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

Materia medica and therapeutics, inorganic substances; (Volume 2) online

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mainly those of severe gastric and intestinal inflammation, as already de-
scribed, and the post-mortem appearances will correspond; while with
doses of 2 to 10 gr., when the patient survives much longer, and yet dies
ultimately from the'effects, these will be evidenced rather in the nervous
system (Hunt). If the poisoning be very chronic, and result from con-
tinued doses of -fa to gr., a general irritation of the system is apparent
from the symptoms of erethism or pyrexia with chills, redness of eyes and
of orifices of nose and anus, vesication on palms and soles, with dryness
of skin and brownish spots, pain in head and joints and abdomen, with
vomiting, purging, and gradual marasmus. The soreness of mouth and
salivation have sometimes suggested mercury as the poisonous agent,
and sometimes the general condition has been mistaken for phthisis, or
for typhoid. Gaethgens further suggests points of resemblance with
diabetes and with phosphorus-poisoning ( Centralblatt fur Med., 1875,
Bd. xiii., p. 32, Abstract in Schmidt, 1876). An instructive case which,
for a time, completely deceived the medical attendants, and yet which



ARSENIC. 41

reveals exactly the physiological action of arsenic as we have described it
including renal and nerve-symptoms is that of Mrs. Wooller as col-
lated by Sir R. Christison (Edinburgh Medical Journal, 1855).

PATHOLOGICAL CHANGES. In cases of acute poisoning, the principal
changes occur in the stomach and intestinal tract; redness and inflamma-
tion of these parts may be found within a few hours of administration;
ulceration is not uncommon, gangrene and perforation are rare. In ex-
ceptional cases no marked redness has appeared, though arsenic has been
found in the stomach (Taylor). Under full arsenical influence there is
marked tendency to fatty degeneration of all tissues; in acute cases this
is preceded by inflammatory change, and according to Dr. Pinkham (Bos-
ton) it may be induced within forty-four hours (Medical Times, ii., 1878).
Jaundice occurs, and after death the liver-cells, the renal tubules, and the
intestinal glands are found choked with granules and fat-globules, their
epithelium being detached or destroyed. Salkowsky found these changes
in poisoned animals within three to six days, the glycogenic function of
the liver being impaired very early (Virchow's Archiv, Bd. xxxiv. ); it is
noteworthy that in such cases the fourth ventricle may be punctured
without causing glycosuria. Virchow described a swollen state of
Peyer's patches and the solitary glands, with fatty degeneration of epithe-
lium and " rice-water " secretion containing a fungus that had been
thought peculiar to cholera (Archiv, Bd. i., 1870). C. Gies has recently
given additional evidence of fatty degeneration of tissue under continued
small doses of arsenic, but notes also that the subcutaneous fat was in-
creased, and the animals gained weight. Increase of fat and of weight
have been observed in chronic arsenical poisoning in man (Boston Jour-
nal, 1876).

TOLEBAXCE. Arsenic Eating. Under certain conditions the system
may be brought to " tolerate " full, and even toxic doses of arsenic as of
some other drugs, without showing the usual physiological effects. To pro-
duce such result, it is necessary to begin with very small doses, and in-
crease them by degrees: thus Flandin, giving at first -^ gr. of arsenious
acid to animals, gave, after nine months of progressive increase, 15 gr.
per diem without poisonous symptoms (quoted by Stille).

Taylor distinguishes between "habit" and "tolerance," meaning, by
the latter term, only that power of bearing large doses which is shown in
certain exceptional states without any preparation ; thus, opium may be
tolerated in tetanus, alcohol in fever, and antimony in pneumonia; and
with regard to the ordinary form of tolerance as induced by habit, he re-
marks that it is mainly restricted to products of the vegetable or organic
kingdom as opium, tobacco, ether, strychnia. He doubts whether any
human being can obtain by habit any real tolerance of such mineral drugs
as corrosive sublimate and arsenic; and certainly experiments on the
point can never be pushed far in our own experience.



42 MATERTA MEDIC A AND THERAPEUTICS.

Yet, on the other hand, evidence in the affirmative does exist. I
understand that at Whitbeck (Cumberland) the inhabitants habitually
use a natural water which contains nearly a grain of arsenic in the gallon,
and are remarkably healthy and long-lived ( Chemical News, August,
1860). Professor La Rue reports the case of a man who so far accus-
tomed himself to the drug that he could take 3 or 4 gr. " without more
effect than cold water " (Boston Medical and /Surgical Journal, 1866) ; but
the main evidence seems curiously localized in parts of Austria and Styria,
nor can it be any longer dismissed as " pure fable " (Christison) or a
" Styrian theory " (Taylor), since the reports of Vogt and Tschudi in
1854 (Medical Times, ii.; Wiener Med. Woch., No. 28). M. Heisch, a
trustworthy witness, has recorded his personal experience to the effect
that he took 3 gr. as a daily dose for many years; he began it, when ap-
pointed director of arsenic works at Salzburg, with the object of protect-
ing himself from the effects of the fumes; he retained good health, but
when he attempted to leave off the drug suffered from restlessness, in-
somnia, faintness, and finally from lung-symptoms {Lancet, 1860). Pro-
fessor Schafer records that -^ to -j^ gr. is an initial dose commonly used
for the first fortnight, then it is omitted for the same period, and then
resumed and gradually increased to 5 gr. or more (Nothnagel, p. 241)
Heisch says that 23 gr. have been taken for a dose. Arsenious acid is
the usual form, but sometimes orpiment is substituted. Dr. Maclagan
saw doses of several grains swallowed, and he afterward detected arsenic
in the urine (Edinburgh Medical Journal, 1864); and I have myself
learnt from persons at Salzburg that the habit was very common, and have
seen men who had taken from 5 to 10 gr. daily for many years, with oc-
casional intermissions, and who looked robust and healthy. Near Harz-
burg they have the curious custom of regulating their doses by the moon
they gradually increase to the full moon, and then diminish and take
purgatives of aloes: some avoid drinking with their dose of arsenic, others
avoid fat, and others keep to a farinaceous diet, but the majority eat and
drink anything. The practice prevails mostly, if not entirely, among
the working-classes, but is not confined to men. Its effect is said to be
to increase fat and stoutness, and yet to render them more equal to exer-
tion, and especially to mountain-climbing without difficulty of breathing;
also to give freshness to the complexion, brightness to the eye, and gen-
eral vigor to bodily function. 1 It is agreed that much depression and
emaciation occur on the withdrawal of the drug from those who are ac-
customed to it, and although a certain number who commence early to

1 Gubler explains these effects by diminished oxidation and tissue-change (v. p.
40), suggesting the connection of muscular fatigue with formation of sarco-lactic
acid ; he presumes this to be lessened by arsenic alike in thoracic, respiratory, and
other muscles. They can therefore work longer, there is less carbonic acid to be dis-
charged by the lung, and less labor or hurry in respiration.



ARSENIC. 43

take it continue its use to an advanced age, yet it is said, and we can well
believe it, that it does much harm and even proves fatal in an insidious
manner to many persons, especially among the young. We cannot de-
pend upon securing an indiscriminate tolerance of arsenic; nothing of
the kind has been reported in this country, but on the contrary many
have suffered from a foolish imitation of the Styrian custom.

Effects of Arsenical Wall-Papers, etc. It is now clearly ascertained,
though the knowledge is comparatively recent, that all the serious symp-
toms already described may be produced, in greater or less degree, by
arsenical emanations from wall-papers and paints, hangings, dresses, or-
naments, etc.; and not only from the green colors containing arsenite of
copper, and which have long been suspected, but also from red, drab,
blue, gray, and enamel papers generally (.British Medical Journal, ii.,
1871), arid from aniline colors fixed by arsenical mordants in carpets, cur-
tains, etc. (Taylor: "On Poisons," 3d Ed., p. 353). Soon after the ear-
liest observations on the subject, in 1858, Mr. Phillips (the chemist con-
sulted by the Board of Trade) stated that a more than bearable heat
would be required to volatilize arsenic, but Fleck has pointed out that the
contact of moist organic substances (such as sizing) readily disengages
arseniuretted hydrogen from Schweinfurt green (Zeitschrift fur Biologic,
Bd. viii., 1872), and Hamberg has verified its presence in the air of rooms
(Pharmaceutical Journal, August, 1874). This gas is a very powerful
poison. Gehlen, the chemist, was killed by a small quantity, and in
some recent cases it caused severe epistaxis, haematuria, and jaundice
(Comptes Rendus, 1863; Gazette de Paris, No. 18, 1873). Usually, how-
ever, the injury is done by material particles of arsenical dust (Chevalier:
Annales d'Hygiene, vol. xii., p. 49). Some time ago I met with many
cases of catarrh, irritation of mucous membrane, etc., which proved to be
due to this cause, and I can quite corroborate the observations made by
Mr. Clarke, of Bristol (in a careful paper in British Medical Journal, i.,
1873), who finds that in one set of cases dyspepsia, nausea, sore throat,
and conjunctivitis are the prominent symptoms, while in another nerve-
troubles, headache, irritability, prostration, and ^restlessness are more
complained of, though dyspepsia, and especially coated tongue, are not
absent; in a third group the prostration, headache, and nervous excite-
ment simulate a mild typhoid. He records violent sneezing, and also
an eruption of eczema and of nasal ulceration as exceptional symptoms,
and further points out that a case of ordinary illness may be much ag-
gravated by an arsenical atmosphere, and that some patients are much
more sensitive to it than others. Arsenic was detected in the secretions
of several of Mr. Clarke's patients. The symptoms are generally worse
in a damp atmosphere, and in the evening when the room is heated. Dr.
Hinds describes " depression, faintness, nausea, and colic," after reading
by gaslight in a green-papered room (Medical Times, 1857). Mr. White-



44 MATERIA MEDICA AND THERAPEUTICS.

head reports similar symptoms in a youth every time he occupied a cer-
tain bedroom only (British Medical Journal, 1858).

The real cause of chronic ill-health may be long unsuspected, and a
striking case is related of the simulation of various forms of disease in
one family for upward of twelve years before their true cause was discov-
ered in arsenical wall-papers (British Medical Journal, ii., 1871). Dr.
G. Johnson has reported the case of a medical practitioner, in whom
chronic dyspepsia, catarrh, cough, and even asthma were due entirely to
the same agency (Medical Times, ii., 1874). Similar symptoms have fol-
lowed, though less frequently, from painted walls, gas-shades, etc. (Base-
do w, in Monthly Metrospect Medical Science, 1849; New Sydenham
Society's Year Book, 1860, etc.). Dr. F. Brown (Boston) has reported
several interesting and important cases of chronic illness from arsenical
paints and wall-papers: he notes that most of the patients had increased
in weight (Boston Medical and Surgical Journal, 1876). Some years ago
arsenic was purposely used for clarifying candles, and thus serious effects
were produced, which still sometimes follow the use of candles colored
green. Arsenical poisoning has occasionally occurred from cigars (New
Sydenham Society's Year Book, viii., p. 432), and from green cigar-hold-
ers (British Medical Journal, i., 1879). Mr. Jabez Hogg has drawn spe-
cial attention to eye-inflammation from arsenical papers and to other ill-
nesses produced by them (Sanitary Record, April, 1879).

SYNEKGISTS. Antimony is the most complete analogue of arsenic,
except that the former is a more certain emetic: phosphorus also is allied
in action.

The effect of small doses, upon the nervous system especially, is allied
to and supported by quinine and by alkaline bromides, while the tonic
influence of similar doses on the vaso-motor nerves (leading to contrac-
tion of vessels, at least temporarily) is allied to that of acids, astringents,
ergot, and cold applications. Doses sufficient to lessen oxidation and
combustion act somewhat like cyanides and other substances which pre-
vent these processes.

ANTAGONISTS II*COMPATIBLES. Diffusible stimulants, alcohol,
warmth, and, according to Gubler, opium, are the vital antagonists to
arsenic. Iron, in the form of hydrated peroxide, magnesia, calcined or as
hydrate, lime, animal charcoal, and astringents generally, are chemical
or mechanical antidotes. Iron and magnesia have power over arsenic in
solution, since they precipitate the poison in an insoluble form.; with solid
arsenic " they have no more effect than powdered brick-dust " (Taylor).
A mixture of hydrate of magnesia and persulphate of iron is best to use,
and the resulting sulphate tends to act on the bowels. The " antidotum
arsenici " of the German and other Pharmacopoeias contains calcined
magnesia 7 parts in 120 of water, solution of persulphate of iron (sp. gr.
1318) 60 parts in 120 of water: the two parts to be kept separately and



ARSENIC. 45

mixed at the moment of administration. Pure dialyzed iron is not anti-
dotal, but according to Mattison becomes serviceable if salt be added to
it (Medical Record, 1878), since this precipitates a hydrate.

In cases of poisoning, vomiting should be produced and promoted as
early as possible, by ipecacuanha or zinc sulphate: nor is antimony so
undesirable as has been stated; many cases have recovered under its use
(Morgagni, and Gazette des Ilopitaux, August, 1844, etc.), also after in-
fusion of tobacco (Medical Times, i., 1857). Milk and demulcent drinks
containing, e.g., eggs, flour, or fats, should be given, and large frequent
doses of any of the antidotes named, a tablespoonful of the iron com-
pound every five to ten minutes (British Medical Journal, ii., 1863).

THERAPEUTICAL ACTIOX (EXTERNAL). Parasitic Diseases. In sca-
bies, and in phtheiriasis, arsenic has sometimes been used, and a lotion
containing a small proportion 1 with soft soap and spirit of wine has been
much commended: it is painful in application, and has not seemed to me
so good as other remedies; neither is the use of this substance free from
danger, for an arsenical salve applied for scabies has produced poisonous
effects.

For ascarides Trousseau recommended an injection of -|- gr. of white
arsenic in 4 oz. of water; it is not often used, but would probably be
effective. M. Boudin used the same remedy in larger doses, but it is un-
necessarily dangerous.

X/upus Cancer. In these maladies the caustic action of arsenic is
often extremely valuable, and the powdered drug may be used sufficiently
strong to destroy diseased tissue without affecting the adjacent sound
skin. For chronic superficial lupus, especially of the face, Hebra recom-
mends " Cosme's paste," containing 20 gr. of arsenious acid and 60 gr.
of cinnabar in 1 oz. of rose ointment (cold cream): this is spread on linen,
and applied firmly for twenty-four hours, and then renewed for the same
period, a third application being made if required. I have often used
this with good results; at first there is little change produced, but by the
second day the growth turns gray, and by the third day commences to
slough, and may be separated in a poultice. Pain and oedema may occur,
but can be relieved by sedatives and warm applications. Among many
hundred cases thus treated no poisonous symptoms have been reported.

In epithelial cancer arsenic has long been used. Rousselot combined
it with cinnabar, and Dupuytren with calomel, and Mr. Marsden has writ-
ten in praise of its association with an equal part of mucilage. The paste
commonly known in Ireland by the name of Miss Plunkett's is prepared
with arsenious acid, sulphur, and two species of ranunculus: it often acts
powerfully.

1 Arsenious acid 1 part, carbonate potash 20 parts, soap spirit 200 parts, water 2,000
parts. (Soap spirit is made with equal parts of soft soap and spirit of wine.)



46 MATEKIA MEDICA AND THERAPEUTICS.

As already stated, caution is required in the external use of arsenic:
not that it should be applied in a more diluted form, for then its absorp-
tion would be even more probable, but only a limited area not more
than one square inch should be covered at one time. Dr. Walshe has
specially insisted that its use should be restricted to superficial cancer.
From the internal administration of arsenic I have had good results in
epithelioma (v. p. 66).

Dental Surgery. Arsenious acid is in daily use for destroying the
nerve-filaments in a tooth-pulp before filling the cavity, and it is still con-
sidered one of the best agents for the purpose. It is true that violent
symptoms have sometimes followed its use, which always needs caution:
still osteitis and its accompanying pain might occur after any destructive
application, and we may fairly consider that -^ gr., especially when com-
bined, as it usually is, with a little morphia, is free from any serious risk
of arsenical irritation.

Rheumatic Gout. Baths containing from 15 to 30 gr. of arseniate
of soda, with a few ounces of the carbonate of soda, have been well
spoken of by Dr. Gucneau de Mussy, as relieving both the pain and the
deformity consequent upon rheumatic arthritis. There is some evi-
dence in favor of the internal use of the remedy for this malady (v.
p. 51).

THERAPEUTICAL ACTION (INTERNAL). The therapeutical powers of
arsenic, which are many and various, may be traced along the same lines
as its physiological action, and without implying any definite limits as to
the pathology of the under-mentioned diseases, we may, for the sake of
clearness, arrange them in four groups for consideration in detail: (a)
General or blood-diseases, such as intermittent fever, phthisis, struma, lym-
phoma, anaemia, chronic rheumatism, diabetes; (>) more specially nerve-
disorders, neuralgias, asthma, chorea, tremor; (c) disorders connected
mainly with capillary congestion, cerebral, renal, uterine, or cutaneous;
(d) disorders affecting chiefly mucous membranes, coryza, chronic bron-
chitis, dyspepsia, gastric catarrh, vomiting, diarrhoea, English cholera,
gastric ulcer.

Intermittent Fever Ague. Long used as an empirical remedy for
ague, in the East, its more scientific employment dates from Slevogt, of
Jena, in 1700. 1 Condemned by Baron Storck, it was reintroduced by
Dr. Fowler, of Stafford, in 1786, after experience of the effects of a
"patent ague drop" which contained it; and again condemned by Brous-

1 Of the older writers on this subject, Melcbior Frick, and the two Plencitz, of Vi-
enna, deserve mention. The former says " Experientia nos docebit, arsenicum in
febribus intermittentibus adhibitum omnes eas dotea possidere, quibus optima reme-
dia prasdita ease debeat" (Paradoxa de Venenis, 1710). Of the practice of the latter
at the Orphans' Asylum, Harless reports " Ej usque (arsenici) usu in millenis fere
febrium intermitteutium casibus, rare frustrates fuisse affirmant."



ARSENIC. 47

sais. Its value was finally re-established by Boudin, in 1842, after a pro-
longed experience in Algeria (" On Intermittent Fevers," Paris, 1842).
The English physician reported several hundred, but M. Boudin, four thou-
sand cases, almost all successful. The former was accustomed to press the
remedy to its "operative" or physiological effects; the latter aimed at
inducing " tolerance," commencing with fractional doses every quarter-
hour, so as to introduce as much as possible into the blood, and to " sub-
stitute an arsenical for a paludal saturation." The names of Sistach,
Millet, Fremy, and Isnard are associated also with records of large num-
bers of successful cases, while opposite experiences may be found in the
works of Gintrac, Oesterlen, and G. See.

In 1860, Mr. J. Turner reported such favorable results with -J-dr. doses
of Fowler's solution, given every second hour for four or five doses, that
the Director-General recommended the plan to army officers (Medical
Times, ii., 1871), and Dr. Chappell supported it with an account of
eighty cures out of one hundred and forty cases (Medical Times, i., 1861).
The same dose was used by Dr. Broderick, but not without sickness
(British and Foreign Review, 1866). These observers found, as did
Fowler, Rayer, and others, that much better results in curing ague were
obtained with large doses, as of 30 to 40 drops, than with ordinary, full,
or unusual doses up to 20 drops; but Sistach and others observed that as
soon as the fever ceased, the system ceased to " tolerate " such quantities,
and there is always a possibility of the remedy doing harm. Quite re-
cently has been recorded the case of a physician, aged fifty, who took 12
drops of Fowler's solution twice daily for about three months with ap-
parent benefit to the intermittent, but he got diminished secretion of
urine, colic, tenesmus, weak heart, etc., and died rather suddenly with
vomiting and syncope; his attendant (in South America) traced his symp-
toms to arsenic, and Dr. A. S. Taylor concurs. It must be said, however,
that an ordinary cerebral attack i.e., independent of arsenic is not ex-
cluded by the history given (Medical Record, February, 1879).

We cannot doubt that arsenic, suitably administered, is an effective
remedy for ague, but on comparing it with quinine, and allowing for a
percentage of spontaneous recoveries from mild attacks, we conclude
that the latter remedy is still to be preferred for severe and acute cases,
and in "pernicious" or "malignant" forms; also it acts better usually
in tertian ague. When, however, it has failed to cure such cases even
in excessive or long-continued doses, or when the malady is of moderate
severity, subacute or chronic, especially of quartan type and accompanied
with marked oedema and prostration, then arsenic is specially indicated.
The element 'of risk may be much lessened by careful attention to the
urine and the general symptoms.

Splenic or hepatic hypertrophy may be another indication for it, as
Boudin suggested. It is good in malarious cachexia (when quinine often



48 MATERIA MEDICA AND THERAPEUTICS.

renders but little service), also when jaundice is present; further it has
some prophylactic power, and assists in preventing relapse.

I have records of nineteen cases of severe chronic ague of the quartan
type, all successfully treated by arsenic. Most of the patients were
Americans who had taken quinine very largely, being in the habit of car-
rying it in their pockets and taking from 5 to 20 gr. whenever they fan-
cied an attack was impending. Many of them had clean, red, irritable
tongues, and were suffering from oedema or anaemia; in most of them the
spleen was enlarged, and in some the liver. I prescribed the liquor ar-
senicalis in 5 to 10-min. doses thrice daily, and the result of this treat-
ment was uniformly good. Both quinine and arsenic have been credited
with an " anti-zymotic " power of destroying malarial germs in the blood.
As regards the prevention of relapse, Hirtz, judging from 120 cases,
found quinine and arsenic nearly equal; probably the best results may be
obtained by a judicious combination of them both, full doses of the former
being given to ward off an impending paroxysm, and arsenic in the in-
tervals: this mode of treatment I have frequently adopted with success.
Prof. Gubler uses arsenic in ague as a -sedative, and " indirect reconstitu-
ent," and connects its anti-relapse efficacy with its permanent deposition
in the tissues.

Phthisis. For the employment of arsenic in chest diseases we may
go back as far as Dioscorides, who states that " sandarach " (probably the
sulphuret) " is given to patients suffering with lung-suppuration, and
mixed with resin is inhaled in vapor for obstinate cough." Dr. Bed-
does used it early in this century, and recently the value of the drug in
certain stages of tubercular phthisis has attracted renewed attention.
Herard and Moutard-Martin have especially recorded good results from
it in relieving the lung-congestion and the general pyrexia of early



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 6 of 40)