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

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tric disturbance, he adopted its hypodermic use, and in some cases, espe-
cially of localized choreic action, with signal benefit; thus, in a woman in
whom the neck-muscles were affected, and who was not relieved by a long
trial of sedatives, 1 to 12 min. of Fowler's solution were injected locally,
and, before the fourth injection, improvement had taken place. He recom-
mends dilution with half water; in some cases he has preferred the en-
dermic use of the remedy on a blistered surface (" Reynold's System,"
vol. ii.). Schmidt has also practised hypodermic injection with success
(Wiener Med. TFbcA.,1871, No. 44). Dr. Anstie records the severe case
of a girl who had been treated in hospital with camphor, cod-liver oil,
bromides, and zinc, also with succus conii in the dose of many ounces
daily, yet without relief, and who recovered under 3 to 5-min. doses of
Fowler's solution : he used at the same time ether spray to the spine, but
this application has not proved itself of such power as he then thought
it (Practitioner, June, 1874), and therefore I do not believe that it much
influenced the result. Dr. Ringer considers arsenic as by far the best
remedy in simple chorea; he remarks that failure may be owing to small-
ness of dose; also that children above five years of age bear nearly as
much as adults, and that girls seem to require more than boys. Dr.



ARSENIC. 57

Eustace Smith and others have also specially noted the tolerance of cho-
reic children for arsenic, and the necessity of full doses to secure success
(British Medical Journal, i., 1875). In my own practice, for upward of
twenty-five years, I have seldom known arsenic fail to cure simple chorea,
although many of my cases were severe and of long duration, and quite
incapacitated for the ordinary duties of life 3 to 10 min. of Fowler's so-
lution thrice daily has been the dose usually prescribed by me, but I have
frequently observed no permanent good effects follow until the develop-
ment of some of the slighter physiological symptoms.

From the above quotations and remarks, though they represent an
ample experience, we must not conclude that the value of this remedy is
equally acknowledged by all. The counter-claims of iron, of zinc, of bella-
donna, etc., are urged by some observers, and the natural tendency to
cure of the malady under favorable conditions is still more strongly in-
sisted upon by others. Vogel, the distinguished Russian professor, classes
arsenic with " a number of empirical remedies that are more praised than
curative." Dr. Wilks attributes much more importance to rest (British
Medical Journal, ii., 1876), and my colleague, Dr. Sturges, includes
arsenic among a number of other " useless medicines " (" Lectures on
Chorea," 1876). In estimating the value of any remedy, we are con-
stantly met by the difficulty of proving how far we have affected the
course of nature; this difficulty is not greater with the present medicine
than with others, and even allowing that chorea will recover with proper
rest, food, and management, yet I am clearly of opinion that arsenic will
promote, and quicken, and confirm the cure. I cannot affirm that it will
always, of itself, and in despite of circumstances, control the disease.
Judging from private practice and from hospital in-patient records, a
large number of cases recover while taking arsenic, either far more
quickly than is consistent with the ordinary course of the malady, or
(making the contrast more striking) recover after many powerful reme-
dies have been tried without effect under equal conditions. The ordinary
duration of a chorea well managed, but without medicines, has been
stated as six to eight weeks; if it continues three months Jaccoud con-
siders it chronic, almost incurable, yet we have already quoted and have
seen many cases that improved within two or three days, and recovered
within three to five weeks, and we have quoted also cases of cure after a
duration of many years. A certain proportion of cases of chorea are
connected with embolism, and these were excluded by Dr. Anstie from
the range of the beneficial action of this drug, but from what we know
of its value in cerebral congestions, we should think it often appropriate
even in such serious conditions. In markedly anaemic patients we might
prefer iron, or at least combine it; and if sexual excitation were present,
as in the case of some girls at puberty, we might substitute bromides or
antispasmodics; acute rheumatic symptoms would also modify the treat-



58 MATERIA MEDIC A AND THERAPEUTICS.

ment, but with these exceptions we must consider arsenic a most valuable
agent in all varieties of the malady.

Tremor Ataxia. Allied to the use of arsenic in chorea, is its use
(which, however, is much less markedly beneficial) in these nerve-condi-
tions. Tremor may be due to various causes, which are often central and
connected with organic disease, and scarcely amenable to treatment; but
Eulenburg reports several cases successfully treated by hypodermic injec-
tion of 2 to 3 min. of Fowler's solution diluted with two parts of water
(Berlin. Klin. Wbch., 1872, No. 46). Isnard says the remedy is valuable
in ataxia developed during acute fevers; he gives it even during febrile
accessions.

Congestive disorders. The value of arsenic in the following group
of cases seems best explained by its power, in small doses, to regulate
and equalize the circulation in capillary blood-vessels.

Cerebral Congestion. As a preventive of apoplexy, the remedy has a
traditional, and perhaps not an easily proved, reputation, but one that
would be quite in accord with our view of its action. Lemare-Piquot,
after relating marked relief to giddiness, sense of oppression, epistaxis,
and other premonitory symptoms, both in his own case and that of five
other persons about sixty years of age, reasonably restricts its use to
cases of cerebral congestion occurring in the strong and plethoric, who
have an excess of blood-corpuscles (v. p. 33). He recommends from 4
milligr. to 1 ctgr. daily for about a month, taken at meal-times, and
founds his latest conclusion upon forty-four cases occurring without
one death (Bulletin de Therapeutique, 1859, and JRecherches sur PApo-
plexie, Paris, 1860). Cahen, writing upon its value in congestions gen-
erally, and cerebral hyperaemia in particular, traces it, as we do, to a
regulating influence on vaso-motor nerves (Archives de Med., September,
1863), and Dr. Handfield Jones expresses similar views. Hirtz has had
reason to think it efficacious in obviating apoplexy, and suggests that it
would tend to prevent atheromatous degeneration (" Nouveau Diet.").
It is extremely useful in cerebral congestion, and especially when there
is puffiness below the eyes, drowsiness, and mental torpor, with sluggish,
venous circulation, and suspicion of commencing atheroma. By a similar
action, perhaps, it benefits the melancholy and those suffering from hypo-
chondriasis, especially aged persons.

Epilepsy has been plausibly connected with congestion in and near
the medulla oblongata, and certainly the older writers, such as Alexander
and Duncan, have recorded cases cured under arsenical treatment. It is
of necessity no more a universal cure than any other medicine is, but
there seem to be some cases specially amenable to it for instance, those
that are connected, however remotely, with malaria. We must note a
case recorded under the supervision of Dr. Bristowe, that of a lad of
fourteen, described as anaemic, but free from evident organic disease, and



ARSENIC. 59

who had suffered severely from epileptic attacks, mainly nocturnal, for
about two years, and afterward from attacks, day and night, so frequently
that he remained unconscious for some days, and was apparently dying;
being roused, however, from this condition, he remained partly paraplegic,
and the fits, preceded by screaming and by an aura in the feet, recurred on
movement of the legs, or on excitement; for nearly a month he took zinc
sulphate in increasing doses with valerian, but remained in the same state,
sometimes disturbing the ward for a whole night; he was then ordered
5-min. doses of Fowler's solution thrice daily, and although he was not
made aware of any change in treatment, the -attacks ceased at once for
many days; they recurred for a time under excitement, and the numbness
of lower limbs persisted for some days; eventually, however, he got quite
well. There is evidently some alliance between such a case and cases of
chorea, but the periods of insensibility indicate a more serious condition;
the exact character of the " fits " is not, however, described (Medical
Times, i., 1862).

Dr. Clemens (Frankfort) strongly recommends a " liquor arsenici bro-
midi," which he has used for twenty years in the treatment of epilepsy of
all varieties with much success; it has relieved even in cases connected
with thickening of skull and congenital malformation (Medical Record,
1877). This preparation is said to be more reliable than Fowler's, and to
act well without increase of the daily dose: it is made by boiling potash
carbonate and arsenious acid, of each 1 dr. in \ pint of water: making up
to 12 oz., adding 2 dr. of bromine, and mixing thoroughly.

Cardiac Weakness Mitral Disease Venous Congestion. For such
conditions, arsenic is often found serviceable, and under its use dyspnoea
on exertion, the palpitation, the faintness, and the oedema of extremities
have all improved. Dr. Papillaud has verified similar improvement, and
also marked relief to palpitation, but he generally alternated or combined
the remedy with antimony (Bulletin de FAcademie de Med., December,
1870, p. 885).

When intermittent pulse occurs from cardiac weakness, whether of
temporary character or dependent on degeneration or mitral disease, ar-
senic is often serviceable, as it is also in the same condition when due to
nerve-causes. Darwin relates a case of " regular intermission " cured by
4-min. doses of a saturated solution of the drug (Headland, p. 197). I
have seen numerous cases cured by the continued use of 2 to 5-min. doses
of Fowler's solution after each principal meal. Under such circumstances
it often produces a marked diuretic action, which is quickly followed, in
many instances, by disappearance of any swelling, and by relief of the
dyspnoea, faintness, and palpitation.

Albuminuria. The influence of arsenic upon this condition is well
worthy of further investigation. A case of "acute renal anasarca " in a
woman, aged nineteen, is briefly recorded from Dr. F. Farre's practice



60 MATERIA MED1CA AND THERAPEUTICS.

(Lancet, i., 1862); six weeks after the commencement of the attack she
developed psoriasis, for which Fowler's solution was prescribed, and
under its influence the albumen disappeared, and the patient gained flesh
and strength. I have for many years used it in albuminuria following
scarlatina; it removes the dry inactive condition of the skin, checks thirst,
and causes a copious flow of urine, which gradually becomes less loaded
with 'albumen; should dyspnoea be present, the remedy quickly relieves
it, and the oedema of face and body disappears. In 1876 a case came
under my care of chronic character, occurring in a builder, aged forty-
three, of dissipated though hard-working habits; he had general anasarca
and epileptiform convulsions, which were relieved for a time by laxatives,
but the amount of albumen was uninfluenced by them, or by a long-con-
tinued use of iron. Fowler's solution was substituted, and the albumen
diminished and soon ceased to appear; then, omitting the medicine, a
relapse occurred; this again yielded on resuming the remedy, and the
albumen, anasarca, and convulsions all disappeared, and in two to three
months the patient's health was quite re-established, and he has since
been quite well. I have also treated by liquor arsenicalis, with excellent
results, numerous cases of temporary or intermittent albuminous urine
dependent on imperfect digestion.

Dr. Brunton has discussed this subject in an interesting and scientific
paper (Practitioner, June, 1877): he remarks on the important distinc-
tion between " true and false" albuminuria (Gubler), including under
the latter term, not only the presence of albumen from pus or blood, but
also the so-called Bence Jones' albumen, egg-albumen, the albumen ab-
sorbed from the intestine after imperfect digestion : it is a case of the
latter kind that is recorded by him as being much benefited by arsenic,
and it had several peculiarities. The patient was aged thirty-three, sallow
and thin; the first symptom was great fatigue on exertion, then albu-
minuria was noticed (on examination for life insurance): it was at first
present only during the summer; it came on after work and ceased on
rest; it ceased also under strychnine (but this caused headache and sick-
ness), and it ceased during quiet residence at the seaside. Fatty food
brought it on, and meat taken in the morning, not when taken at night.
Quinine .and phosphoric acid at once increased the quantity, but rigid
adherence to a farinaceous diet quite controlled it, and there were other
evidences of its direct connection with digestion. After many years of
treatment, including milk-diet, sea-voyages, digitalis, hydrarg. c. creta,
etc., Dr. Brunton ordered 3 min. of Fowler's solution at meal-times,
"and almost at once the albumen disappeared, and the patient was able
to do much more work than usual, without its return." Later, the med-
icine was changed for hypophosphite of soda, and the albumen returned,
to cease again on resuming arsenic. The whole case is very interesting,
but we need only mention further that pancreatine, which increases pan-



AKSENIC. 61

creatic digestion and aids in the solution of albumen, was also found
beneficial. This affection should be classed under faulty digestion or as-
similation rather than as renal disorder. The special form of chronic
albuminuria in which I have proved its value is that dependent upon ve-
nous congestion, mitral disease, or emphysema, after the right ventricle
has begun to yield, but it deserves a trial also in cases where the actual
kidney structure and epithelial lining are affected. I have carefully
watched many of these latter cases in which the beneficial action of ar-
senic was very marked.

Uterine Congestion.- -This condition may accompany either menor-
rhagia or amenorrhoaa, and that arsenic may remedy either symptom is,
therefore, not contradictory. ,In the former, the catamenia being too
copious and too frequent (leucorrhosa often occurring in the intervals), and
the patient becoming weak and ansemic, small doses of from 2 to 6 min.
thrice daily will be found to lessen the flow and to improve appetite and
general health. Mr. Hunt has recorded some striking cases of uterine
hemorrhage at various intervals after labor or miscarriage, some accom-
panied with symptoms only of irritable uterus, "but for the most part
atonic in character" (Medico- Chirurgical Transactions, vol. xxi.); all
improved under arsenic. Sir C. Locock found great advantage from it in
similar cases. Dr. A. Burns, from experience of it in all varieties of
uterine hemorrhage, has reason to express the greatest confidence in the
remedy, and records several cases treated by rather large doses, 10 to 20
min. repeated every fifteen to twenty minutes (American Journal Medi-
cal Sciences, October, 1859).

Amenorrhcea. When this depends upon congestion or torpor of the
uterus, or is connected with anaemia or chlorosis, I have known arsenic
succeed well, and have several times found that when iron preparations
had been taken without marked result, the addition of arsenic was quick-
ly followed by relief it seemed to act as a regulator of the circulation
and as an uterine tonic.

Hemorrhoids. The efficacy of arsenic in this form of venous conges-
tion has been sometimes well shown; thus, in one case, a gentleman had
suffered for many years, and had undergone cauterizing and other opera-
tions, when this remedy was given to him for hay-asthma, and he found
his hemorrhoids to be more relieved in a few days than under any other
treatment. Relapses occurred more than once, but always yielded in a
few days to 8-min. doses of Fowler's solution (Parvin, in J3raithwaitc 's
Retrospect, ii., 1866). I can recommend it strongly in painful hemor-
rhoids, and also for ordinary external piles.

Cutaneous Disease. Arsenic is largely used by the profession, almost
as a routine remedy, in cutaneous disease, but its value has been variously
estimated by specialists of experience. We may exclude at once from its
influence the ordinary acute exanthemata, also nasvus, parasitic and syph-



62 MATEKIA MEDICA AND THERAPEUTICS.

ilitic eruptions, and the rarer maladies of scleroderma, keloid, xanthel-
asma, and true leprosy. We may exclude also all forms of skin disease
while in the acute stage, or while accompanied by marked inflammatory
reaction, and then, speaking generally, we may say that as we have noted
arsenic to be valuable in rheumatic, malarial, and neurotic affections, so
is it also valuable in most cutaneous manifestations of these conditions.
With regard to the last-mentioned, my own experience agrees rather
with that of Hunt and of Anstie, as against Bazin and others, that in
neurdtic subjects with highly strung excitable natures, arsenic is less
readily borne, and more usually causes diarrhoaa.

The forms of skin disease in which the remedy is of generally accepted
value, are such as psoriasis, eczema in the dry or scaling stage, pemphi-
gus, lichen, alopecia, and chronic urticaria; and those in which its pow-
ers are more controverted are acne, lupus, ichthyosis, herpes zoster, 1 sy-
cosis, prurigo, epithelioma, cancer, and elephantiasis grsecorum.

Psoriasis. From the time of Girdlestone (1806), Willan and Bate-
man, Biett and Cazenave, arsenic has held the first place in the treatment
of this malady. Modern dermatologists agree upon this point, but some,
as the late Mr. Startin and Mr. Hunt, rely upon this drug much more
positively than others. The preference of Hebra for local over any con-
stitutional treatment is well known, but even he recognizes " a decided
curative action of arsenic in this form of disease." Dr. Tilbury Fox in-
clines to restrict its use to the more typical cases, especially those of
chronic character and accompanied with nerve-debility; on the other
hand, many cases will be found to occur in persons otherwise strong, and
in such cases after preliminary purgative treatment I have found the
remedy useful. " Before undertaking to deal with psoriasis," remarks
Gaskoin, "it is necessary to know all about arsenic" ("Treatise on
Psoriasis "). Its success, however, is, as Stille remarks, by no means
uniform, and any want of due attention to the excretions, to the presence
of gouty or other constitutional tendencies, or to the proper regulation
of dose, will readily prevent a satisfactory result. It can by no means be
considered a specific, but as a valuable agent only under certain condi-
tions; neither can it be accurately stated that " the more chronic the mal-
ady the more suited it is for this remedy," for after it has lasted for
eight or ten years I have seldom found it amenable, and Devergie has
recorded a similar experience ("Maladies de la Peau ").

Mr. Malcolm Morris notes that sometimes arsenic not only does no
good in psoriasis, but harm, in rendering the patches more hypenemic
and irritable; he finds it impossible, however, to diagnose the cases in
which this may occur (Pb'actitioner, 1880).

1 The reason for doubting the value of arsenic in herpes is that it is a disorder of
definite course, which must develop, but the neuralgic pain, if severe, is markedly
lessened by arsenic (v. p. 67).



ARSENIC. 63

In judging of its true power, we must allow for the natural improve-
ment of the malady in certain circumstances, e.g., on the cessation of lac-
tation, at changes of climate or of season, etc., also for the effect of ex-
ternal treatment by tar or bathing carried on at the same time. But
after these allowances there remain, no doubt, many cases which show
improvement distinctly from arsenic; the best illustrations are seen in
children, and then in older persons in whom the attack is comparatively
recent yet not in an acute stage; chronic cases that have been left un-
treated often do well, but previous irregular trials diminish the chances
of recovery. In any case, if cure be effected, freedom from relapse can-
not be guaranteed (Wilson); Hunt has shown how important it is to se-
cure a due action of the absorbents, and also that one preparation may
succeed when another has failed; for instance, to one of two girls simi-
larly affected, he gave the potash, and to the other the soda solution; for
a time both did well, and then both ceased to improve, but later on, when
he exchanged their medicines, they progressed to cure (Journal of Cuta-
neous Medicine).

Eczema. In this, which is a catarrhal form of disease, arsenic has not
so large a measure of success as in the last mentioned; still it is often
very useful, and especially in combination with other remedies. Acute
cases not only receive no benefit, but I have seen them much aggravated
by it; the proper period for its use requires, therefore, careful considera-
tion. It is very suitable in scaly which are of necessity rather chronic
stages, and have received the distinct name of " eczema squamosum "
in superficial subacute forms with moderate infiltration, and in cases with
persistent irregular patches about the scrotum, anus, or vulva (Rayer), or
about the hands or fingers (Duhring). Sometimes the later stages of a
chronic infantile eczema seem much benefited by the addition of the drug
to iron or cod-liver oil, and sometimes an infant has been successfully
treated by arsenical medication through the mother (Begbie, Anderson).
The last-named observer, in his excellent special treatise, estimates the
value of arsenic highly: he points out, as others have done, that children
will readily bear a proportionately large dose; at the same time, he notes
that there is much tendency to " catching cold," or even bronchitis, dur-
ing an arsenical course, also he insists on the necessity for its prolonged
continuance. Mr. Erasmus Wilson considers that the treatment of ecze-
ma resolves itself into that of " debility," and advocates the use of ar-
senic "as a nerve-tonic and stimulant to cutaneous function;" 1 ami
generally combines it with a non-astringent preparation of iron, as the
vinum. My own use of arsenic in ordinary eczema is rather the exception
than the rule, and I am much in accord with Dr. Piffard, who, after call-
ing this mode of treatment " empirical, as opposed to rational," and quot-
ing the prevalent opinion, " that if only sufficient of the remedy be used,
the eruption must yield," states that, in his experience, it sometimes does



D-t MATERIA MEDICA AND THERAPEUTICS.

harm and at other times has no influence, though in a minority of cases
will give brilliant results: these may be hoped for in the dry scaly stages
when extensive tracts of surface are affected (" On Skin Diseases," 1870) ;
I would add, and when there are persistent patches oh the pudenda or
extremities, as already described.

Pemphigus. There is an ephemeral form of this malady in which one
or two crops of bullse come out, and subside under mild general treat-
ment; there is also a syphilitic form, mainly congenital, and an epidemic
form which occurs sometimes in lying-in and in children's hospitals, and
is connected probably with blood-poisoning; in none of these do we ex-
pect benefit from arsenic. There is a fourth form, occurring sometimes in
the later months of pregnancy, which may be severe, and although it tends
to subside after parturition, yet may receive some benefit from the reme-
dy; but the variety of the malady to which we would specially refer is
that known as " pemphigus diutinus, in which the blebs come out freely,
often symmetrically, and extensively which often lasts long, and almost
invariably exhibits its constitutional origin in a marked tendency to re-
cur." Mr. Hutchinson, from whom I quote, has certainly furnished us
with valuable evidence of the great power of arsenic in this variety, and
although by Hebra and others it is commonly held to be incurable, and
often fatal, Mr. Hutchinson " has never met but with one case that resisted
this treatment, and has come to consider the malady as one of the most
hopeful " (Medical Times, ii., 1875). He furnishes an abstract of twenty-



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 8 of 40)