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

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

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six cases that have been under his own observation, and refers to others in
the practice of Hillier, Wilks, Fagge, Startin, etc.: many of them had re-
lapses, but these were mild in character. In many, the influence of the
medicine was proved by the rapid improvement, and by relapse, on resump-
tion and omission of it respectively, and in at least one case it appeared
to prevent a patient's death. A delicate man, aged forty-four, recently
become subject to epileptic attacks, presented a general rash, at first very
like herpes, and attacking the face and extremities. There was much
prostration, and the patient was treated with quinine and iron, and lib-
eral diet, yet became extremely emaciated, and as the pemphigus charac-
ter became more developed, he was covered with large superficial sores
and completely prostrated; then the tonics were stopped, and 4 min. of
Fowler's solution prescribed, and from that day no fresh blebs appeared
until a few weeks later when nearly well and able to leave his bed: it was
then found that his medicine had been omitted for three days, and on re-
suming it, the blebs at once receded, and six weeks afterward he was in
good health and wholly free from eruption (Op. cit., p. 625). Dr.
James Russell has also published a well-marked case in a child in whom
the numerous relapses were always distinctly controlled by arsenic (Medi-
cal Times). On the other hand must be noted the observations of the
late Dr. Tilbury Fox: "There is no specific for pemphigus; arsenic is



ARSENIC. 65

declared to be one, but it often signally fails to cure the disease, and I
have seen quinine, in full doses, do much more good."

In Lichen Simplex, and certainly in its more chronic forms, the value
of arsenic is generally conceded. Dr. Liveing's expression is, " In chronic
lichen it is the only remedy; " but, as a rule, alkalies are required in ad-
dition, and mercurial treatment may succeed still better. A similar ob-
servation would apply to another form of papular disease true prurigo.

In Lichen flames, Mr. Morris (loc. cit.) and others speaks well of it.
Thus, a lady, aged fifty, with an itching eruption of flat-topped violet-
colored papules, slightly scaly, situated on .the inner side of the thighs
and outer sides of forearms, took 8 min. of liquor sodas arseniatis, at first
twice and then three times daily, and the eruption faded in one month,
and the treatment being continued for a time, no relapse occurred (how
long the eruption had lasted is not stated). He considers arsenic " an
invaluable remedy." Dr. Fox has, however, seen no benefit from it.

In the more generalized form of the malady, Hebra, who names it
" lichen ruber," places much reliance on the " Tanjore pills " (arsenic
with black pepper).

Alopecia. From the effect of arsenic in improving the coat of horses,
it has been plausibly thought to have a special power in promoting hair-
growth, and certainly after any sources of baldness, such as syphilis, dys-
pepsia, or local irritation, have been treated and removed, the internal
administration of small doses may be carefully carried out for a time with
advantage. Hunt practised this treatment successfully.

Chronic Urticaria is often relieved under arsenic, but any evident
intestinal disorder should, if possible, be remedied in the first instance.

Acne. In acne it should be the exception to prescribe arsenic. Mr.
E. Wilson goes so far as to say that " no one having even a rudimentary
acquaintance with cutaneous pathology and therapeutics would think of
doing so," and yet I have certainly seen cases cured by this remedy after
others had failed. According to Dr. Bulkley, this has occurred with all
forms of acne the simple, the indurated, and the rosaceous and his
best results have been attained with De Valangin's solution of chloride.
Dr. Duhring speaks well of it in the indolent papular form, and many
special authorities might be quoted to the same effect. This does not
seem to me so unreasonable as it does to Mr. Wilson, for acne is fre-
quently connected with gastric and uterine irritation, and we have seen
that arsenic has great power to relieve various forms of this malady.

In " bromic acne " the pustular rash which frequently follows the
use of full doses of any bromide arsenic is decidedly useful. If given con-
currently with the bromide it will often prevent any skin trouble (Bartho-
low; also Gowers, Lancet, i., 1878), and I can corroborate this observa-
tion.

Lupus. There are differences of opinion as to its value in lupus: Mr.
VOL. II. 5



66 MATERIA MEDICA AND THERAPEUTICS.

Hunt, for instance, and Mr. Milton esteeming it highly, and recommend-
ing its continuous administration for months or years; but others, and,
indeed, the majority of observers, recording no definite result from it. 1
have never been able to satisfy myself that it controlled the disease, al-
though the local caustic effect is, as already mentioned, highly valuable.

Ichthyosis is congenital, and, though it may be relieved, is scarcely
curable; the evidence as to the value of arsenic in its treatment is but
slight.

Herpes Zoster. Trousseau has observed that the pain in the course
of affected nerves, which is often severe and long persistent in the zos-
ter of elderly persons, may be relieved by arsenical medication, though
this will not cut short the course of the attack itself (" Clinical Medi-
cine ").

In Sycosis, non-parasitic in character, there is much evidence of the
value of the drug, and this would accord with what we know of it in
other cases of pus-formation. Dr. Laycock has used an arsenicated gly-
cerin (2 dr. of Fowler's solution in 10 dr.) as a local application, with
good results; it is somewhat strong, and acts as a " substitutive irritant "
(Medical Times, ii., 1864).

Erysipelatous Inflammation of a phlegmonous typo is liable to give
rise to sloughing, but if, at the first appearance of this change, small
doses of arsenic be administered, together with a generous diet, the more
severe results may be warded off, and even after sloughing has taken
place, arsenic will often control it effectually.

In Hospital Gangrene the results obtained strongly incline me to
consider it very beneficial. In twelve cases in which I have tried it, giv-
ing 4 to 10 min. of Fowler's solution every two or four hours, I was well
satisfied with the result, especially as arsenic was the only active treat-
ment used; no local caustics were needed. In various other affections of
gangrenous character the same remedy has proved very reliable.

The so-called " cancrum oris " and ulcerations about the tongue often
receive benefit from the same treatment.

Epithelioma, etc. Cases of this disease affecting the lip, the tongue,
the scrotum (chimne} r -sweep's cancer), etc., are stated to have been cured
by its internal administration; and although Hirtz concludes that all re-
ports of true cancer being cured by arsenic internally are founded on
mala fides, or bad diagnosis, yet there is some trustworthy evidence of its
relieving cancerous pain in the stomach and in the uterus. Sir C. Locock
mentions his own confidence in it, together with cases from his practice,
and from that of Brodie and Sir A. Cooper (Lancet, 1837), and Mr. Hunt
records a marked instance of relief under small doses frequently repeated,
not amounting to more than 10 min. in twenty-four hours. The case
was said to be undoubted uterine cancer, and the relief given was greater
than from morphia: as a rule, a pill was preferred, containing ^ gr. or



ARSENIC. 67

less. Fordyce Barker also speaks highly of its power to relieve pain and
improve the general condition, in doses of about 3 min. of Fowler's solu-
tion (American Journal of Obstetrics, November, 1870). Dr. Walshe has
written specially to recommend the iodide of arsenic as most valuable
(Dublin Quarterly Journal, August, 1857, v., p. 9). I have given Fow-
ler's solution internally in many cases of epithelioma, when the disease
was extending rapidly, and have known it apparently retard for a con-
siderable time the progress of the malady, relieve the pain, and improve
the general condition. Cases where the lower lip or the scrotum was
affected have given me the best results: the dose usually prescribed was
5 min. thrice daily.

Elephantiasis Gfrcecorum (Leprosy}. Dr. Waring says that for this
almost incurable disease arsenic is still highly esteemed in India, and Dr.
Benet (formerly of Lahore) records benefit from the Tanjore pill (Gazette
des Hopitaux, December, 1842). The external application of arsenious
acid is also reported to have cured (Dublin Medical Press, 1864), but this
must be exceptional.

Disorders of Mucous Membranes. Without implying that the fol-
lowing maladies are solely disorders of mucous membranes, it will be
found convenient to group them under this heading. The value of arse-
nic in them is very marked, but is of comparatively recent recognition,
and has not yet been noticed in many text-books.

Coryza Bronchial Catarrh flay Asthma. In these disorders, in
which a profuse secretion is connected with local irritation, and with gen-
erally depressed nerve-power, Fowler's solution is often effectual, and it
is especially so in patients subject to paroxysmal sneezing, with much
itching about the alse nasi. Dr. Mackenzie had previously reported satis-
factory cases of catarrh treated by doses of 3 min. and upward (London
Medical Journal, July, 1851).

Chronic bronchitis. I have witnessed marked improvement under
the continued internal arsenical treatment of chronic bronchitis, for which
cigarettes and inhalations are sometimes even more suitable than ordinary
doses. Bretonneau and Trousseau have recorded good results, and the lat-
ter devised a simple cigarette, made with suitable paper, soaked in solution
of arseniate of soda, or of potash (1 to 4 gr. in 20 gr. of water for twenty
cigarettes). Four or five mouthfuls are inhaled several times daily; more
often when the patient becomes accustomed to it. M. Papillaud recom-
mends, in chronic bronchitis and emphysema, a combination of the drug
with antimony (an arseniate of antimony), and considering the relations
between these two substances, the recommendation is likely to prove very
good (Gazette de Paris, 1865, No. 43, etc.).

Dyspepsia. In many cases even of irritative dyspepsia, when the
tongue is furred, with red edges and tips, and there is pain after food
and heartburn, and tendency to diarrhoea after eating, I have had ample



68 MATERIA MEDICA AND THERAPEUTICS.

experience of the value of Fowler's solution given in 2 or 3-min. doses
after meals. Dr. Thorowgood finds that it acts best when the attack
seems localized in the stomach, and is independent, e.g., of hepatic con-
gestion (Practitioner, 1870). Dr. Anstie, whose first published observa-
tions were directed to the value of arsenic in gastralgia, previously
mentioned to me its equal efficacy in the dyspeptic conditions described.

Vomiting Diarrhoea. In chronic forms of vomiting connected with
ordinary dyspepsia, and in that of alcoholism which occurs usually in the
early morning, and is of a bilious character, with painful straining, arsenic
is of ten useful: also in the retching and vomiting of pregnancy I have
obtained excellent results from 2 to 5-min. doses. Dr. Decamp has highly
recommended the same treatment {Philadelphia Medical and Surgical
Reporter, 1872, No. 27), and Bartholow mentions, as additional indica-
tions for it, the rejection of the food, streaked with blood, or blood only,
also gastralgia and interscapular pain. It is not only serviceable in cases
of the rapid passage of half-digested food occurring very soon after
meals, but also in cases where the motions are frequent, watery, contain-
ing mucus, offensive and irritating to the anus, and even when bloody
and dysenteric in character and accompanied with tenesmus, prostration,
and vomiting. In true dysentery, especially when of malarial origin, and
verging into a chronic state, arsenic is often of the greatest value.

Chronic Gastric Catarrh. In cases of this malady marked by op-
pression and discomfort after eating, with a sense of weakness and
emptiness at the stomach, thirst, offensive breath, coated and red-edged
tongue, flatulence and pyrosis, with rejection of glairy acid fluid, and
general symptoms of depression, coldness of extremities, and emaciation,
I have had ample experience of the good effect of small doses. In acute
gastric catarrh also, I have not been often disappointed, though a more
cautious use is needed, but in the chronic forms, especially when co-
existing with emphysema, with chronic bronchitis, or with phthisis, arsenic
always gives some relief. Germain speaks favorably of the treatment
{Gazette Hebdomadaire, 1860), and Trousseau remarks that the evidence
in its favor is such as to warrant a fair trial of it. Many mineral waters
that have a reputation in chronic gastric maladies contain an appreciable
quantity of arsenic, notably those of Mont Dore, Plombieres, and Bus-
sang. Dr. Wilson Fox, however, while referring to the favorable reports
of others, states that "he has not had successful results himself, possibly
because he has not seen definite indication for the remedy ";. sometimes
it seemed to aggravate the malady (" Reynolds' System," ii., p. 884).

Gastro-enteritis "English Cholera." 1 " 1 Fowler's solution is an effec-
tive medicine in severe cases of this disorder. I have seen it give relief
when the patient was suffering from retching and bilious or sanguineous
vomiting, passing white, odorless, or slimy flocculent stools, with pain,
tympanitis, and tenesmus; other symptoms present have been thickly-



ARSENIC. 69

coated tongue, thirst, pyrexia and prostration, muscular cramps, scanty
urine, pinched and anxious features. Even when the stage of collapse
has commenced, and the surface is dusky and covered with cold perspira-
tion, the medicine has seemed to me of great service 5 min. every one
or two hours was the dose given, lessening it as the patient improved.
Black has written very fully in praise of this remedy in English cholera,
recommending 10 to 15 drops every ten to fifteen minutes till the sym-
toms abate, then less frequently. He has found this most valuable in
various forms of choleraic attack, but especially in serious cases con*
nected with defective drainage, and presenting the symptoms of vomit-
ing, purging, and rapid collapse; he records several instances of immediate
and striking improvement (Lancet, ii., 1857). Dr. Hitchman speaks
equally strongly, and describes fully the indications for arsenical treat-
ment in such cases (loc. cit., p. 535).

Cholera Infantum. This term has been applied to dysenteric diar-
rhffia in children, probably because of the collapse so readily induced;
The child looks pale and thin, and refuses food, the motions are very fre-
quent and brown, offensive, and mixed with blood; tenesmus also is com-
monly present, and often with such symptoms minim doses of Fowler's
solution produce excellent results.

Gastric Ulcer. Not only in chronic inflammation, but in ulceration
of the mucous membrane of the stomach, I have seen very beneficial re-
sults from arsenic, the appetite returning, and the thirst, the vomiting,
and the pain subsiding, so that the patients became strong and stout who
had before been weak and emaciated. Dr. Ringer has observed similar
results, and states that he has seen relief from this remedy in chronic ul-
cer after failure of the more commonly-used medicines (Op. cit., p. 253).

1 usually prescribe 1 to 5-min. doses four times daily with a little nour-
ishment.

PREPARATIONS AND DOSE. Acidum arseniosum : dose, -fa to y 1 ^ gr. in
solution or pill. Liquor arsenicalis Fowler's solution (4 gr. in 1 fl. oz.):
dose, 2 to 8 min. Liquor arsenici hydrochloricus (4 gr. in 1 fl. oz.) : dose,

2 to 8 min. Sodce arsenias : dose, ^ to -J gr. Liquor soda} arseniatis (4
gr. in 1 fl. oz.): dose, 5 to 10 min. Liquor arsenici et hydrargyri hydri-
odatis (not officinal): dose, 10 min. to fl. dr., diluted, and given with
the usual precautions for preparations of arsenic. Ferri arsenias: dose,

TV to i r -

Liquor arsenicalis, if long kept, is liable to vary in strength on ac-
count of the deposition of a thin film of metallic arsenic; the compound
tincture of lavender contained in it is nauseous to some palates, and
would be better omitted.

The solution of chloride is liable to become cloudy in warm weather,
from the development of a fungus: this may be prevented by the addi-
tion of a little perchloride of iron (Hunt).



70 MATERIA MEDICA AND THERAPEUTICS.

In acute or subacute maladies, as of the stomach or intestine, small
doses, 1 or 2 min., either every hour, or every four or six hours, are suit-
able; in chorea, or neuralgia, or struma, where there is no visceral irrita-
tion, the dose may be gradually raised to 10 or even 15 min., and in
chronic conditions of ague, or of cutaneous disease, the secret of success
will be found in securing the tolerance of a moderate dose for a consider-
able time.

In agues, it is true that a large dose may be required, arid may be
well borne during a certain condition of the system, but so soon as that
condition is relieved the large dose cannot be tolerated.

In skin diseases, large doses are never desirable, and any increase be-
yond 4 or 5 min. should take place only after this dose has been used
three or four weeks without physiological symptoms. This remark refers
especially to the potash and to the acid solutions, not to that of the ar-
seniate of soda, for although nominally of the same strength, the last-
mentioned is markedly milder, and is often better borne in doses of G to 8
min., or more, than the others in less quantities. The remedy, sufficiently
diluted, should always be given in several such moderate quantities daily,
rather than in one full dose, and always at a meal, or with some food, so
as to secure absorption and lessen the degree of local irritation; the
symptoms of its physiological action, such as irritation of conjunctivas,
oedema, nausea, etc., should be constantly watched for, and the dose di-
minished rather than entirely omitted, if the reason for its administration
remain.

In some obstinate cases, especially of chorea and of skin disease, it is
justifiable and not harmful to keep up a moderate degree of physiologi-
cal action for some time, but this must be done very cautiously. It is a
matter of daily experience that the secretions must be in good order if
we are to expect the full advantage of the remedy in chronic disease.
Mr. Hunt observes, " Above all, the bowels must not be allowed to act
sluggishly. In many cases a full dose of calomel and compound colocynth
pill will be required two or three times a week, and these doses are some-
times essential to the cure. If the legs, or feet, or abdomen become oede-
matous, and the urine scanty, the case will not go on well till we have
roused the kidneys to vigorous action by full doses of spiritus setheris
nitrosi and acetate of potash, etc." (Journal of Cutaneous Medicine, ii.,
p. 353).

The administration and the powers of arsenic in combination with
other remedies require special consideration. We have already noted
that it enhances the value of iron, for instance, in amenorrhcea, anaemia,
struma, eczema, etc., and Messrs. Young and Postans have introduced a
good effervescing citrate of arsenic and iron, which I have often found ser-
viceable. The direct combination of iodine and arsenic has been esteemed
by some practitioners on the Continent and in Ireland, especially by Neli-



GOLD. 71

gan: from -5*5- to ^gr. in pill thrice daily has been given. The same phy-
sician employed also an ioduretted solution, containing 5 min. of Fow-
ler's solution, 1 gr. of iodide of potassium, and gr. of iodine in 1 dr. of
orange syrup; it is rather agreeable, and keeps well, and has given good
results. He found this preferable to Donovan's solution (Dublin Jour-
nal, vols. xvi., xviii., xxii.), (y. p. 27). This has been specially used in
syphilitic skin disease, but it is, as Mr. Hunt observes, though " very ac-
tive, yet a most unmanageable preparation." The mercury is liable to
injure the general health of some weakly subjects, and to interfere with
the effects of arsenic or of iodine, which are quite powerful enough, and
require special caution as to their own effects. Dr. Clemens, of Frank-
fort, recommends a direct combination of arsenious acid and bromine, and
Ferris and Co. prepare a liquor arsenici bromati.

[PREPARATIONS, U. S. P. Acidum arseniosum ; Arsenici iodidum
dose, -gV to -j^ grain ; Arsenicum / Liquor arsenici chloridi ; dose, 2 to 8
minims; Liquor arsenici et hydrargyri iodidi / dose, 2 to 10 minims ;
Liquor potassii arsenitis Fowler's solution; dose 2 to 8 minims.]



AURUM GOLD, Au, = 196.6 (not officinal).

This " king of metals," as it was formerly termed, is found native in
the "veins " of rocks, and as gold-dust or nuggets in the sands of certain
plains and rivers; it is separated by washing, or by means of mercury,
which is afterward driven off by heat; it occurs also in alloy with silver,
copper, and iron, but not as an oxide, nor in any other than the metallic
form.

CHARACTERS AND TESTS. When pure it is of yellow color, having a
tinge of green by reflected light, and is decidedly greenish when liquefied;
it is of great density (sp. gr. 19.5), and is remarkably malleable, 280,000
thin leaves making only one inch in thickness. It is less easily oxidized
than any other metal, and will not combine with oxygen by direct action,
only through the medium of another oxide: thus the protoxide of gold is
prepared by adding solution of potash to one of protochloride; it precipi-
tates as a green pc>wder. Gold combines also with chlorine and iodine,
not with nitrogen or hydrogen. It is soluble only in a mixture of nitric
with hydrochloric acid (aqua regia).

PULV18 AURlPOWDER OF GOLD (not officinal).

PREPARATION. By triturating gold leaf with some hard crystals, as of
potassic sulphate, or with some glutinous substance as honey; and after



72 MATERIA MEDIC A AND THERAPEUTICS.

complete disintegration of the metal, the foreign ingredient is removed
by washing the resulting powder retains the color of the metal.



COMPOUNDS OP GOLD.

AURIPERCHLORIDUMPERCHLORIDEOF GOLD " POTABLE GOLD"
OF ALCHEMISTS, AuCl s ,-303 (not officinal).

PREPARATION, etc. By dissolving the metal in nitro-hydrochloric
acid, with gentle heat. On evaporating, yellow crystals of the salt are
left in combination with some free acid (AuCl 3 2HClH 2 0). After the
acid has been driven off, the color of the crystals is red, and they have
the composition AuCL. This salt is used in photography and in analyt-
ical chemistry, and a solution of it, freed from excess of acid, is placed
in the appendix to the Pharmacopoeia as a test solution for atropia.



AURI PEROXIDUM PEROXIDE OF GOLD ." AURIC ACID," Au,O 3 , =

441.2 (not officinal).

PREPARATION, etc. By treating the perchloride with magnesia, wash-
ing the precipitate, and digesting in dilute nitric acid, which removes the
magnesia. The peroxide forms, when dried, a brown powder, insoluble in
water, and decomposed by exposure to light.



AURI ET SOD II CHLOR1DUM CHLORIDE OF GOLD AND SODIUM,
AuCl 3 NaC12H 2 O (not officinal).

PREPARATION, etc. By mixing in solution about 5 parts of chloride
of gold and 1 part of chloride of sodium, and evaporating to crystalliza-
tion; long, four-sided prisms are left, of deep yellow color. This combi-
nation, which is deliquescent arid soluble in water, is the form most com-
monly prescribed; it has a nauseous taste, and should not therefore be
given in solution.

AURI 10DIDUM IODIDE OF GOLD, Aul, (not officinal).

PREPARATION, etc. By mixing solutions of iodide of potassium and
perchloride of gold. The precipitate, when collected, washed, and dried,
forms a greenish yellow powder, insoluble in cold, but slightly soluble in
boiling water.

ABSORPTION AND ELIMINATION. Salts of gold are readily decomposed
by organic substances, and they coagulate albumen, but when the soluble
chlorides are given internally they become absorbed to some extent,



GOLD. 73

probably in the intestine, as oxides combined with albumen. When
rubbed upon the gums and tongue, according to an old-fashioned method
of administration, they are also absorbed, but are liable to cause much
local irritation. Neither metallic gold nor the oxides can be absorbed
(although poisoning by gold leaf is said to be an aristocratic method of



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 9 of 40)