATERIA MEDICA AND THERAPEUTICS.

the drug in this direction is not so generally known, we may, with advan-
tage, speak of it more fully.

Arsenic exerts a paralyzing influence certainly upon sensory and mo-
tor, and we may say probably upon vaso-motor nerves also. Dr. Sklarek,
experimenting on the frog, found that arsenical injections, in minute quan-
tities, destroyed common sensibility, probably by influence on the cord
(Reichert's Archiv, 1866). Lesser, while verifying this, noted a transient
increase in reflex irritability, then diminution of it, then cessation; after
some time the frog became completely paralyzed.

Drs. Ringer and Murrell, remarking that paralysis occurs in the same
order after mechanical arrest of circulation (as by ligature or excision of
heart), instituted experiments to show whether the latter was the real
factor in Sklarek's results, and concluded that they were due rather to a
toxic action on the central nervous system; peripheral motor nerves re-
tained their function for some time, for the muscles continued to contract
under direct galvanic stimulus; ultimately both nerves and muscles were
paralyzed by arsenic, and they ceased to re-act long before similar mus-
cles did in a brainless frog, and the observers named concluded that "ar-
senious acid is a protoplasmic poison, affecting first the more highly or-
ganized nervous centres, next the nerves, and last the muscles: . . . that
it is a poison to all nitrogenous tissues (Journal of Physiology, i., 1878-
79, pp. 227, 228).

Clinical records clearly indicate paralysis as a symptom of arsenical
action. So early as 1711 Morgagni notes " tremor of limbs, and palsy of
feet" (Op., vol. iii., Trans. Alexander, Letter 59). Mr. Trend reports
the case of a pregnant girl, who took 2 gr. twice daily for three months,
and besides intestinal symptoms, suffered from pricking pain in both legs,
impaired sensation, and loss of power (British MedicalJournal, ii., 1858).
Partial paralysis and numbness from habitual taking of the drug are re-
corded in Schmidt (Bd. clxv., p. 238), and tremor and partial palsy from



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