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

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stages; at the same time the latter physician observes that it is most
efficacious when phthisis assumes a slow torpid course, acute tuberculo-
sis not being modified by it. " It has a reconstituting action, and modi-
fies secondarily the pulmonary lesion " in suitable cases (Lancet, i., 1868).

Before suppuration of tubercular deposits has taken place, I have
found arsenical solution in 2 or 3-min. doses, three times daily, give par-
ticularly good results; it is well to combine it with a course of cod-liver
oil and change of climate, and it should be continued for weeks or even
months if possible. I agree with the account given by Isnard (which is
still more favorable), for he found it relieve profuse sweatings, improve
appetite, and promote in some favorable cases not only healing of cavities
but absorption of tubercle {Bulletin de Therapeutique, t. Ixxvii.). It
controls diarrhoea in these cases in a very marked way.

Cersoy traces to arsenic an effect which has been also attributed to it
in bronchitis, and which really accords with what we know of its physio-
logical action viz., the lessening of congestion both in the bronchial



AKSENIC. 49

mucous membrane and in peritubercular lung-tissue; thus he finds that it
benefits haemoptysis ( Gazette des Hopitaux, 1869). Prof. Stille thinks
it probable that any benefit conferred in phthisis is due to an influence
upon the accompanying bronchitis.

Massart is almost alone in his recommendation of an arseniate of gold ',
which, in doses of ^ to ^ gr., he found useful even in advanced cases
(Revue de Therapeutique, 1860, p. 21). The general opinion of French
observers, however, would restrict the value of arsenic to early stages,
or to the relief of certain symptoms: thus Nouat agrees as to the good re-
sults of yo-to -jV-gr- doses given early in the malady, and finds that in later
stages, especially in the cases mostly seen in hospital practice, benefit is
exceptional (Lancet, i., 1870); and Trousseau, while recording improve-
ment as to diarrhoea, hectic, expectoration, and cough, does not speak of
cures, but of the gradual development of the malady and the formation
of fresh tubercle. He prescribed cigarettes containing arseniate of soda,
and pilules of arsenious acid.

I do not find many English observations on this subject, nor has this
medication for phthisis been generally adopted among us. Dr. Williams

says, " I have tried it only to a limited extent It has only seemed

to be useful in chronic cases with asthmatic or cutaneous complication,
but well deserves further investigation " (" Pulmonary Consumption," p.
362). Dr. Ringer suggests that allowance must be made for a natural
improvement in some forms of phthisis, but has himself seen instances
of recovery under its use " in children with general tuberculosis," and
" in adults suffering from subacute and chronic forms." He corroborates
also, to some extent, the statement that it will reduce temperature
(Handbook). Dr. Sanger reports, from the convalescent hospital at
Seaford, favorable results in a large number of phthisical patients to
whom he gave 5-min. doses of Fowler's solution, but he generally combined
it with iron or hyposulphites (Lancet, i., 1869). Dr. Leared based a
favorable opinion upon observation of nine cases, but finds the remedy
"trying to the digestive system" (Medical Times, i., 1863), and this I
believe to be a very common result owing to the dose prescribed being
too large. Dr. Bartholow, without offering detailed evidence, affirms that
" we have no single drug of equal utility in the chronic forms of phthisis,
but it is not' serviceable in caseous pneumonia .... neither is it bene-
ficial when much hectic is present with rapid disintegration of pulmonary
tissues."

Struma Strumous Ophthalmia. In chronic cases of glandular en-
largement, pallor, and anaemia, occurring in subjects with the ordinary
evidences of struma, arseniate of soda is often beneficial; it improves ap-
petite and color, seeming to stimulate the lymphatic and arterial systems.
I have frequently known Fowler's solution prove serviceable in strumous
ophthalmia, giving relief to the redness and swelling of lids, as well as to
VOL. II. 4



50 MATERIA MEDIC A AND THERAPEUTICS,

conjunctival congestion and excessive secretion. It has seemed also to
help in cicatrizing ulcers, and in diminishing the exudation which would
produce leucoma. Mr. Oglesby speaks of its special value in that form of
strumous ophthalmia which is accompanied by herpes (Practitioner, vol.
it).

Strumous Cachexia Lymphoma. Prof. Bouchut restricted the value
of arsenic in glandular disease to cases where this was superficial and
limited, and where cachexia was not present, but later experience has
proved the remedy to be more generally useful than he believed. I have
seen it of much service, especially when combined with iron, in relieving
cachexia, and Billroth has recorded a remarkable case that of a woman,
aged forty, in whom the cervical, axillary, and other glands, as well as
the spleen, were affected, and who recovered under Fowler's solution,
taking 5 to 20 drops for a dose. Billroth's observations have not been
often repeated, but have been recently supported by Dr. Winiwarter.
He records good results in cases of malignant lymphoma, or Hodgkins'
disease, a malady limited to lymphatic structures, and to be distinguished
from a sarcoma commencing in the glands, and spreading from thence.
In the latter condition arsenic has no influence: neither is " Hodgkins'
disease " to be confounded with scrofula, for there is no tendency to sup-
puration; nor with leukaemia, for th.ere is no increase of white corpuscles.
The malady referred to occurs in strong young persons, often begins in
the cervical glands, which enlarge separately, and it is fatal if left un-
treated; it has*been observed to follow intermittent fever. Under the
use of arsenic, continued for three or four months or more, and also in-
jected into the tumors, they have disappeared, at least for several years,
and the patients have become convalescent. It is recommended to begin
with 5 min. of Fowler's solution and 5 min. of tinct. ferri night and morn-
ing, cautiously increasing the dose up to 30 to 40 min., or to the produc-
tion of physiological effects (Strieker's Jahrb.^ 1877, part ii.).

Chlorosis. In this disease arsenic often acts particularly well, and
has been strongly recommended by Isnard.

Progressive Pernicious Ancemia. The remarkable and serious malady
now known under this name, and which was first described by Dr. Ad-
dison as "idiopathic anasmia," has proved sometimes amenable to arsenic.
It occurs often, without appreciable cause, about or beyond middle age,
the patient becoming blanched and waxy-looking, sometimes jaundiced,
and suffering later from oedema, dyspnoea, giddiness, and coldness. The
blood is found to be dull-red in color, and the red corpuscles to be dimin-
ished and altered; retinal and other hemorrhage may occur, also oc-
casional attacks of vomiting and diarrhoea. The patient remains, or be-
comes, fat rather than emaciated, yet the disease has usually ended
fatally by exhaustion and collapse in spite of iron and food, etc. Dr.
Bramwell has recently recorded a typical case, which was carefully treated



ARSENIC. 51

in hospital for three weeks with full doses of quinine and iron, and later
phosphorized cod-liver oil, and yet steadily got worse until 2 min. of
liquor arsenicalis were given thrice daily, the other remedies being
stopped. The dose was gradually increased to 16 min. thrice daily, and
" the after-progress of the case may be described as one of slow but un-
interrupted improvement." In a month's time he was able to attend as
an out-patient, and continuing to take arsenic considered himself well,
and resumed work. His color improved, cardiac murmurs disappeared,
and the condition of the blood was found to be normal (Medical Times,
ii., 1877). Such a case, in conjunction with others, offers much encour-
agement in the use of the remedy, and serves to illustrate further its
alliance with phosphorus, which drug has also proved useful in some
similar cases (v. p. 55).

Dr. Lockie has lately published illustrations of the value of arsenic as
a "blood and cardiac tonic in anaemia" (British Medical Journal, ii.,
1878). Dr. M. Finney has recently reported three well-marked cases of
"pernicious anaemia," two of which recovered under arsenic, and he calls
it " one of our surest tonics to the blood-making organs " (British Medi-
cal Journal, i., 1880). Dr. Withers Moore informs me that in a similar
case (idiopathic anaemia), under his care at the Sussex County Hospital,
arsenic also proved of service. The patient, a woman, aged thirty-two,
showed characteristic symptoms of the malady nine months after a bad
confinement, and after frequent epistaxis: she was extremely pale and
feeble; the red corpuscles of the blood were few, small, and altered in
shape, the white corpuscles not increased in number. For the first three
months of her stay in hospital iron was tried in various forms without
any benefit whatever; for the last two months she got 3 min. of Fowler's
solution thrice daily, and ultimately left convalescent. The case was a
typical and severe one, with occasional pyrexial attacks, raising the tem-
perature to 104 F., and even, on one occasion, to 106 F. These attacks
were controlled by full doses of quinine, but excepting this arsenic was
the only medicinal agent used during the stage of recovery.

Chronic Rheumatism Chronic Rheumatic Arthritis. In the con-
dition now designated by the latter term, the value of arsenic has been
frequently shown since its recommendation by Haygarth, and the elder
Bardsley in Manchester (Medical Reports, p. 32). I quite agree with
the latter physician in his opinion that the remedy promises well in cases
where the vital powers are diminished, and the ends of the bones, the
periosteum, capsules, and ligaments are swollen; under the continued use
of the drug I have known the joints return to their natural size. Sir R.
Christison records a similar experience in cases of " nodosity of joints,"
and Dr. W. Begbie describes fully the case of a man with swellings of
the small joints of hands and feet, very painful, especially at night and
in changeable weather, and almost preventing any movement. The pa-



52 MATERIA MEDICA AND THERAPEUTICS.

tient had received no benefit from a long trial of many remedies, but
under a course of Fowler's solution recovered the use of the joints, and
was able to resume his work. Dr. Fuller speaks highly of the remedy in
"chronic rheumatism," and especially in rheumatic arthritis, when the
skin is dry and inactive, and the patient chilly.

Snake-bite. Among blood diseases we may include this form of
blood-poisoning, and although it is difficult to credit arsenic with efficacy
in such cases, we must admit not only a long tradition in its favor in
India (v. Dr. Russell's " History of Indian Serpents "), but some amount
of clinical evidence. A compound of white arsenic with black pepper
and native herbs is the popular form, known as " Tanjore pill," but Mr.
Ireland used 2-dr. doses of the liquor arsenicalis with 10 min. of tinct.
opii every half-hour for four successive hours in five cases, and all of
them recovered, although other patients died from similar bites (Jfedico-
Chirurgical Transactions, ii., p. 393). No doubt, the system, under ab-
normal influences, can tolerate larger doses than in its healthy state.

Diabetes. Like most other medicines, arsenic has been tried in this
malady, and it has received commendation. Dr. B. W. Foster says that
he has seen it act well in improving nutrition and lessening thirst, but
not in diminishing the excretion of sugar; hence, he considers it acts
mainly by saving the waste of albuminous tissues (" Clinical Medicine,"
p. 208). Dr. Bartholow finds it beneficial in thin subjects with defective
assimilating power, but not in the " stout subjects " who suffer from boils
and carbuncles. I have frequently prescribed it in both stout and thin
subjects, with good results, but as a rule it only acts as a palliative,
checking the sudden emaciation and prostration and relieving the exces-
sive thirst and dryness of mouth. In several cases it lessened for a con-
siderable time the quantity of urine, and in some instances appeared to
diminish the sugar; it certainly in nearly all cases improved digestion.

Neuralgia. Arsenic holds a chief place among remedies for neural-
gia. Dr. Fowler's original reports contain several conclusive cases, al-
though their relief seems somewhat counterbalanced by the gastric
symptoms, which he did not scruple to produce. Maculloch, in a well-
known " Treatise on Malaria," speaks highly of arsenic in confirmed neu-
ralgia; and Romberg, a still higher authority, notes its value especially
in facial neuralgia, and in forms connected with uterine or ovarian dis-
ease. Anaemia is also an indication for its use, and full doses are neces-
sary. Among modern French observers, Isnard reports many cures of
various typical neuralgise, and of ordinary neuralgic pain (" De 1'Arsenic
dans la Pathologic du Systeme Nerveux "). M. Boudin found it invari-
ably succeed in periodic probably malarial forms, and M. Cahen has
published sixty-five successive cases of almost uniformerly good result
(Archives de Med., 1863). Borella devotes a long chapter of his work in
praise of arsenic, to its value in nerve-disorders (Brussels, 1866). Of



ARSENIC. 53

modern German writings on the subject we may quote Erb, who adopts
mainly the views of Isnard, considering the remedy as " a neurosthenic
tonic," with the power of restoring order to disturbed action. He places
it in the first rank among specific remedies, not only in recent and peri-
odic cases, but also in chronic forms of purely idiopathic neuralgia. In
the facial variety and in sciatica, he endorses its high reputation, but in
the latter affection places its value below that of turpentine ("Ziemssen's
Cyclopaedia"). In the treatment of sciatica, arsenic is most suitable
when the pain is deep-seated, worst at night, but with occasional marked
intermissions, and temporarily relieved by hot applications.

Sir Thomas Watson notes the great use of the drug in hemicrania or
migraine (Op. cit., i., p. 733), and successful results in various cases from
full doses of Fowler's solution were published by Mr. Thomas Turner, of
Manchester (Medical Times, ii., 1861). Dr. Anstie, in his "Treatise on
Neuralgia," speaks of arsenic as " one of the most powerful weapons in the
physician's hands," " likely to act best in affections of the fifth and of- the
vagus nerves, but probably the most generally effective remedy in almost
any given case." He looked upon it as calculated to improve the quality
of the blood, to stimulate the nerve-system, and oppose periodic (disor-
dered) action. The same physician also pointed out the connection and
frequent interdependence of gastralgia, angina pectoris, and asthma, as
neuroses of different branches of the vagus, and he illustrated this con-
nection by the history of families in which these affections occurred in
alternate generations. From my own extensive trial of arsenical medica-
tion in neuralgias, and especially of the fifth pair of nerves, I also con-
clude it to be almost our best remedy, particularly, as in my own person,
when the pain felt is of burning stinging character, and when the attack
is connected with miasmatic influence.

Gastralgia is a term properly restricted to painful affections of the
stomach unconnected with organic disease or inflammation, or even with
ordinary dyspepsia. Such cases are not very frequent nor very easy of
diagnosis, but occur especially in females during youth, and at the climac-
teric period, and are accompanied with other evidences of impaired nerve-
power: sometimes they are reflex (being connected with uterine derange-
ment), and sometime malarial (Niemeyer). Trousseau describes attacks
dependent on exhaustion, and Budd on alcoholism. The nerve-character is
evident when, as in Dr. Anstie's cases, the malady alternates with attacks
of asthma, and Tessier (Journal de Med. de Lyon, 1848) and Anstie
agree in estimating highly the value of arsenic in such cases. Dr. Clif-
ford Allbutt speaks of gastralgia as readily distinguishable from dyspep-
sia, and described sudden violent pain in the gastric region and back, and
another form less severe and more gradual in onset, and irregular as to
time, and unconnected with eating (Liverpool and Manchester Reports,
1873). Dr. Leared also restricts the term to a nerve-disorder with cramp-



54 MATERIA MEDICA AND THERAPEUTICS.

like, fixed or diffused pain, coming at irregular intervals, often at night,
accompanied by prostration, followed by bilious vomiting, and occurring
generally in middle-aged persons from mental anxiety (British Medical
Journal, 1867). Such cases furnish a special indication for arsenic, and
Allbutt says it is, for such, the " king of remedies," only I would interpret
" gastralgia " in a wider sense, and without attempting to diagnose it
rigorously from dyspepsia, would include under the term many forms of
painful stomach-disorder, not inflammatory nor organic. In this sense it
is used by Barras (" Traite sur les Gastralgies ") and other French writers,
and a reference to the observers I have named will show that, in their
cases, such symptoms as flatulence, vomiting, and pain increased by food,
were often present, and although the tongue might be clean, and certain
dyspeptic symptoms absent for a time, yet they would readily occur, and
to restrict the use of the remedy to purely nervous attacks is needlessly
to limit its value: we shall see, in fact, that in gastric catarrh it is an ex-
cellent medicine.

The following is one of many cases of climacteric gastralgia, compli-
cated with dyspepsia at times, and relieved by arsenic. Mrs. S., aged
forty-three, auburn hair, thin, describes very acute pain in upper front
chest, and sometimes in the back about the second dorsal vertebra and
interscapular region, almost constant; sometimes easier after food, some-
times worse: no vomiting, pyrosis, or heematemesis: no physical signs in
the chest, no evident hepatic disease, and bowels regular. Pulse 64. No
heart or lung complication. Youngest child is five years old. Menstru-
ation lately irregular and prof use; has some prolapsus and back-pain, dis-
tinct from her gastric pain. Nursed her husband anxiously for two
years, during which time the pain first came on, and is now often brought
on and always aggravated by mental worry, of which she has much.
The pain is generally worst on waking, about 2 A.M. ; gets better after
breakfast, and worse again in the evening: it is sometimes referred to the
epigastrium and left shoulder, and described as " like a hot bar pressing,"
or " like a hand gripping." Arsenic relieved the pain more effectively than
any other remedy tried, and although during attacks of painful digestion
nux vomica given before food did much good, according to the patient's
own statement, the steady use of arsenical solution was always the most
effective.

Angina Pectoris. This malady, even if primarily dependent on cal-
careous or other degeneration, is mainly a neurosis, and nearly -100 years
ago was successfully treated with arsenious acid by Alexander. Philipp
and others record very striking benefit in cases that had been rebellious
to quinine (Sydenham Society's Year Book, 1865-66), and I can fully
bear out Dr. Anstie's testimony to the great relief given by arsenic to pa-
tients suddenly attacked with spasmodic pain, embarrassed heart-action,
and sense of impending death: he found the medicine reduce the severe



ARSENIC. 55

attacks to little more than a tightness of the chest, and it availed most in
anaemic patients, suffering from overwork and anxiety. (Reference may
also be made to cases in Berlin. Klin. Woch., 18G5, and Archives Gen.,
1863.)

Spasmodic Asthma Asthma JVervosum. In this, the third of the
trio of vagus neuroses, Dr. Anstie also records good results, but others
had preceded him in this observation. We have already noted its im-
proving the breathing-power of mountaineers, and this had suggested to
Kappel its use in asthma. Rilliet speaks highly of it (Bulletin Med. du
N^ord, 1863), and also Trousseau, who used it partly in cigarette (Bulle-
tin, 1861). Dr. Leared recommends a form of cigarette containing gr.
of arsenic with a little nitre (Lancet, i., 1863). Dr. Thorowgood, while
laying stress on the frequent gastric causation of asthma, and its special
treatment, has found arsenic useful in gouty and rheumatic cases, and
Riegel notes its value in preventing relapses in " bronchial asthma," and
in the form which occurs alternately with some cutaneous diseases, known
as " herpetic asthma " (" Ziemssen's Cyclopaedia," iv., p. 582). Dr. Berkart
seems to attribute any good effect more to improving the nutrition, appe-
tite, and digestion, and to negative any specific virtues (" On Asthma,"
1879). One method of its application is by spray, which has been used with
much success by Wistinghausen (Petersburg Med. Zeits., 1862), and more
recently by Dr. Wahltuch, of Manchester: the latter used arseniates of
potash, soda, or ammonia in spray containing ^ to % gr. at first twice daily,
and by degrees less frequently; his excellent results were, however, ren-
dered less certain for clinical purposes by the concurrent use of galvanism
and other remedies (British Medical Journal, ii., 1877).

Martelli has recently reported immediate relief to an asthmatic parox-
ysm from the hypodermic injection of Fowler's solution (1 part to 2 of
water): the cure was complete after 2 dr. used at intervals in divided
doses in this manner (Medical Record, 1878). Arsenic acts best in sim-
ple cases of idiopathic or spasmodic asthma of neurotic origin: but it lias
done well in cases dependent on bronchitis, emphysema, or cardiac dis-
ease. In cases due to compression of air-tubes by enlarged glands it may
be carefully tried (Berkart). The solution should be administered in
5-min. doses, three or four times daily, during the intervals between the
attacks, and should be persevered with for many weeks, and, in some in-
stances, for months, but the dose under these circumstances should be
decreased. For upward of twenty years I have used it in these cases
with unmistakable success.

Chorea. From the time of Girdlestone, 1806 (London Medical and
Physiological Journal), there has been a large accumulation of evidence as
to the value of arsenic in chorea. Reese, of New York, in 1840, describes
cures in two hundred children under 6 to S-min. doses of Fowler's solu-
tion twice daily. Rayer corroborates his results ( Union Medicale, 1847).



56 MATERIA MEDICA AND THERAPEUTICS.

Romberg calls it " the foremost remedy," when given in sufficient doses
(Klin. Ergebnisse, 1856), and records severe cases one of eight years'
duration, rebellious to many other medicines, but cured in two months
by arsenic; and another patient had been unable for six months to stand
or speak, having such violent choreic movements, yet recovered after
two months of treatment with 4 min. of Fowler's solution thrice daily.
The well-known names of Aran, Henoch, Steiner, and Barthez may also
be cited as authorities in the same direction; and continental work with
regard to it is fully summarized in the thesis of M. Gelle (" Hopital des
Enfants," Paris, 1860). He quotes cases where improvement was mani-
fest within eight days, three days, and even forty-eight and thirty-six
hours respectively, but concludes that from five to eight days is an aver-
age period. He gives also several cases equal in severity to those of
Romberg, and expresses similar conclusions viz.: that some failures of
the remedy may be expected in neurotic, sanguineous subjects, but very
great success in the lymphatic, chlorotic, and cachectic. M. Aran urges
the rapid attainment of a full dose rather than a long-continued small
one (Sydenham Society^s Year Book, 1859). Dr. Steiner, on the other
hand, commences with 1 min., and considers 8 min. should be the maxi-
mum daily dose: within fourteen days he expects improvement.

Among English observers there is a large preponderance, though by
no means a consensus of opinion in favor of arsenic as the best remedy
for chorea. Gregory, Babington, and many others have all written to
this effect. Dr. Radcliffe fully agrees as to the efficacy of the medicine,
but, having been obliged sometimes to discontinue it on account of gas-



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 7 of 40)