Arsenicum Album

THIS substance is generally prepared by subli- mation from the ores of cobalt, and is often found adulterating the ores of zinc. It is a white powder, completely soluble in boiling water. It has neither taste nor smell, but leaves a somewhat acrid sensation on the fauces ; and when fused and thereby deoxidized, it emits the odor of garlic which char- acterizes the heated metal.

In medicine, the forms of Arsenicum chiefly used are the arsenious acid and the solution of the arsenite of potassa known as " Fowler's solution," or the *' tasteless ague drop." The latter is pre- pared by dissolving equal parts of arsenious acid and carbonate of potassa in boiling distilled water. A very little compound spirit of lavender is added to give color and flavor. It contains four grains of arsenious acid to the fluid ounce.

Five to twenty drops ; it may be repeated several times daily.

Arsenious acid has been known since the eighth century. In the fourteenth century, it was used as

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a medicine in the treatment of diseases of cattle. In the seventeenth and eighteenth centuries, it was used as a caustic appHcation to malignant ulcers, but its use was condemned by regular physicians. Irregular practitioners, however, had learned its value in the treatment of skin diseases and of intermittent fever. How they found this out is more than we can say.

The same has been true of nearly every drug of the materia medica. It is certain, however, that while in irregular and domestic practice intermit- tents and skin diseases were being cured by Arsen- icum every day, its use was condemned by the faculty; and Goeffroy said, "Though it may be a good remedy for the present, it will afterward* prove a poison and bring on very dismal symptoms. Arsenic, therefore, is, in my opinion, worse than the fever!"

Not so, however, thought the patients who were glad to get rid of their fevers, and to run the risk of the dismal symptoms. The popularity of the remedy, and its extensive use, unsanctioned by the faculty, at length converted learned doctors ; and Arsenic was received into the orthodox pharma- copoeia, and became forthwith " a safe remedy," and much better "than a fever itself."

Arsenic is a poison to plants as well as to animals.

Upon animals it acts in its well-known peculiar way, however it be introduced into the system, whether by the stomach or by the rectum, or

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through the external surface of the body by the endermic method. Cases of fatal poisoning are on record in which the arsenic was introduced in a wash applied to cutaneous eruptions or to ulcers.

The fumes of arsenious acid act very sensibly on the system. It is recorded that persons have been poisoned by inhaling the air of a room in which had been burned candles the wicks of which had been saturated with a solution of arsenious acid. The same result has followed the use of arsenious acid in candles to harden them. Clay tobacco pipes are glazed with a preparation of arsenious acid, — at least those having a superior finish, and designed for the use of the aristocracy.

At the first smoking this glazing is volatilized, and the smoker inhales a dose of arsenic. Every new pipe involves a new dose. Some persons scorn to use any but a new pipe. Fatal poisonings have resulted from this fastidious extravagance.

A beautiful green wall-paper gets its color from the arsenite of copper, a pigment known as Scheele's green. The exhalations from this paper have caused illnesses and death. The same pig- ment is used in almost every form of ornamenta- tion of dress and furniture and condiments, from the artificial flowers of the fine lady's head-dress, which give her the mysterious arsenical neuralgic headache, to the green candy toy of her spoiled child, which, when eaten, gives the child the equally mysterious arsenical stomachache.

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The effects of small doses of arsenic frequently repeated, producing chronic arsenical poisoning, are thus described:

" Loss of appetite, nausea, deranged digestion, diarrhoea, thirst, salivation, tenesmus, colic and intestinal cramps ; respiration labored and painful ; a sense of oppression with pain in the breast ; cough ; extreme wasting of the flesh, and hectic fever ; the limbs grow tremulous, and not unfre- quently are paralyzed, especially the lower extrem- ities ; pains in the whole body, but particularly in the hands and feet ; stiffness and contraction of the extensor muscles succeed; numbness invades the extremities, and the mental faculties subside into insensibility and torpor ; oedema of the face and extremities, and even general anasarca are not unusual ; the hair falls out ; epidermis scales off; pustular and other eruptions, ending in ulceration, attack the skin, which acquires a lifeless, earthy hue ; the countenance, if not oedematous, is sunken ; the conjunctiva is strongly injected, and a reddish circle surrounds the eyes."

The symptoms of acute poisoning are as follows :

" Immediately after the poison is swallowed a metallic taste is perceived, with constriction of the fauces. A violent burning pain, which soon becomes excruciating, is felt in the stomach, and gradually extends itself over the whole abdomen, steadily increasing in severity until it becomes intolerable. Retching and vomiting and cramps of the bowels ensue, with spasms of the oesophagus and chest,

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which resemble those of hydrophobia. The thirst is insatiable, but even the mildest drinks cannot be retained. The tongue is generally fissured, hard and dry, although occasionally there is profuse sali- vation, and the voice is hoarse. There is also tenesmus, with bloody and offensive stools and retraction of the abdomen.

The irritation extends to the urinary organs, producing strangury. Some- times the urine is completely suppressed, and sometimes it is mixed with blood. Christison says that in women there is burning in the vagina and excoriation of the labia, but this does not happen unless life is prolonged beyond three days. Bach- man had previously noticed the pain above alluded to, and also profuse menorrhagia among the symp- toms in women.

"The pulse is irregular, rapid and intermittent; the muscles are spasmodically affected; the skin presents a livid eruption, as already described. The sense of anguish is unutterable, and sometimes there is delirium. The breathing is oppressed. A consuming fire seems to prey upon the vitals, while the whole body is pale, cold, shivery and clammy.

The features are sunken and sharp; if vomiting occurs it is convulsive and affords no relief Exhaustion of mind and body; prostration and despair, with anxious restlessness, generally attend this stage of the attack. On the approach of death, spasm yields to general exhaustion, the pulse grows slow and feeble, and urine and faeces are passed involuntarily, but sensibility and

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consciousness are lost only in the last moments of life

" The duration of the symptoms is variable, and may be stated, in general, as from six to twelve hours, but occasionally they last several days.

" But even when recovery from the acute symp- toms takes place it is rarely complete. For months or even years, the joints remain stiff and swollen, rendering walking difficult and painful ; the digestive organs continue irritable and feeble, and all the functions of the nervous system are impaired. In some cases paralysis of the upper or lower extrem- ities occurs, and gangrenous ulcers attack the legs."

"The quantity of arsenious acid sufficient to cause death will depend," says CEsterlein, "on the condition of the stomach at the time the arsenic is swallowed. If the stomach be full of food at the time a large quantity may produce only a slight effect." Thus QEsterlein reports a case in which just after a hearty meal a man swallowed a quarter of an ounce. Emetics were given immediately and no evil followed.

On the other hand, very small doses may pro- duce very violent and fatal symptoms.

Four, three, and even two grains of arsenious acid have destroyed life.

A summary review of the effects of Arsenic leads us to conclude:

I. From the fact that, after death from poi- soning by it, it is found in almost every tissue and secretion of the body, that it is universally

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diffused throughout the body and acts upon every part.

2. From the fact that its action and diffusion are uniform, however it be introduced into the body, whether through the skin or by the aHmen- tary canal, that its action is specific and not local.

3. From its effects in chronic poisoning, pro- ducing anaemia, exhaustion, emaciation, etc., that it acts upon the blood composition, as well as directly on the tissues and on the nervous system.

We consider now the more intimate specific effects as gathered from provings on the healthy body, made by Hahnemann and his pupils.

A few words from Hahnemann's introduction to his proving may not be amiss, and especially since the use of Arsenic as a remedy has been denounced on the ground of its frequent abuse as a poison.

"When I utter the name Arsenic, powerful recollections possess my soul.

" In creating Iron, the All-Merciful left it free to His children to transform it at their pleasure, either into the murderous dagger or the blessed ploughshare, and to use it either for destruction or preservation. * * * * *

" It is not the fault of Him who loves us all that we abuse powerful medicinal agents, giving them either in too large doses or in cases for which they are not suitable, being merely guided by the caprice of miserable authorities, and without having taken the trouble to investigate the inherent cura-

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tive virtues of the drug, and to make our selection depend on the knowledge thus obtained."

GENERAL ANALYSIS.

1. Arsenic exhausts the vital power of certain organs or systems or of the entire organism, pro- duces symptoms of impeded activity in the func- tions of organs ; indeed, in some cases, positive paralysis.

This asthenic condition characterizes the entire symptomatology of Arsenic. For this reason, the sensations of prostration, lassitude, weakness, etc., sinking of the forces, etc., are highly characteristic indications for Arsenic. They are so peculiar to Arsenic that Hahnemann says: "Even circumstances that are in themselves not very important and would otherwise produce but little effect, occasion in the Arsenic patient a sudden and complete sinking of the forces." This is a vital phenomenon and not a result of chemical or physical destruction of vital organs, as the stomach or intestine ; for this sink- ing occurs when there is no such destruction.

2. The organic substance of the body is acted upon throughout. A cachectic dyscrasia and colli- quative destruction of tissues is indicated by symptoms of the complexion, excretions, ulcers, eruption, and the skin generally.

Hence the use of Arsenic in persons of a cachectic habit, in leucophlegmatic persons.

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3. The sphere of action embraces almost all the organs and systems of the body, but it acts especially on the mucous membranes and the exter- nal skin.

4. It is one of the most eminent periodics of our materia medica.

5. As characteristic peculiarities may be men- tioned :

That the symptoms of Arsenic are almost always accompanied by great restlessness and anxiety, indeed sometimes by frantic desperation.

That they are sometimes relieved for a time by external warmth.

That they occur and are aggravated during repose, but are ameliorated by standing and by moving.

That the symptoms are almost always attended by concomitant symptoms ; that is, by symptoms which stand in no pathological relation to the former.

That as regards the time of day at which the symptoms occur or are aggravated there is a great variety. Most of them occur at night after lying down, or about two a. m. ; some on rising, and after dinner.

SPECIAL ANALYSIS.

The action on the head is not very striking. Pressing pain and semi-lateral headaches are mentioned by provers, but not graphically. It is

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probable that the general symptoms alone will suf- fice to guide the prescriber in selecting Arsenic for headache.

Upon the eyes and their appendages Arsenic produces : itching, drawing and pressure around the eyes, swelling of the lids, pains on moving the eyelids, as if they were dry and rubbed against the eyeball ; agglutination of the lids ; increased lachrymation ; drawing and pressure, but especially tickling, itching and burning (the charac- teristic sensation produced by Arsenic.) The con- junctiva is reddened, there is photophobia, the pupils are contracted; in fact there is every symp- tom of inflammation. As regards vision itself, it is obscured and weakened.

With regard to the ears, no symptom seems characteristic, except that, almost all the paroxysms of pain, wherever located, begin with roaring in the ears. But when it is remembered that great debility and exhaustion attend the pains of Arsenic, and that these in turn are apt to be attended by roaring in the ears, this symptom will not be regarded as indicative of a special affection of the ear.

Let me, however, caution you against supposing that because Arsenic has hitherto produced no defi- nite ear affection it cannot nevertheless cure one. I shall have occasion to relate to you a severe case of otalgia, cured in a very short time by a single dose of Arsenic ; which was indicated by the gen- eral constitutional symptoms of the case.

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The face is altered in complexion, which assumes a sunken, yellow, ghastly aspect ; the skin around the mouth is livid, the face is cold and sunken.

Swelling and inflammation of the lips, bleeding of the lips, painful tumor in the lip, an ulcer, phagedenic, with a tearing, biting, burning pain, aggravated by touch, and in the air, and especially at night. These symptoms must be remembered in connection with the well-known and long-known use of Arsenic in ill-conditioned ulcers of the lip, lupus, and epithelial cancer.

The tongue is excoriated at the tip, which has a biting or burning pain.

Action on the fauces is eminently exerted by Arsenic, however it be introduced into the system.

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The same may be said of its action upon the entire alimentary canal.

The nausea which Arsenic produces is conjoined with a sensation of the greatest weakness, with anxiety; it recurs periodically. It is often con- joined with symptoms that seem to have no patho- logical connection with it ; it is worse during repose, and is aggravated by motion.

Actual vomiting occurs, with great anxiety, with diarrhoea, with severe griping and burning pains in the stomach and abdomen.

The vomiting requires great effort ; is scanty in quantity, as are all the excretions of Arsenic ; and it is followed by extreme prostration.

The matters vomited may be first water, then thick, glairy or grass-green mucus, and then blood. The stomach becomes at times so irritable that it will not tolerate food.

Hahnemann says. Arsenic provokes in the stom- ach rather an irregular convulsive action than an ordinary peristaltic or anti-peristaltic motion ; rather an anxious, fruitless retching than a copious vomiting.

In the stomach itself, pressing, gnawing, burn- ing, and a feeling as though the stomach were distended.

The burning pains are the most constant. With them come violent thirst, lamentation, anguish.

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They may be continuous or periodic. If the latter, they occur most frequently at two a. m., or after eating.

Intestines. All the varieties of pains analogous to that which is so characteristic of Arsenic, viz. : burning, may be confined to single parts of the abdomen, or may be general, — generally in the hypogastric region, — accompanied by thirst, rest- lessness and the other conditions of Arsenic.

Most important symptoms.

The stool, as regards its character, is diarrhoeic. It consists of a pappy (not often watery), yellow, bloody or greenish, or more frequently a blackish, very offensive substance.

The characteristics may be said to be small quantity, dark color, offensive odor ; great prostra- tion following it.

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No Other drug combines all these character- istics. Phosphorus has some ; but Phosphorus is never indicated where the loss of power, the prostration, is a striking symptom.

Veratrum has some, but the quantity of the excretion is as remarkably large, as, under Arsenic, it is notably small.

Secale cornutum has some, but the stool is watery, putrid, dark brown ; and there is not the restless anguish of Arsenic.

Graphites has some, but the stool is pasty, of a light brown color, and a most atrocious odor, with scarcely any pain, and no restlessness, nor weakness, etc., etc.

Arsenic produces a yellow, acrid leucorrhoea, and increases the menstrual flow.

During the menses, sharp sticking in the rec- tum, extending to the anus and pubes ; cutting pains in the abdomen, with the conditions charac- teristic of Arsenic.

The menses are often followed by a discharge of bloody mucus.

It should be added, that, in cases of chronic poisoning, profuse metrorrhagia has occurred ; and this fact has led to the successful use of Arsenic

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in such cases, where the constitutional symptoms correspond.

Arsenic seems to produce in the mucous mem- brane of the respiratory organs a hypersemic and inflammatory condition, the symptoms of which vary according to the locaHty.

Thus, in the nasal membrane, the irritation is shown by frequent sneezing, by obstruction alter- nating with fluent coryza, with hoarseness and drowsiness ; the nares burn, and the discharge is watery and very acrid.

On the larynx, the action is not marked. But we have constant tickling in the entire trachea, which provokes a cough, a feeling of rawness, soreness and burning in the chest ; scanty, tena- cious mucus in the chest, hard to dislodge ; and when dislodged it is blood-streaked.

Constriction of the chest (here we meet the characteristic constriction, as in the oesophagus, the rectum and the bladder), dyspnoea, asthma, whis- tling respiration — indeed all degrees of difficult

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respiration, dyspnoea, orthopnoea, apnoea. They may be paroxysmal, intermittent, periodically recurring, worse at night.

Burning in the chest.

The heart is especially affected by Arsenic, and it is probable that some of the dyspnoea is thus explained.

We find anguish in the praecordia, stitching and sore pain there on coughing; pain under the prae- cordia restricting respiration ; palpitation ; at night, about three a. m., an irregular but very violent palpitation, which seems to him audible, with great anguish ; palpitation much worse when he lies on the back.

Pathologico-anatomical investigations show the heart to be " lax, not over-filled with blood, the muscular substance infiltrated with blood. The pericardium contains serum." It would appear that Arsenic affects the muscular substance of the heart.

In the trunk. Arsenic produces various pains of stiffness, lassitude and powerlessness.

Autopsies show that the spinal marrow is always affected, especially the lower part of it.

In the upper extremities (as might be supposed) the symptoms are few, chiefly those of loss of power.

In the lower extremities they are numerous, but may be reduced to three varieties : pain, spasm, paralysis.

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paralysis occurs, generally, in fatal cases, not long before death, and is hardly a specific effect of Arsenic, but rathfer a forerunner of dissolution.

The skin is one of those organs on which the action of Arsenic is most powerfully exerted.

Thus Arsenic produces : i. Pains, itching, biting, gnawing; but above all, burning.

2. Watery swellings ; from puffiness of the feet or the face to general anasarca.

Inflamed spots on the face, head and neck; nettle-rash, yellow spots.

Whitish papules or elevated spots, itching and burning, like lepra, red pimples, pustules.

Ulcers already existing and hitherto painful become very sensitive, as if red-hot coals were laid upon them; the margins become elevated, and they bleed, discharging black blood; the ulcers become offensive.

The fever may be continued, or remitting, or distinctly intermittent; quotidian, or quartan.

The paroxysm is not complete. One stage is generally wanting.

The fever is most apt to occur at night.

The sweat occurs only at the end of the fever, or only at the beginning of sleep.

The pulse is small; quick, but weak.

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Thirst never accompanies the chill, but comes after it. It does not accompany the night fever, but is very violent during the sweat.

The disposition is :

a. Depressed, melancholy, despairing, indifferent.

b: Fearful, restless, anxious, full of anguish.

c. Irritable, sensitive, peevish.

PRACTICAL APPLICATIONS.

The fact cannot be too often called to mind, nor too strongly insisted upon, that our most characteristic indications for the use of a drug which presents well-defined general symptoms, as Arsenic does, and indeed as every well-proved drug does, are derived not from its local action upon any organ or system, not from a knowledge of the particular tissues it may affect, and how it affects them, but upon the general constitutional symptoms and their conditions and concomitants. If this were not so, in the presence of how many maladies, of the intimate nature of which we are wholly igno- rant and which nevertheless we cure, should we be utterly powerless for good.

I mention and urge this, because the opposite is strongly presented by an author whose volumi-

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nous productions are evidence in themselves of the notorious fact that his life has been that of a stu- dent and compiler ; that he entirely lacks the practical experience in the treatment of the sick, which serves as the test and corrective of any- theoretical opinions we may form of the mode of selecting drugs, and of their mode of action.

A few cases will illustrate what I mean.

It intermitted, the intervals varying from ten to ninety minutes.

As regards character, the pain was described as a fine, burning pain.

The effects of the pain were very remarkable. Whereas during its continuance the patient's vie-

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lent movements indicated the possession of no inconsiderable muscular vigor, no sooner had the paroxysm passed over than she fell into a state of really pitiable exhaustion and weakness. Moreover, she had burning thirst, though she cared to drink but little at a time.

A second case will serve to illustrate not merely this point but also another, viz. : the detection and treatment of what is sometimes called "masked intermittent ; " by which is meant a disease clearly resulting from marsh-malaria, and which neverthe- less does not manifest itself by the customary paroxysm of chill, heat and perspiration, which constitute intermittent fever.

A precocious child in Dutchess County, twelve years old, had complained for more than eighteen months of a severe pain in the left ear. She was brought to my office for treatment, with the state- ment that for this affection she had been treated,

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both locally and constitutionally, for an inflammation of the middle ear, by some of the most distin- guished surgeons of the city of New- York, but with no good result. I could discover no distinct signs of local lesion, but nevertheless supposed it to be a case of otalgia, and from a very close corre- spondence of the case, as described to me, with the symptoms of Chamomilla, gave that drug.

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recurred for four days, gradually diminishing in intensity. They then ceased, leaving the patient well.

Instances almost without number might be adduced in corroboration of this statement, that cures are to be made in a multitude of instances which present local symptoms and lesions of tissue, to which the symptomatology of the drug presents no analogy; provided always the general and con- stitutional symptoms correspond closely to those which characterize the drug. And it may be added that perhaps no other drug is so often useful and available in this way as Arsenic, for the reason that hardly any other drug produces general symp- toms so strongly marked, and so easily detected ;

I may add, so frequently met with in patients. Whatever, then, may be the local nature of the disease before, whatever pathological name it may bear, if the general symptoms correspond to those of Arsenic in the way that I have pointed out, do not hesitate a moment to give that drug. (How otherwise could we cure lupus, cancer, ulcers ; for these do not occur in provings !)

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very famous in the last century under the name of "the tasteless ague-drop."

During the wars consequent on the French Revolution, and the Napoleonic wars on the conti- nent of Europe, while England held control of the ocean and effectually blockaded the European sea- ports, thereby preventing the importation of foreign products, and among them of Peruvian bark, the recognized specific for intermittent fever (for, what- ever opinion the English may now entertain of the barbarity of our withholding medicines from our enemies, they had then no doubt of the propriety of withholding them from theirs) ; — at this time attention was turned to the practicability of using Arsenic as a substitute for bark in treating inter- mittent; and large rewards were offered for an effectual method of so using it, or for any efficient substitute for bark.

It is amazing that this idea of using one specific as a substitute for another specific could ever be entertained ; since the virtues of a specific reside in its peculiar, individual prop- erties, which are never common to two different substances. Nevertheless, even at the present day and in our latest works on materia medica, we find the subject of the substitution of Arsenic for Quinine gravely discussed, and statistics referred to to show, as the case may be, its inferiority or superiority to Quinine.

As might be supposed, the testimony of different physicians differs widely on this point. Some affirm that almost all the cases treated by them during a certain period, were promptly cured

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Now, it is a wonderful thing that medical men should still argue, in the face of these statistics, upon a question of the relative value of certain drugs in the treatment of a disease, regarded not in the light of the individuals affected by it, but solely with reference to its great pathological feat- ures. It seems to me the only sound deductions from these testimonies are these : That there are diversities in the form in which intermittent fever appears in different persons and in different epi- demics ; that these forms require different remedies, and that thus there is a form which is capable of being cured by Arsenic, and by nothing else; a form capable of being cured by Quinine, and by nothing else ; and so of other drugs.

In this view, when a case of intermittent fever presents itself, the question can never be : Is Arsenic a better remedy for this disease than Quinine is? Does it offer greater chances of a cure ? There can be no better or worse. The question is between right and wrong ; suitable and not suitable.

The ques- tion would be always : Which remedy corresponds to this particular case, and is, therefore, indicated in it ?

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very famous in the last century under the name of "the tasteless ague-drop."

During the wars consequent on the French Revolution, and the Napoleonic wars on the conti- nent of Europe, while England held control of the ocean and effectually blockaded the European sea- ports, thereby preventing the importation of foreign products, and among them of Peruvian bark, the recognized specific for intermittent fever (for, what- ever opinion the English may now entertain of the barbarity of our withholding medicines from our enemies, they had then no doubt of the propriety of withholding them from theirs) ; — at this time attention was turned to the practicability of using Arsenic as a substitute for bark in treating inter- mittent; and large rewards were offered for an effectual method of so using it, or for any efficient substitute for bark.

It is amazing that this idea of using one specific as a substitute for another specific could ever be entertained ; since the virtues of a specific reside in its peculiar, individual prop- erties, which are never common to two different substances. Nevertheless, even at the present day and in our latest works on materia medica, we find the subject of the substitution of Arsenic for Quinine gravely discussed, and statistics referred to to show, as the case may be, its inferiority or superiority to Quinine.

As might be supposed, the testimony of different physicians differs widely on this point. Some affirm that almost all the cases treated by them during a certain period, were promptly cured

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Now, it is a wonderful thing that medical men should still argue, in the face of these statistics, upon a question of the relative value of certain drugs in the treatment of a disease, regarded not in the light of the individuals affected by it, but solely with reference to its great pathological feat- ures. It seems to me the only sound deductions from these testimonies are these : That there are diversities in the form in which intermittent fever appears in different persons and in different epi- demics ; that these forms require different remedies, and that thus there is a form which is capable of being cured by Arsenic, and by nothing else ; a form capable of being cured by Quinine, and by nothing else ; and so of other drugs.

In this view, when a case of intermittent fever presents itself, the question can never be: Is Arsenic a better remedy for this disease than Quinine is? Does it offer greater chances of a cure? There can be no better or worse. The question is between right and wrong ; suitable and not suitable.

The ques- tion would be always : Which remedy corresponds to this particular case, and is, therefore, indicated in it ?

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"Again, the longer the disease has lasted, the more is Arsenic generally indicated ; because the niore deeply have the organs and tissues been affected, the more nearly has the patient's condition approached that known as the intermittent cachexia, and which so nearly resembles the arsenical cachexia. Especially is this the case when the liver and the spleen have become swollen.

**The intermittents which find this homoeopathic remedy in Arsenic present in their paroxysms the following peculiarities : the paroxysms are general, violent, and of long duration ; the stages are either distinctly developed, and equally proportioned to each other, or else, as is most frequendy the case, the one or the other stage is absent, or is very feebly present ; if the latter be the case, it is gen- erally the cold stage which fails, and the hot stage, is all the more violent. The more intense the heat, the longer it continues, the higher the degree of development of the accompanying excitement in the vascular system, and the more burning and insatiable the thirst, the better is Arsenic indicated. The sweating stage may be altogether wanting; or the perspiration may be very copious ; it breaks out generally several hours after the end of the hot stage, and lasts a long time.

"With the paroxysms are associated many distressing accessory symptoms, which are con- nected, some with the disturbances in the ner- vous system, some with those of the vascular system, e. g., spasms, pains, delirium, paralyses,

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and the anguish and restlessness that are so characteristic of Arsenic.

"The apyrexia is not pure, but is disturbed by symptoms of the most various kinds; restlessness, sleeplessness, spasms, digestive disorders, feeling of weakness and general prostration ; and it is espe- cially characteristic for Arsenic, that, after every paroxysm, there is a notable increase of pros- tration."

Much of what has been said will serve to point out the indications for Arsenic in continued fever as well as in intermittent. A careful analysis of the symptoms of Arsenic shows them to be a mixture of prostration and of destruction in the vegetative system, with erethism and excitement in the animal system and In the circulation. In this respect it is related to Rhus toxicodendron, being more active and more penetrating in each respect than Rhus. As representing torpor and collapse without erethism, we have already (following Wurmb) mentioned Phosphoric acid as the less powerful and Carbo vegetabills as the more power- ful drug, — correlatives respectively of Rhus toxico- dendron and Arsenic.

Wurmb thus describes the typhoid fever in which Arsenic Is indicated :

"The patients are very restless and anxious, and generally so weak that they move only the hands, feet and head, and not the trunk ; and hence do not voluntarily change their posture in bed. The pulse Is very frequent, small and irregular;

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the temperature greatly elevated, the cheeks burn- ing hot and red, the thirst insatiable. With these symptoms of excitement those of decomposition of the blood hold equal pace, as is shown by the exanthema and ecchymoses, the often profuse haemorrhages from various organs, the character of the blood thus excreted, and the destruction of the tissues in the parts on which the patient lies.

"The sensorial functions are withdrawn from the influence of the will ; the delirium is always full of anguish and distress, and is sometimes violent, but more frequently is muttering. There are sudden startings and jerkings of muscles in the face and trunk.

"The patients often perceive nothing, and com- plain of nothing; the excretions pass involuntarily, but the urine is frequently retained, and the bladder is often so distended as to threaten a rupture, which indeed really takes place if the urine be not drawn off The lips and tongue are dry, the latter often hard and either clean and dark red, or else thickly coated, the coat being a dark-brown fur, which also covers lips and teeth ; speech is often impossible.

ARSENICUM ALBUM. 207

The indications for Arsenic in neuralgia, in affections of the eyes and teeth, must be drawn from the character of the pain and from the gen- eral symptoms. In cholera morbus, in diarrhoea, and in malignant dysentery, it may be indicated, as the symptoms, both general and local, already described, clearly show.

HYDRARGYRUM.

HYDRARGYRUM. 2O9

erties and uses of Mercury should be carefully and fully treated.

Mercury has been and is used in various forms :

Mercurius vivus of Hahnemann, prepared for

use by homceopathicians, by triturating Hydrargy- rum with Milk Sugar, according to the rules of the Homoeopathic Pharmacy, until the required attenu- ation is reached.

. dered liquorice root i oz.

Then there are combinations of metallic Mer- cury with fats, for external use.

Mercury 2 lbs., lard 23 oz., suet i oz.

5. Black oxide, protoxide ; the precipitate in black wash.

Red deutoxide. Red precipitate, used chiefly in the red precipitate ointment.

7. Black sulphuret, or Ethiop's mineral.

8. Red sulphuret, bisulphuret; cinnabar.

2IO HYDRARGYRUM.

Its English name, calomel, which signifies "beautiful black," is said to have been given it by Sir Theodore Mayerne, in compliment to a negro who assisted him in preparing it.

The officinal compound cathartic pill contains calomel, with compound extract of colocynth, ex- tract jalap and gamboge.

Ammonio- chloride of Mercury. White precipitate, precipitated by ammonia from a solution of corrosive sublimate.

Soluble Mercury of Hahnemann.

Three parts of pure quicksilver are treated with four parts of concentrated nitric acid until about two parts of the quicksilver are dissolved. To the hot solution are then added twelve parts of dis- tilled water; it is filtered, and to it is added a mixture of one and a half parts of strong aqua ammonia, sp. gr. .95, and eight parts of distilled water. A black precipitate is formed, which is the soluble Mercury of Hahnemann.

HYDRARGYRUM. 211

It is a tasteless, black powder, volatile in heat

Hahnemann's excellent proving of Mercury was made chiefly with this preparation.

In treating of the action of Mercury on the organism, I propose to follow Hahnemann's proving of mercurlus solubilis ; speaking afterward of dif- ferences in the action of other preparations.

GENERAL ANALYSIS.

But, in considering the action of Mercury on the vital force, we distinguish at once that its action on the sensorium, on the nerves of animal life, is subordinate to that on the nerves of vege-

212 HYDRARGYRUM.

tation. Here is a distinction at once between Mercury and the narcotics or cerebrants.

HYDRARGYRUM. 213

In cats that had been rubbed with Mercurial ointment, CEsterlen found globules of Mercury in the pancreas, liver, spleen, lungs, heart, mesenteric glands, kidneys, etc., and also in the bile, milk, urine and saliva. Van Hasselt has proved that metallic Mercury itself, and not merely the oxide, is absorbed.

It is notorious that nurses and internes in hos- pital wards become salivated from inhaling the mercurial atmosphere of these wards. (Colson, in "La Pitie," 1821-24; and Goulard, Van Swieten, "Comments," 1726.)

In 1 8 10, Briickmann published an account of a lady who, a year after being salivated, having become violently heated by dancing, had dark stains appear upon her breast, and metallic Mer- cury was found upon her linen. Here a year had elapsed since she had taken Mercury.

Jourda gathered a quantity of metallic Mercury from the urine of a syphilitic patient who was taking Mercury.

Elk and Buchner found it in the blood of a person who had been salivated. Colson found that a brass plate, which had lain for some time in the blood of a person treated by Mercury, became

2 1 4 HYDRARGYRUM.

In this connection Melseus reminds us it would be improper to overlook the fact, that when Mer- cury has been taken so as to produce its constitu- tional effects, and these have entirely disappeared, they may long afterward be re- excited by the action of medicines, which, becoming decomposed in the system, form soluble compounds with Mer- ^cury. One of these is the iodide of potassium. Therefore, iodide of potassium has been recom- mended as a cure for symptoms which depend on Mercury retained in the economy (Melseus), and it is held by many that iodide of potassium is useful only in those cases of constitutional syphilis in which the body has been impregnated with Mercury; the action of which it certainly has the power of re-awakening.

These facts show the permanence of the action of Mercury ; how it makes itself at home in the organism and ''will not out."

A few more facts may be cited to show its diffusibility, and its penetrability into the tissue.

A quantity of metallic Mercury escaped from the bags, in which it was being conveyed, into the hold of a vessel. Not only were all the

HYDRARGYRUM. 215

vermin on board killed, but the crew were all salivated.

The chronic diseases, and especially the mercu- rial trembling, produced on gilders, are well known.

I cannot forbear interrupting the methodical treatment of this subject to call attention to the facts that :

2. Mercury acts energetically on the system when presented to it in inconceivably small quan- tities, in a most attenuated form.

2l6 HYDRARGYRUM.

When all these things are duly weighed, is it not amazing that physicians who testify to and accept all these marvelous facts, will accord neither merit nor credence to homoeopathicians, who divide the drug very minutely, in order that it may easily penetrate the tissues ; and who give exceedingly small doses, even smaller than those given by Bou- chut, through the intervention of the nurse.

Peculiarities, It may be mentioned as a peculiarity of Mercury, that the symptoms are

HYDRARGYRUM. 21 7

aggravated just after getting warm in bed, and that they are attended by a disposition to sweat.

Periodicity is not strongly marked in the action of Mercury, though saHvation has been known to recur regularly at certain seasons for years. (Stille.)

The first appreciable effect of a moderate dose of Mercury is an increased activity of the secre- tions, particularly of the intestinal canal ; the discharge becoming liquid and bilious. The mucous membrane of the respiratory apparatus, and some- times also of the urino-genital, displays a similarly augmented secretion. Then the appetite fails, digestion is irnpaired, the secretions become still thinner and more copious, the firmness of the tissues diminishes, recently healed wounds open afresh ; the muscles waste, the skin becomes earthy-pale, the eyelids and ankles become oedema- tous, and even general dropsy may ensue.

These symptoms seem to depend on a radical change which the blood has undergone by losing a large proportion of its normal, solid constituents, and perhaps a portion of that vitality on which its coagulability in part depends. The unwonted fluidity of the blood predisposes to haemorrhages, which may become dangerous.

2 1 8 HYDRARGYRUM.

The salivary glands become swollen and tender, the saliva is increased in quantity, it is ropy, alkaline, and has a penetrating taste and smell. The daily discharge sometimes amounts to several pints. In bad cases it is very distressing. The mouth and tongue swell, the patient cannot speak or eat; extensive ulcers, sometimes coated with false membrane, appear on the gums, cheeks and fauces; and in healing, these sometimes cause adhesions of adjacent parts ; oedema glottidis may occur, the breath is horribly fetid, the teeth loosen and fall out; and caries attacks the residue and the maxillae.

The digestive apparatus is affected, appetite impaired, tongue coated; there is nausea, with oppression, and sometimes pain and tenderness at the epigastrium ; the bowels are loose, and the stools often contain blood. QEsterlen found metallic Mercury in the intestine of a person who had used the medicine only by inunction.

It used to be thought to increase the discharge

HYDRARGYRUM. 2ig

of bile, though how it does so is disputed. But it does not.

It produces great depression, great sensibility to cold, pain in the limbs, irritability.

It causes menorrhagia.

It causes albuminuria (and cures it).

220 HYDRARGYRUM.

(not full nor hard), tongue coated, great tendency to perspire, skin very sensitive to cold, often relieved by salivation.

Mercury produces a skin affection, which may be a rash, closely resembling measles; or a miliary eruption, or an erysipelatous inflammation, or a gangrene.

Ulcers appear on the gums, on the inside of the cheeks, and on the tongue, attended with salivation. These ulcers usually advance from within outward, raising and then casting off the epithelium, and exposing a red, irritable surface, which secretes an acrid fluid. They are irregular in shape, without defined edges; they bleed readily, have a dirty, whitish surface, are surrounded with a dark halo, and are apt to run together.

Let me call attention to the difference between these and syphilitic ulcers of this membrane. The latter are "circular, attack the posterior parts of the mouth, have well-defined edges; the surround- ing membrane has a coppery hue, and they do not extend from their primary seat." I may remark that these ulcers find their remedy more often in Nitric acid than in Mercury.

Haemorrhage may occur from these mercurial ulcers, or they may prove fatal by gangrene.

The destructive action of mercury on the glands (lymphatic) is unquestionable. Ulceration of both the inguinal and axillary glands occurs.

The bones are the seat of destructive inflam- mation. Periosteal nodes appear, which ulcerate,

HYDRARGYRUM. 221

and then ulceration progresses from without inward into the bone. Canstatt says "it is most frequent in the spongy bones at the base of the cranium, and in the ends of the long bones."

To these details of the general action of Mer- cury on the human organism I shall append the finer and more exact data which resulted from Hahnemann's proving on the healthy subject:

Further, there is a general itching about the joints and over the body in the evening and at night.

Jaundice ; the perspiration stains the linen yellow.

Great disposition to perspire on slight exercise.

As a general thing the symptoms are aggra- vated in the evening, and during repose, when lying or sitting. Great restlessness in the limbs in the evening ; cannot remain anywhere quiet nor in any position ; must constantly change posture.

Great weakness and prostration, yet orgasm of the blood ; erethism.

222 HYDRARGYRUM.

The disposition is restless, anxious, irritable, and yet despondent.

Vertigo with nausea, distracted thoughts, moment- ary loss of vision.

Tearing, burning in the temples; semi-lateral tearing in the head at night, as if the head would burst, along with soreness and a tired aching in the nape of the neck. Sensation as if the head were bound around with a hoop.

HYDRARGYRUM.

low scabs in the face, which bleed when scratched. Swelling of the submaxillary and cervical glands.

Toothache, tearing at night, excited by cold air, by eating, and by both cold and warm drinks. Worst in the evening and at night; intolerable when warm in the bed.

Canine hunger. Aversion to food.

Insatiable, burning thirst.

Flat, putrid or metallic taste.

Nausea, with sweetish taste.

Weak digestion, with constant hunger, oppres- sion of the stomach, and feeling as if the stomach were dragged down after each meal.

Inflammation and hardening of the liver, with stitching pains.

Abdomen distended, with soreness; cutting and pinching pains.

224 HYDRARGYRUM.

acrid, of bloody mucus. Sour-smelling, green, acrid stools.

Prolapsus ani, when straining at stool and after stool.

Frequent, rapid urination, with scanty discharge, often followed by discharge of mucus. Urine dark red, offensive, or it may be very abundant and light.

Menses too copious, with anxiety and abdominal cramps. Leucorrhoea purulent and acrid.

Violent fluent coryza, with an acrid watery discharge, making the nose and lip red, and very sore.

Dyspnoea on rapid motion.

Dry fatiguing cough — as if the head and chest would burst — from tickling in the larynx. Hemop- tysis.

Burning in the chest ; palpitation.

Secretion of the mammary gland repulsive to the infant.

The warmth of the bed increases all the symp- toms until they become intolerable.

The practical applications of Mercury are very diverse.

HYDRARGYRUM. 225

PRACTICAL APPLICATION.

The discussion of the practical application of any remedy in the treatment of diseased persons should always be opened by the reminder that each diseased state is to be regarded as a new case, distinct from all others, and different from every other ; and that a remedy must be selected for it in accordance with the similarity which the symptoms produced by the remedy in the healthy subject bear to the symptoms of the sick person for whom it is selected. This cannot be too often repeated, nor too strongly insisted on.

This being premised, I may call attention to a few cases in which Mercurius is more especially likely to be required and useful.

And first, of general diseases.

That in which Mercury was first employed, and in the treatment of which it has acquired the dignity of a specific, is syphilis.

Touching this disease I desire to say, that in so far as my experience in the treatment of it is concerned, I have not found it less amenable to treatment than other constitutional maladies. The patient, otherwise in vigorous health, who presents himself for treatment, without having previously saturated his system with, drugs, and without hav- ing undertaken to eradicate the morbific poison by caustic applications to its primary local manifesta- tion, the chancre — such a patient, if Mercury be

226 HYDRARGYRUM.

indicated by his symptoms, will be cured as readily and by as small doses as though his disease were something of a totally different character. (A prejudice to the contrary exists.) And my profes- sional experience satisfies me, that in these, as in other cases, the high potencies, and infrequent doses, produce a more speedy and a more effectual cure than low potencies and frequent doses do. But inasmuch as I do not regard the chancre as the "fons et origo mali," but rather as the blossom and product of a constitutional infection which already pervades the system, I am not in so great haste as some are to destroy the chancre, well satisfied if, under internal treatment, I perceive it gradually heal by healthy granulations, no other symptoms meanwhile appearing.

Above all, I dread the local treatment by caustic, the much-vaunted method of Ricord. For observation has satisfied me that even a majority of his patients, discharged as cured through the local cauterization, present, after the lapse of from one to eight weeks, all the signs of secondary syphilis, and become candidates for, and victims of, the ''constitutional treatment."

It is not every case, however, of so-called chancre, for which Mercury is indicated.

That which is now denominated chancroid, and which, being a shallow and flat-bottomed ulcera- tion, shows a disposition to spread irregularly and indefinitely, having never well-defined outlines nor a lardaceous bottom ; but exuding a thin, serous discharge, and which is probably not at all

HYDRARGYRUM. 227

syphilitic in its origin, does not call for Mercury, and is not benefited by it ; indeed is rather aggra- vated. I have found the totality of the symptoms to indicate Nux vomica more frequently than any other drug, and under this a speedy cure to follow.

The form of chancre in which Mercurius is indicated is the regular indurated Hunterian chan- cre, with the lardaceous base.

In continued or remittent fevers, particularly those which are complicated with enlargement or sub-acute inflammation of the liver, Mercurius may be indicated by the symptoms.

The peculiar headache of Mercurius — dullness in the forehead, stitches through the temples, a band around the head, and aching and weariness in the posterior cervical muscles, from the occipital ridge downward — is often found conjoined with gastric symptoms and a state of the tongue which clearly call for Mercury.

A catarrhal or superficial otitis often exists, which is promptly relieved by Chamomilla or Pul- satilla, according as the characteristic indications for one or the other may be present. But there is another form, in which the inflammation is deeper seated, affecting the sub-mucous and sub-cutaneous cellular tissue, extending to the parotid gland, which becomes swollen and tender, and accompanied by throbbing pain, worse at night on getting warm in bed; accompanied, too, by the tongue and gastric symptoms peculiar to Mercury ; in which Mercury is the proper remedy.

2 28 HYDRARGYRUM.

The stomatitis has been described.

I may mention that qualmishness and a peculiar sense of weakness and tenderness at the pit of the stomach, are very characteristic symptoms of Mercury.

To be distinguished, however, from Calcarea carbonica, which has soreness and intolerance of pressure from the hand or by clothing ; and from Sepia and Murex purpurea, which have a " sink- ing," an " all-gone feeling," and a faintness and die-away sensation at the pit of the stomach.

The stool of Mercury is a symptom of great importance.

In large doses, Calomel produces copious semi- fluid, pasty evacuations of dark green or greenish brown faeces, with great weakness and prostration at the epigastrium, griping and soreness in the abdo- men, moderate tenesmus and burning in the rectum,

HYDRARGYRUM. 229

with exhaustion after the evacuation. If the administration be continued, the discharges become frequent but small in quantity ; consist of mucus and blood mixed together, and often containing shreddy substance, like strips of mucous membrane; and are attended by tenesmus, which is not relieved by the evacuation of stool, but continues almost without interruption ; also with burning and sore- ness in the rectum and anus, as if the secretions were acrid.

This describes a form of dysentery of which every year furnishes examples in practice. The chief point is to distinguish such cases from those which correspond better to Nux vomica or Podo- phyllum or Sulphur than to Mercurius.

Under Mercurius the desire for stool is not relieved by the evacuation ; the patient would gladly sit and strain for an indefinite period. Under Nux vomica the tenesmus is relieved by stool ; and the patient enjoys a respite from suf- fering.

Under Sulphur, likewise, the tenesmus is relieved by stool, and the Sulphur stools have the peculiarity that the blood is not uniformly mixed through the mucus, but occurs in thready streaks.

It is needless, I hope, to remark that to those who are capable of looking at the entire condition of the patient, and of keeping their attention from being engrossed by the one group of symptoms made prominent by the patient's complaints, the general symptoms furnish an unfailing guide. For

230 HYDRARGYRUM.

excellent distinctions between remedies for dysen- tery, I refer to Dr. Wells's articles in the "American Homoeopathic Review," iii.

Proto iodatus. Throat symptoms.

Tongue thickly coated, yellowish white at the back part, the front and edges being clean and red.

Empty deglutition ; is painful. Desire to swal- low; sense as of a lump in the throat.

Posterior wall of the pharynx red and irritated, and dotted with patches of mucus and spots which look ulcerated.

CUCUMIS COLOCYNTHIS.

SQUIRTING cucumber: BITTER APPLE.

WE use in medicine the pulp of the fruit, an exceedingly bitter and nauseous production.

It was known to the early Greeks, and a great regard for its medicinal virtues is expressed by all the ancient writers. Among moderns it has fallen into disuse and some discredit, except as an ingre- dient of the officinal and other compound cathartic pills.

It was classed as a drastic or as a hydragogue cathartic along with scammony and gamboge. And in modern times, under the sway of the physiological school, which denied to drugs the possession of any individual specific properties peculiar to each, according them only certain gen- eral properties which were common to them and other members of a group, it was thought that for Colocynth might be advantageously substituted some less powerful, perhaps, and less distressing, purgative. But we shall see that Colocynth has certain properties which no other drug possesses.

I may remark, in passing, that it seems remark- able that physicians who dreaded the too powerful

232 CUCUMIS COLOCYNTHIS.

But what a discovery was that of Hahnemann, so laughably simple, yet so unsuspected, that the too powerful action of a drug may be moderated by just diminishing the dose, and by going on to diminish it until the dose acts as gently as you wish.

Another Columbus with another ^^^ !

The action of Colocynth in large doses is shown forth by the following cases :

CUCUMIS COLOCYNTHIS. 233

Scarcely had she swallowed this, when she was seized with fearful pains in the region of the stomach, great anxiety, vertigo, faintness and cramps. She vomited several times without relief; then evacuated copious stools, at first watery and feculent, then consisting of pure blood, with dis- tressing tenesmus ; along with these came large pieces of the inner membrane of the intestine. The pain then concentrated in the stomach and in the lower part of the rectum; the abdomen became collapsed ; at last the tenesmus ceased, and the patient gradually fell asleep. Great exhaustion fol- lowed, but she finally recovered."

Hahnemann and six of his pupils proved Colo- cynth, but the result was quite meagre. It was reserved for the Austrian Proving Society to show us a full picture of the pathogenesis of this drug.

These provings, viewed collectively, show us, what indeed we knew before, that the effect of Colocynth upon the alimentary canal is immediate and profound, that it produces vomiting and purg- ing of watery matters, and then of mucus and blood ; great flatulent distention of the abdomen ;

234 CUCUMIS COLOCYNTHIS.

and cruel, griping, flatulent colic. They give finer shades of delineation, however, than cases of poi- soning could.

SPECIAL ANALYSIS.

upon the mind Colocynth exerts no deep action. It produces impatience, vexation, excitement, fol- lowed of course by prostration and dejection.

Sensorium. Dullness of the head, vertigo, con- fusion.

Violent headache, as if brought on by exposure to a current of air. Aching pain along the sagit- tal suture, increased by exercise and by stooping.

CUCUMIS COLOCYNTHIS. 235

changes to lancinations, the same being felt simul- taneously in the left shoulder.

Colic and diarrhoea after taking the least nour- ishment.

Flying pains in the hepatic region.

Constricting pain in the centre of the abdomen, recurring at short intervals, and passing into a sharp griping.

Griping in the abdomen, especially about the umbilicus, like a cutting or squeezing; relieved by bending forward or on evacuating the bowels.

Pain in the whole abdomen, as if the bowels were squeezed between stones.

Rumbling and commotion in the hypogastrium.

The colic comes on every fifteen or twenty minutes, and is relieved by pressure and by bend- ing forward.

Diarrhoea, with nausea. Stool semi-liquid, brownish yellow, retained with difficulty; preceded

236 CUCUMIS COLOCYNTHIS.

Abundant urine. Frequent desire to pass water, with burning in the bladder and stitches in the bladder; alternating with stitches in the rectum.

Menses early and more abundant.

Under Dr. Frohlich, Colocynth was proved by two young women, who both experienced, beside the symptoms of the abdomen and bowels, deep stitches in the ovaries on both sides, but worse on the left.

The respiratory organs are not markedly affected.

(It is to be remarked that with all these symp- toms there is no fever, no sensitiveness, no heat; motion generally relieves.)

Drawing and paralytic pain in the arms.

The lower limbs are weak and heavy.

CUCUMIS COLOCYNTHIS. 237

Tension in the right groin. Pressure at the left sacro-ihac articulation, with tingling at the sole of the foot.

Only during motion pain in the right thigh, as if the psoas muscle were too short ; better on ceasing to walk; recurring on moving again.

Cramp-like drawing in the internal femoral region. Stiffness of the knee, as if bound around with a cord.

Tearing, drawing and pressure throughout the limb.

Dr. Watzke of Vienna says :

"The hemicraniae and prosopalgiae which Col- ocynth will cure, are, in all cases, purely functional derangements of the filaments of the trifacial nerve.

"In the prosopalgiae of Colocynth there are no twitchings of the muscles, nor any palsied feelings in the affected side ; the pain follows the course of the nerve, is periodical, and accompanied by toothache." Colocynth is related to Belladonna, Capsicum and Verbascum.

Colocynth is adapted to what Romberg describes as neuralgia hypogastrica, and which is often de- scribed and regarded in women as menstrual colic;

238 CUCUMIS COLOCYNTHIS.

and in men as haemorrhoidal colic; attended by pains and aching in the thighs.

" The intestinal affection indicating Colocynth is hardly inflammatory (and yet the autopsy shows

it)."

''The ischialgiae are not due to strumous dia- thesis or to organic changes."

And yet unless many skillful physicians have been greatly deceived, Colocynth has arrested and cured, in its early stages, morbus coxarius.

It is not easy nor safe to undertake to distin- guish, in early stages, functional and organic affec- tions, and to set apart remedies for the one and for the other on pathological grounds. Experience gives the lie to our hypothesis.

The presumptive action of Colocynth on the ova- ries deserves attention and experimental research.