Arsenicum Album

[oxide of arsenic, white oxide of arsenic, arsenious acid.]

Metallic arsenic combines naturally with oxygen and sulphur. "We have two natural compounds of arsenic with oxygen, viz., arsenious acid and arsenic acid ; the former is the preparation of arsenic in common use among physicians of our school ; the latter is met with in combination with bases, such as arseniate of silver, soda, iron, lime, etc. Orpiment and realgar are the compounds of arsenic with sulphur. Both are used in the arts and were well known to the ancients.

Pereira gives an accurate description of the process of obtaining

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arsenious acid on a large scale from arsenical iron. This process is resorted to at Altenburg, in Silesia, where this ore is obtained. It consists of a series of very simple operations :

2. Boasting this powdered ore in a muffled furnace.

The glassy mass thus collected on the sides of the iron vessels in which the refining process is conducted, is termed white arsenic glass, weisses arsenih-glass ; this is sometimes purified by a second and even a third sublimation.

In some parts of Saxony, arsenic is obtained as a secondary product in the roasting of cobalt ores, arseniurets of cobalt. It is deposited in long horizontal flues, so-called poison flues (Giftfangen), and is purified by sublimation.

Arsenious acid is also manufactured in Cornwall, from the white mundic or mispichel found with the tin-ore. Mispickel is the name which the German miners give to arsenical iron.

Arsenious acid occurs both in the shape of regular crystals and in an amorphous condition. The crystals are either octohedrons or tetrahedrons. In the amorphous condition, arsenious acid occurs in large, glassy, colorless or yellowish, transparent cakes [vitreous or glacial arsenious acid). These masses soon lose their transparency, the opacity gradually extending towards the contre ; in some cases, the acid becomes friable and pulverulent.

Krueger ascribes this change to the absorption of water, from the atmosphere ; he says that such a change only takes place in moist air, and that the weight of the arsenious mass increases in consequence of this transformation. Pereira mentions a fact which seems to confirm this theory ; he had arsenious acid enclosed in a glass tube, hermetically sealed without its transparency being affected in the least ; the tube was subse- quently cracked, and the acid soon became opaque.

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of such treatment would inevitably be to cause the solution of the poison and to increase its virulence to a fatal degree of intensity.

Arsenious acid is also soluble in alcohol. An alcoholic solution of this acid is used by some homoeopathic practitioners.

A description of the characteristic of arsenious acid in its different forms, solid, pure, liquid, and in organic mixtures, belongs to the domain of toxicology. The solid acid is distinguished

Heated on the point of a pen-knife in the flame of a spirit lamp, arsenious acid produces a white smoke which speedily disappears.

If arsenious acid be burnt on red-hot charcoal placed in a saucer, metallic arsenic is evolved in the form of vapor, having a garlic odor. At the distance of an inch or two from the embers this scarcely-perceptible vapor is converted into a dense, white, odorless smoke.

The garlic odor is not peculiar to arsenic ; for Orfila has shown that a compound of albumen and fat exhales this odor when heated.

If arsenious acid be mixed with recently-ignited charcoal that has, however, been allowed to cool and to which some carbonate of soda may be added ; and if this mixture be heated in the bulb of one of Berzelius' reduction tubes, the deoxidized acid is sublimated, and the condensed vapor is deposited in a cooler portion of the tube in the shape of a crust which is metallic arsenic and is distinguishable by its brilliancy externally, by its crystalline appearance and grayish-white color within, by its vola- tility and by the results it yields when treated with the various and well-known tests for arsenic. These tests are described in works on chemistry.

For homoeopathic purposes we never use the so-called flowers of arsenic to which allusion has been made previously, for they are fre- quently found adulterated by admixture with other substances ; we use the solid arsenic, of which we make triturations in the proportion of one to ninety-nine, or one to ten.

Arsenic, as a medicine, is mentioned by Hippocrates, Dioscorides, (who first uses the term " arsenikon," ) Plinius, Celsus and others. Arabian physicians understood its value in the treatment of the itch,

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putrid ulcers, ulcerous lepra, asthma, etc.; using it in shape of an ointment and by inhalation of its vapor.

The introduction of arsenic into the recognized materia medica was bitterly opposed by many eminent men, among whom special mention may be made of Stoerk, Dierbach and Hufeland. We can hardly experience surprise at this opposition, when we remember that these men were thoroughly acquainted with the far-reaching power of the poison, while they could not conceive the therapeutic value of a dose sufficiently small to avoid the development of toxical effects ; or, in other words, when they had not learned the all-important fact that the curative power of a certain dose of ?nedicine does not depend upon its power to produce pathogenetic symptoms when taken in the same dose. The fact, for instance, that aconite12 or 30, may fail to produce health-disturbing or pathogenetic effects, if introduced into the healthy organism, is by no means a proof that the same attenua- tion of the same drug may not exert the most positive curative action, when the human system presents a group of pathological con- ditions, to which aconite is homoeopathic. Have we a right to wonder at this short-sightedness of members of the physiological school, though a Dierbach or an Hufeland, when this all-important fact fails to be recognized, even at the present time, by many prac- titioners of our own school ?

In a legal point of view, it is important to know how small a dose may produce poisonous effects, and how long a period of time may elapse before the poison manifests its deleterious effects.

In regard to the first point, there are many facts going to show that a very small dose is sometimes sufficient to produce poisonous symptoms and even to destroy life. Fodere has seen a case where half a grain of arsenious acid caused violent griping pains in the stomach, colic and dysentery ; these symptoms continued until the

VOL. I. — 28.

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applied to a scarified tumor of the breast, the first symptoms of poisoning were not perceived until about ten hours after the applica- tion of the drug. In this case the poison acted by absorption.

Arsenic exercises its poisonous effects not only on man, but like- wise on plants. Jaeger, whose experiments are communicated in an inaugural thesis published at Tubingen in 1808, states that seeds which have been soaked for some time in arsenious acid are incapable of germinating, and that buds which have been plunged in it, are no longer capable of expanding.

Ohatin poured upon the denuded roots of a plant a few quarts of a watery solution of arsenic ; in a few days, the plant turned yellow from below upward. If only a small quantity of the solution was used, or if the plant, after the first symptoms of poisoning had made their appearance, was transplanted into fresh soil it soon recovered its health. The application of warmth likewise affected the restora- tion of the plant. A chemical analysis of the different parts of the plant showed that the poison had been absorbed, but that it was not uniformly distributed through every part of the plant.

According to Jaeger's experiments, infusoria are destroyed in an arsenical solution. The extensive investigations of this experimenter show that all animals are liable to the poisonous action of arsenic. In all of them it convulses the stomach and irritates the mucous lining of the intestines, causing vomiting and increased alvine evacu- ations. The power of voluntary motion, with the irritability of the muscular fibre, is destroyed by arsenic ; after the death of the ani- mals which Jaeger experimented upon wTith arsenic, the muscles soon ceased to be influenced by the galvanic battery.

In animals which breathe by lungs, respiration became difficult and laborious ; and in warm-blooded animals great thirst was experienced.

It is well to note these effects of arsenic upon the respiratory system and upon the mucous lining of the alimentary canal, as we shall afterward see that in diseases of the organs of respiration and digestion arsenic constitutes one of our main remedies.

It appears that horses can bear enormous quantities of arsenious acid without any injurious effects. Pereira states that Berthe, a French veterinary surgeon, gave two, and afterward three, drachms to a mare for the cure of an obstinate skin disease, without any injurious effects. It appears from experiments by Beissenhirz and Dalemonde that it takes from one to two ounces of arsenic dissolved in water to destroy a horse.

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On the subject of poisoning with arsenic, Hahnemann is recog- nized as an authority, even by old school physicians. He is frequently quoted by Christison, Taylor, Flandin and other toxicologists. In his essay on arsenic he quotes a host of medical writers, which makes this highly interesting volume one of the most valuable contributions to the vast domain of toxicology. In the November number, 1858, of the North American Journal of HomcBopathy, we find an abstract of the contents of this work, which we will transfer to our own pages with some slight modifications.

Hahnemann distinguishes three degrees of poisoning :

The first degree is, where a large quantity is taken under circum- stances favoring its full effect, viz., on an empty stomach or with heating liquors, in persons with irritable nerves and choleric temper- aments, subject to spasmodic and inflammatory affections, or shattered by anger, grief, jealousy or fear, overloaded with acrid bile or affected with chronic disease.

The poisoned person first experiences a cold shuddering which seems to pervade the whole body ; while an inexpressible anxiety, or nausea, which seems to oppress the chest as well as the stomach, a cold, deathlike sweat, and a general trembling of the limbs, alternate with one another in frequent paroxysms.

Second, the hands, feet and tip of the nose become cold ; blue circles form around the eyes, while the pulse gains in hardness and quickness.

Third, follow violent attempts at vomiting, which, although very forcible, are fruitless at first, and finally become almost ineffectual from spasmodic closure of the cardiac orifice, and emptiness of the stomach of everything but arsenic, which is tenaciously plastered on its walls. The patient complains of burning and tearing pains in his throat, oesophagus and stomach, and knows not what to do with himself.

Fourth, the arsenic continues to ravage and destroy the stomach without compelling it to full and relief -affording vomiting; it clings fast to the villi of the mucous membrane, and contracts it as boiling water would. The whole nervous system trembles and struggles.

Fifth, the fruitless retchings, the fever, the frightful chills, the anxiety, the internal heat and unquenchable thirst increase; the breathing becomes quicker and hotter, more spasmodic and violent; and the glistening eyes project from their sockets. The inexpressible anxiety, and the burning, rending and overpowering pain in the

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epigastrium, torture the patient more and more as they progressively increase.

Sixth, at first the abdomen is contracted ; afterward, when inflam- mation and irritation of the stomach, liver and spleen occur, it becomes hot and distended; the attempts at vomiting become irresist- ible and incessant; the panting and gasping lungs, the dry and parched tongue, the gaping mouth, seek refreshment from cool air and water. The stools and urine are suppressed; the substances ejected from the stomach have a disgusting smell and color, and may be mixed with blood. Cutting and griping pains in the bowels ensue, especially around the navel; the patient is beside himself, so that he neither hears nor sees correctly, while his expression is fright- fully anxious and fearful.

Seventh, we now see the evidences of the ascendancy of the cor- rosive destroyer, which persists in its internal ravages without check or mercy, in the livid, frothy lips, the swollen and trembling tongue, the. agonizing expression of the bloated face, the viscid sweat on the cold forehead, and the lead-colored circles around the staring eyes.

Eighth, the miserable sufferer no longer looks like himself, but seems a wretched and tortured stranger from another sphere; he screams frightfully, or whimpers despairingly in broken or angry words for help from agony, fire and death; then turns aud struggles violently.

Ninth, soon after this we see signs of loss of feeling and sensation; he becomes more quiet; his heart heaves less frequently; the vomit- ing ceases; his black parched lips tremble, his pulse becomes extinguished, and involuntary putrid stools of a most offensive smell and appearance occur.

Tenth, the pupils dilate; the death-rattle is heard in the throat of the dying and unconscious sufferer ; jerks and spasms convulse his stiffening limbs and his icy-cold face ; his stertorous breathing be- comes fearfully slower and slower, and finally, with a last spasmodic gasp, a ghastly corpse alone is left, the staring eyes and gaping mouth of which fill us with horror.

This graphic description of the effects of poisoning with a fatal dose of arsenic is so characteristic of an acute attack of Asiatic cholera, that we may already at this stage direct your attention to the extra- ordinary therapeutic powers of arsenic in this dreadful scourge.

In Hahnemann's second degree of poisoning with arsenic, life may persist for several days; this degree requires more than four grains to

454 ARSENICUM ALBUM.

produce it; it is most apt to occur in not very impressible, fully grown and not unhealthy persons, especially those who have much mucus in their stomach, or have taken food just before or with the arsenic, or have drank freely of simple diluent drinks, and have not been harassed with aggravating mental troubles. The phenomena of this degree are similar to those of the first degree, only they occur less rapidly, have various less violent episodes, and intercurrent re- missions. The cutting, gnawing and burning sensations of the first degree are more intermixed with twisting, aching, colicky, griping and gnawing pains ; the face swells more ; the abdomen is harder, and aphthous vesicles arise in the mouth.

This second degree is characterized by more frequent offensive and bloody discharges from the bowels, with gradually increasing gripings and less frequent vomitings. The strength of the patient fails more gradually, and his consciousness remains until the last, when convulsions may occur, and incessant hiccough which admits of no palliation or relief. This degree has peculiar agonies which are sometimes wanting in the first. As the pains are less severe and constant, there is more opportunity for the occurrence of remorse, despair, grief, contrition and other mental emotions which harass the soul.

The strange admixture of bodily pain and mental agony often finishes what the poison alone was too weak to accomplish, and the more stealthy approaches of death are aided by regret for the past and hopelessness for the future.

There is no toxical agent which is possessed of the power of plunging the mindjnto a state of hopeless despair in the same ex- traordinary degree as arsenic. You may therefore note the fact, even at this stage of our pathogenetic tableau, that arsenic may be employed with signal advantage in mental derangements of a religious character, characterized by apprehensions for one's future fate, with despair of salvation.

Hahnemann's third degree of poisoning with arsenic may arise from the second degree in consequence of insufficient treatment. In this degree the patient may remain alive, but a long-lasting chronic disorder may ensue. Remitting, but oft-recurring cramps occur in the limbs, but especially in the feet ; repeated paroxysms of fever set in, attended with colicky pains, spasmodic contraction of the abdo- men, intermingled with headache, heat and thirst. After one of these feverish attacks, in whjch both vomiting and diarrhoea are apt to recur, the whole remaining force of the poison is apt to be thrown

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upon the limbs ; tliey become paralyzed, or so much contracted that the patient cannot extend them, at least not the legs. If proper evacuations are neglected, the irregular attacks of fever occur more frequently, the pulse becomes intermittent, the eyes become dim or fixed and sallow, the mouth bitter, the headache and oppression of the heart and chest insupportable, and the contracted limbs are visited with burning, itching-neuralgic pains somewhat similar to those of gout, but not followed by alleviation of the other symptoms.

These. may be succeeded by a very violent attack of fever, and a miliary eruption over the whole body, the vesicles of which often be- come confluent and contain an exceedingly acrid fluid. At times the whole affection is terminated happily by one of those critical fevers and eruptions, but more frequently it is not, and the whole aggregate of sufferings is increased, because the remains of the un- antidoted or unremoved poison are still considerable. In the latter case, the contraction of the limbs is followed by absolute paralysis ; the gout-like pains still rage violently, but the eruption dries up and the skin peels off ; the surface remains tender for a long time ; the limbs, especially the feet, swell ; the irregular attacks of fever still recur, and are attended with stomachache and colic ; palpita- tions are not uncommon ; and opisthotonos, or the eclampsia of Sauvage, in which there is violent bending of the body backward, with convulsions and retention of consciousness may occur.

The patient may recover from this, but remain feeble, cachectic, with irregular febrile chills, oppression of the stomach from the slightest food or drink, or with attacks of vomiting directly after meals, bitter, unpleasant taste in the mouth, pains in the head, dryness of the skin and eyes, painful and irregular discharges from the bowels, restlessness, dejection of spirits, dropsical swellings, night-sweats, etc. All these symptoms point to the scaling off of eschars and con- sequent suppurating patches in the stomach or bowels.

If these corrosions were not very deep they may heal over and the patient may finally recover.

The third degree of poisoning exhibits the disorganizing powers of arsenic in a variety of forms. In this last degree of the arsenic dis- ease, when this agent acts as a slow poison, contaminating life in its inmost principles as it were, the functions of the nervous system are most unmercifully disturbed by the dire destroyer. Contractions and paralysis, fierce neuralgic pains, opisthotonic spasms, mark the presence of the poison ; deep-seated gastric derangements, such as

456 ARSENICUM ALBUM.

have been grouped by pathologists under the names of dyspepsia, gastralgia, colicodynia, chronic gastritis or gastro-enteritis, chronic diarrhoea and dysentery, are permanently entailed upon the organ- ism ; emaciation and an utter prostration of strength, chronic jaundice, dropsy, hypochondria, hectic fever, night-sweats, etc., are the constant companions of the miserable victim.

Hahnemann graphically sums up the effect of slow poisoning by arsenic as a gradual sinking of the powers of life, without any violent symptoms ; a nameless feeling of illness, failure of the strength, an aversion to food and drink, and all the other enjoyments of life.

According to Pereira, the symptoms of long-continued small doses of arsenic may be summed up as follows: disorder of the digestive functions characterized by flatulence, sensation of warmth, or actual pain in the stomach and bowels ; loss of appetite ; thirst, nausea and vomiting, purging, or at least a relaxed condition of the bowels, and griping ; furred tongue, with dryness and tightness of the mouth and throat, or with salivation. Quick, small and some- times irregular pulse ; oppressed respiration, with a dry cough.

The body wastes ; the stomach is often so irritable that no food can be retained in it. Headache, giddiness and want of sleep are frequently observed. The limbs become painful, feeble, trembling, subject to convulsions ; occasionally benumbed and ultimately paralyzed. An eruption makes its appearance upon the skin, and now and then the hair and nails fall off.

Swelling of the feet and face is not in- frequent ; and the patient gradually sinks, in some cases retaining his consciousness to the last, but at other times delirium and stupor supervening.

Of the acute forms of poisoning both Christison and Pereira dis- tinguish three varieties, of which Pereira furnishes the following description :

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diarrhoea which is sometimes blood}', by the tenesmus, and by the occasional heat and excoriation of the anus. There may be difficulty in passing water, with burning pain in the genital organ-. The urine is frequently diminished and sometimes suppressed. The pulse is quick, small, feeble and irregular; cold, clammy sweat; irregular action of the heart, giving rise to palpitation ; breathing short, laborious and often painful ; tongue dry and furred ; the membrane lining the air-passages feels hot and oftentimes painful.

Although the symptoms of gastro-enteritis predominate, yet we have symptoms of nervous disorder, sometimes in the form of tremblings and cramps of the limbs, or delirium, and even in the last stage, in- sensibility ; occasionally eruptions ; death in twenty -four hours.

From among numberless cases of this kind, we may select the following as illustrative of the irritating action of arsenic upon the intestinal mucous lining. The case is extracted from Frank's Phys- iological Magazine.

A man put two ounces of arsenic in his wife's soup. She took but little of it, as it tasted badly. Half an hour after, she was attacked with violent burning in the throat, and severe pains in the abdomen ; the evening and night were passed in great agony, with violent vomitings and burning thirst. She was left until the third day without medical advice, and was then found exceedingly exhausted, with blue circles around her eyes, her tongue and mouth dry and inflamed ; she had burning thirst, was excessively fearful, had pains and tremblings in all her limbs, tearing pains in the stomach and bowels, frequent attacks of ineffectual retching, violent paroxysms of vomiting and incessant diarrhoea ; the alvine discharges consisted of mucous and greenish substances.

She died on the sixth day. A post-mortem examination revealed the following symptoms : Tongue lined with a dirty, yellow coating; the anus gaped o^en and a greenish substance flowed from it ; the blood in every part of the body was black and fluid ; the peritoneum was reddened through- out its whole extent ; the inner surface of the stomach was almost black, and as if swollen and thickened ; the internal surface of the duodenum and upper part of the jejunum were dark-red. Portions of the larynx and oesophagus were almost black.

The stomach con- tained a yellowish-red fluid ; the small intestines a moderate quantity of a yellowish substance, and an unnaturally profuse secretion of yellowish intestinal mucus ; in the cavity of the pleura at least eight ounces of reddish water, and there was a spot on the pleura three inches in diameter, covered with a gelatinous recent false mem- brane, into which vessels had already commenced to project, although it was so loosely attached to the pleura that it could easily be removed.

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This case exhibits all the signs of a malignant form of gastro- enteritis, with tendency to gangrenous disorganization.

In the following two cases the narcotic action of the poison is strikingly manifest. The first of these two cases is reported by Christison ; the second is extracted from Rankin's Half-yearly Abstract:

A young woman was caught in the act of swallowing little frag- ments of arsenic, and it afterward appeared that she had been employed most of the day in literally cracking and chewing lumps of it. When the physician first saw her, the countenance expressed chagrin and melancholy, but not suffering. After being forced to drink, she vomited a good deal, but without uneasiness. Two hours afterward, her countenance was anxious, but she did not make any complaint, and very soon resumed her tranquility.

Five hours after the last portions of the poison was taken, she became drowsv, then remained perfectly quiet for four hours more, and at length, on trying to sit up in bed, complained of slight pain in the stomach, and expired without agony.

The second case is equally remarkable as far as the apparent absence of all signs of acute inflammation is concerned.

A heavy, stupid-looking girl had taken a teaspoon ful of white arsenic. The physician found her sitting in her chair, more asleep

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A number of interesting cases referable to this category are reported in Frank's Magazine ; one of them will suffice for an illus- tration :

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inflammation and swelling about the root of the tongue ; two of them were unable to speak or swallow, and in twenty-four hours were seized with trismus and convulsions of the whole body; in forty hours one of them was in an apoplectic state, breathing with difficulty, with general convulsions, lock-jaw, pale and repulsive face, pulse ninety and weak, when aroused, she complained of violent headache, with burning and pain in the throat; both the others became speechless and were unable to swallow ; with convulsive cramps of the body, locked jaws, frequent spasmodic smiling, bloating of the face, pulse one hundred and six and strong. The next day, two of them were attacked almost simultaneously with headache, followed by violent delirium and loss of consciousness; these symptoms were removed by cold affusions.

POST-MORTEM APPEARANCES.— Having given a full de- scription of the symptoms exhibited in cases of poisoning, we subjoin a description of the post-mortem appearances, which Pereira sums up in the following concise manner:

When arsenious acid kills by its narcotic operation, no morbid appearances are observable after death. The morbid appearances which are observed in cases of poisoning, may be arranged under the following heads:

The blood is some- times, though not invariably, fluid after death, and dark-colored; heart flabby; it is asserted that on its inner surface (particularly the columnge carneas and the valves) is observed redness, sometimes dif- fused, sometimes in the form of spots, which penetrate a line in depth into the substance of the heart. The pericardium usually contains serum.

In some cases inflammation and even gangrene of the genital organs ; the conjunctiva is sometimes very vascular, and cutaneous alterations are often observed; redness, extravasation of blood and effusion of serum are said to have been seen in the brain.

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Another remarkable property of arsenic is to convert bodies into adipocere, a sort of mummy-like substance : these emit a garlic odor characteristic of arsenic. Ohristison believes in this property ; others deny it.

In regard to the physiological action of arsenic, we may safely assert that there is hardly an organ in the body which does not per- ceive the action of arsenic, more or less. However, we may generalize this statement in a more specific manner by stating that the chief influence of this drug seems to bear upon the intestinal canal, the chylo-poietic organs, the heart and the nervous system ; also upon the lungs, skin, salivary glands, urinary and sexual organs, upon the ears and eyes.

CEPHALIC GROUP.

Dvll pains in the head, as from a cold, but with inability to collect one's thoughts, ill-humor ; heavy pain as if the brain were oppressed by a load, with buzzing in the ears ; this form of headache might likewise result from a cold, from some violent nervous or bilious derangement; throbbing headache, the beating being felt immedi- ately above the root of the nose, or in one side of the head ; tensive pain, or a painful tightness of the head, such as might result from rheumatic exposure, or from a derangement of the biliary secretions.

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of bile, and a most distressing dizziness or vertigo. If these head- aches should be traceable to a suppression of intermittent fever paroxysms with large doses of quinine, we may regard this circum- stance as an additional indication for arsenic.

In general we say that the arsenic hemicrania is depending upon deep-seated derangements of the biliary functions. The brain expe- riences the effects of this derangement; the liver, which is the instrument or organ by means of which the brain carries on the secretory functions of this important gland, may be comparatively free from pain.

DELIRIUM TREMENS.— Another distressing affection where arsenic exercises wonderful healing powers, is delirium tremens. If your patient looks sallow, livid, the skin feels dry, inclining to coldness, the pulse is small, irritated, irregular, and the patient requests you to remove the vermin that are crawling on his bed, or is troubled with ugly phantoms, dogs, cats, mice, and the like, you will find a chief remedy in arsenic.

There are cases of poisoning where arsenic has induced all the symptoms of intoxication.

In one case, reported by Christison, there was at first some vomit- ing, afterward little else but faintness, sickness at the stomach, a sullen expression, and a general appearance which led those around him to believe him intoxicated.

Add to these symptoms the peculiar weakness and irregularity of the pulse, and the visual phantasmata, and we have a tolerably accu- rate description of the arsenic delirium tremens.

From the symptoms which arsenic has developed in a few cases of poisoning, we have a right to infer that this agent may affect the brain fatally, through the intermediate agency of the ganglionic system. A case is reported in Rankin's Half- Yearly Abstract, strongly confirmatory of the specific relation of arsenic to the central nervous mass, the brain.

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Harriet T., aged nineteen, a robust and healthy girl, took, on Tuesday night, September 1st, about two ounces of fly-water, contain- ing two and a half grains of ai^enic. It rendered her restless during the night, producing wakefulness and slight pain in the stomach. Next morning she became sick and very thirsty and the tenderness and pain in the stomach had increased. In the course of the day the sickness became worse, she was repeatedly purged, her counte- nance looked pinched, and the extremities became cold.

On Wednes- day night she rallied and became more comfortable and cheerful, but was still thirsty. On Thursday morning she was worse, cold and drowsy, and she was sent to the London hospital ; her counte- nance was then pale and anxious, extremities cold and bedewed with a cold, clammy sweat ; pulse hardly perceptible, and she lay in a state of incipient coma. She then sank, and died in about thirty- six hours after the administration of the poison. The body was examined twenty-one hours after death, and from the appearances present, Dr.

Letheby was led to conclude that death resulted purely from coma, as neither the symptoms during life, nor the state of the stomach after death, would allow him to attribute it to the effects of gastro-enteritis.

A post-mortem examination showed that the brain was much congested, and the several ventricles filled with half-coagulated blood. The lungs looked natural; the heart was flabby and distended with dark, jelly-like blood ; hemorrhagic spots were seen on the endocardiac membrane, especially where it covers the auriculo- ventricular valves. The abdominal and pelvic viscera were con- gested; the stomach was pale and empty, and along the pylorus it had assumed a gamboge tint ; arsenic was found in its tissues.

This case is looked upon as proof that patients under the effects of a poisonous dose of arsenic, may die of coma. The case before us, if viewed as an aggregate of symptoms, may undoubtedly be looked upon as a case of

CEREBRAL APOPLEXY— Both the symptoms exhibited during the lifetime of the patient, and the post-mortem appearances justify this view of the case. There seems no doubt that the post-mortem changes in this case were the result of a direct or sympathetic action of arsenic upon the brain. The stomach in the present case was found pale and empty. May not the cerebral hemorrhage have been occasioned by the fact that the vascular life of the stomach had been destroyed by the poison?

The brain, in its capacity of supreme preserver of life and supreme distributer of the vital fluid among the different organs and tissues, each according to its measure, sends blood to the stomach, but the vessels refuse to receive and circulate this fluid, hence it returns to the brain, as it were, reacts upon the

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brain, causes plethora, coma, apoplexy, death. In a case of cerebral apoplexy I should not consider arsenic indicated, unless symptoms of severe gastric irritation had preceded the attack; symptoms justi- fying the belief that the nervous life of the stomach had become extinct previous to the symptoms of appoplexy setting in.

DROPSY OF THE BRAIN has been cured by the use of arsenic.

Some five years ago I was sent for in the night to see a boy aged about eight years, who had been sick with scarlatina under the care of an allceopathic physician. The messenger informed me that the child had done nicely until very recently. There had been a great deal of pain in the head while the rash was out, but two days previous the eruption had very suddenly disappeared and the medical attendant had left the child with assurances of its perfect safety. The headache having returned with increased violence, and profound stupor, with occasional twitching and jerking, having declared itself, the medical attendant had then as readily given the child up to die.

Upon examination of the case I found the following symptoms : " Pulse almost threadlike ; skin dry, but not very hot ; face anxious, almost deathly pale, hippocratic ; heat at the base of the brain ; moaning and rolling of the head in the pillow; lips dry and covered with brown, dirty, slimy matter; teeth covered with sordes ; urine suppressed ; cannot be roused ; the pupil of the eye responds but little to the light of a lamp ; abdomen hard and sunken ; respiration oppressed ; the skin of the body feels very dry.

The patient made a good recovery under the continued use of ars. alb.30, receiving a daily dose of sulphur30 after a week's treatment, during which time he had constantly improved.

NERVOUS GROUP.

Among the effects of arsenic upon the nervous system, one of the principal symptoms is debility, excessive prostration, fainting or syncope.

Many patients who have poisoned themselves with arsenic have scarcely experienced any other symptom than prostration.

A girl fourteen years of age, took about ninety grains of arsenious acid and died in five hours, having vomited once or twice; she com- plained of some little pain in the belly, and was affected towards the close with great faintness and weakness. The stomach and intestines were healthy.

A stout middle-aged man swallowed a large quantity of arsenic in fragments, and died in a few hours ; he experienced nothing but feebleness and great tendency to fainting. The stomach and intes- tines were not in the slightest degree affected during life, and no morbid appearance could be discovered in them after death.

ARSENICUM ALBUM. 4G5

We have historical proofs that arsenic produces a condition of the body resembling marasmus. We find the following case, reported by Renaut, in Orfila's General Toxicology:

Two chambermaids were living with the same master; one of them conceived such an inveterate jealousy against the other that she resolved on her destruction. She determined to use arsenic for this purpose, of which she put every day a small quantity into her broth. A few moments after dinner, the food and the poison were both vomited, before the latter had sufficient time to act upon the stomach so as to produce any serious accidents. Nevertheless, as the same thing was repeated every day for the space of six weeks, the stomach, in the end, acquired an excessive degree of sensibility ; she felt severe pains in the bowels, and wasted to an extreme degree of leanness ; a spitting of blood succeeded ; the general sensitiveness of the system increased to such a degree that a simple current of air was sufficient to produce spasms and convulsions.

At length, when her stomach could no longer bear anything, she went into the country where her health wras gradually restored. Another attempt at poisoning was afterward made upon her, which led to the discovery of the crime.

DYSPEPSIA. — We are sometimes called upon to prescribe for a form of dyspepsia which might likewise be designated as chronic gas tro -enteritis, and one of the most prominent symptoms of which is general emaciation. The stomach in such cases is very irritable ; the patient is unable to retain any food on his stomach; the bowels incline to be loose, with more or less frequent urging to stool; the pulse is feeble, accelerated, inclining to irregularity in the number of the beats; the skin may be dry and abnormally cool, although fever-flashes preceded by creeping chills or shiverings may trouble the patient. For such a group of symptoms arsenic is a main remedy.

VOL. I. — 29.

466 ARSENICUM ALBUM.

senilis, as certainly and thoroughly as arsenic. Hence we depend upon this agent as our main stay in this affection. In marasmus, or atrophy, of children, arsenic is likewise a principal curative agent. Children at the breast are liable to this affection.

They lose their appetite, they vomit up everything that is taken into the stomach; they dwindle down to mere skeletons, look old ; the skin assumes a sallow, dingy appearance, is dry as parchment ; slimy diarrhoea sets in, hec- tic fever with regular evening-exacerbations creeps along, the inside of the hands and the soles of the feet become burning hot while the rest of the body remains cold, the little patient gradually sinks into a soporous condition, the pulse becomes filiform and so rapid that it can no longer be counted, and death finally closes the scene.

In nervous consumption, patients often complain of weariness, aching and sore pains, and contractive rigidity of the joints. A case is reported in the first volume of Frank's Magazine, where the poisonous effects of arsenic continued for months, developing a con- dition of the system closely bordering upon nervous consumption.

ARSENICUM ALBUM. 40?

•

while, but on the first of November, about four months after the iirst attack, he was suddenly seized, without any perceptible cause, with shivering heat, increased thirst, headache at irregular periods, generally at night, emaciation, sinking of strength ; after more than ordinary exertions his feet felt weak, he complained of pains in the joints, trembling of the hands and weak eyes. The temperature of the skin was rather increased, the tongue clean, pulse accelerated, the region of the stomach painful to pressure, the muscles of the ex- tremities sensitive, the general functions of the reproductive system not materially impaired.

ATROPHY OF THE SPINAL MARROW The distressing

affection which is so well known under the name of atrophy of the spinal marrow, or dorsal consumption, likewise pertains in a measure to the therapeutic domain of arsenic. Pathologists distinguish three stages of this disease, the stages of irritation, that of paralysis, and lastly the stage where the symptoms of hectic fever are fully devel- oped. The symptoms which charactize these three stages respect- ively, indicate arsenic as one of the curative agents in this disease.

In the second stage, the symptoms of palsy become more apparent ; the urinary bladder is paralyzed ; the bowels are either bound in consequence of paralysis of the rectum, or else the feces pass off involuntarily. The emaciation increases, the functions of the special senses become impaired ; the sense of vision often becomes extinct.

In the third stage, the symptoms of hectic fever are fully estab- lished, with colliquative sweats, bedsores which speedily become gangrenous, complete paralysis of the lower extremities.

Arsenic may do much to retard its development and to mitigate the dreadful sufferings of the patient.

ATROPHIA MESERAICA— We may range in this category a disease to which children are liable, I mean atrophia meseraica, or mesenteric ganglionitis, mesenteric consumption.

468 ARSENICUM ALBUM.

In this disease the mesenteric glands seem to constitute the battle- ground where the vital forces and the forces of disease meet in tierce conflict. We might look upon the so-called infantile remittent fever as an acute form of mesenteric ganglionitis. In this tjnie form which, under suitable treatment, may run a course of from two to three weeks, the inflammation of the mesenteric glands is recog- nized by a stinging, sometimes colicky, evanescent pain deep in the abdominal cavity.

This pain is accompanied by fever, first slight chills toward evening, and afterwards heat, with circumscribed red- ness of the cheeks, irritated pulse, violent thirst, and comparatively clean tongue. In this acute form of the disease arsenic may have to be used in proportion as the symptoms of gastric derangement, the loss of appetite, diarrhoea, and the febrile symptoms become more fully established.

In the chronic form of mesenteric ganglionitis, arsenic is indicated by complete loss of appetite, tympanitic distention of the abdomen, alternate coustipation and diarrhoea, discharges of a frothy or yellow- ish substance looking like stirred eggs and excoriating the anus. The evacuations may vary in character, and may, in the same indi- vidual, assume a variety of forms. The muscles become flabby, the emaciation goes on increasingly, the eyes lose their brilliancy, they look dull, are surrounded with blue margins, the skin feels dry and cold, especially on the extremities, the pulse becomes small, filiform, empty. Here arsenic is in its place, even if the glands have already begun to suppurate and the signs of hectic fever are fully established.

TREMORS. — Among the other nervous affections to which arsenic is homoeopathic, we distinguish tremors or trembling of the limbs, when accompanied by signs of acute gastric irritation, or when suc- ceeding severe inflammation of the intestines.

MERCURIAL TREMORS, attended with salivation, sallow com- plexion, constipation, emaciation, night-sweats, loss of appetite.

CHOREA. — In chorea with tremors, twitchings, spasms and con- vulsions, arsenic should not be prescribed unless the accompanying constitutional symptoms, such as gastric irritations, loss of appetite, sallow complexion, dry and cold skin, irregular, irritated, feeble pulse, hypochondriac depression of spirits justify the use of this agent.

The curative virtues of arsenic in certain forms of chorea may be inferred from the following case of poisoning which occurred in England.

The family in which the fatal accident occurred, consisted of six

ARSENICUM ALBUM. 469

Upon analyzing the water from the well, it was found to contain four-tenths of a grain of arsenic to the pint.

The following day, February 19 th, the eldest son was better, and so was his uncle, who had only been there one day and was seized after taking tea in the house. The two daughters and the youngest son were now suffering. There was great restlessness, indisposition to answer questions, numbness of the lower extremities, whilst the arms were in continual motion in the air, as if picking at something above the head; the skin was hot, but not dry, and did not exhibit any discoloration; the tongue was dry and brown, and there was great thirst; the throat seemed dry, and the breathing was quick and audible, the pulse was very quick, 125 or 130, but not hard.

The girls did not complain of pain on pressing the abdomen, but the youngest son slightly moved when this was done, though he said it gave him no pain. They had all uncomfortable feelings which, they could not describe, but were at this time conscious.

470 ARSENICUM ALBUM.

recovered after having exhibited symptoms of a purely nervous char- acter. The workmen, with one exception, were not sufferers.

The post-mortem appearances are important, inasmuch as they illustrate the power of arsenic to induce inflammatory conditions in the respiratory organs, and in the intestinal mucous membrane.

CEKEBEAL EPILEPSY, when the parxoysms occur suddenly,

ARSENICUM ALBUM. ±71

without any premonitory signs, showing that the irritation was trans- mitted to the brain from some point in the peripheral nervous system, arsenic may likewise be useful. If the paroxysms depend upon, or are accompanied by, cerebral disorganizations, suppuration, exostosis, adhesions of meningeal membranes, etc., no curative treatment can be instituted ; all we can expect to do is, to palliate the symptoms, for •which purpose arsenic may prove useful.

Ganglionic epilepsy is a curable disease, and is fortunately the most common form of this distressing malady.

PAEALYSIS is curable by arsenic.

472 ARSENICUM ALBUM.

Paralysis of this kind may occur as a natural disease in conse- quence of over-work or rheumatic exposure.

The arsenical-paralysis may be accompanied by contraction of the paralyzed limbs or rigidity of the joints. Ohristison informs us £hat instead of being palsied, the limbs may be rigidly bent, and cannot be extended. In a case related by Berndt, arising from the arseniate of potash, the paralytic affection consisted in the loss of sensation and motion in the hands, loss of motion in the feet, with contraction of the knee joints.

This symptom is well worthy of your notice. Paralysis with con- traction may arise from rheumatic exposure, or from the retroces- sion of some psoric eruption either in consequence of impaired innervation or after the use of some astringent wash or ointment.

According to Hahnemann, the pains in the paralyzed part may be of a burning character ; these pains may exist without the paralysis, and, although exhibiting a preference for the extremities, they may also invade the spinal column.

ARSENICUM ALBUM. 473

A robust farmer who had been sick for four years and a half, consulted Dr. Shubert on the 12th of January, 1821. He was subject to paroxysms which came on every three or four days, and were characterized by the following symptoms : Loss of appe- tite, qualmishness and nausea ; periodical pressure in the stomach, increasing as the paroxysms became more violent ; always coming on after eating, and sometimes when the stomach is empty; little sleep; this lasted two days; on the third day he felt a pressure near the vertebral column, on the right side, a few inches below the scapula ; a qualmish feeling and pressure in the stomach ; on the fourth day this sen- sation rose to a point between the apex of scapula and the column, where it changed to a burning pain as from a hot coal, made worse by the least contact and moderated by gentle exercise ; he had frequent startings during sleep ; the parts from the left hypochondrium across the stomach were numb ; immediately after rising he experi- enced frequent urging to stool preceded by pinching in the bowels, and followed by burning and sore pain in the anus.

The discharges were yellowish and watery, and then became slimy and scanty. Excessive prostration, depression of spirits, fretfulness. The attack was caused by a cold. On a summer's evening he had been sitting on a cold stone ; the same evening he felt drawing and tensive pains in the small of the back, and next evening a paroxysm, such as described, came on.

One dose of arsenic stopped it ; in three months there was a slight return ; another dose cured him.

INFLAMMATORY GROUP.

SIMPLE ACUTE INFLAMMATION The inflammatory con- ditions which arsenic excites along the tract of the intestinal tube, are marked by evidences of a deeply penetrating nervous disorder. These inflammations have a malignant character, tending to disor- ganization, and generally attended with cramps, spasmodic twitches or convulsions.

The following case reported by Brodie, (Philosophical Transactions, 1812,) gives a very fair view of the inflammatory action of arsenic upon the abdominal viscera.

474 ARSENICUM ALBUM.

ARSENICUM ALBUM. 475

The appearances on dissection were, externally: contraction of the muscles of the face, insurmountable stiffness of the limbs ; a violet color, more or less deep, over the legs, thighs, loins and back; coun- tenance pale, lips violet ; a very sensible heat of the body twenty-six hours after death.

Internally: the lungs were extraordinarily distended with blood, through two-thirds of their bulk, and especially in their posterior part. The incisions made into the lungs, showed a compact and tolerably firm texture ; on the slightest pressure, blood oozed out without any appearance of air-bubbles, from, a multitude of minute points on the cut surfaces. The anterior part of the lungs was red on the surface, and for the rest, tolerably elastic and filled with air. Both ventricles of the heart contained very black blood.

The left ventricle contained more than the other. The stomach was greatly distended by the fluid with which it was filled ; on its external sur- face was seen an infinity of small vessels injected with blood. The intestinal canal exhibited the same appearance as well on its external as internal surface, in some parts of its extent. The liver and spleen were likewise very much engorged with blood.

The stomach, having been emptied, and laid open throughout its whole extent, presented a surface apparently grained, which appearance was caused by the increased bulk of the mucous glands, the color of which was blackish ; whilst the stomach itself was red, more or less dark, and sprinkled here and there, especially toward the pyloric orifice, with extremely black spots. The epithelium of the mucous membrane was entirely removed. There was found in the fluid taken out of the stomach a cyst, formed, according to Professor Dupuytren, by an expansion of the mucous membrane of the stomach, in which some vestiges of the vessels could still be perceived.

It was about an inch and a half long, eight lines in diameter, and its sides were about half a line in thickness. From the interior surface of this cyst, were given out very thin partitions of a cellular texture ; and which contained, in separate cells, unequal fragments of a crystalline matter, which being submitted to several experiments by Dupuvtren and Vanquelin, presented all the characteristics of arsenic. This girl had attempted to poison herself on two previous occasions, and Dupuytren is of the opinion that the production of this cyst belongs to these two anterior poisonings.

This opinion appeared to him to be strongly supported by the circumstances that the patient complained of continual pains in that part of the stomach corresponding to that where the cyst was found.

GASTRO-ENTERITIS.— In all cases of gastro-enteritis, to which arsenic is homoeopathic, we shall find nausea, retching and vomiting of mucus, bile and blood ; burning pain in the region of the stomach and bowels, with excessive tenderness to contact or pressure ; tym- panitic distention of the bowels or else diarrhoeic discharges consist-

476 ARSENICUM ALBUM.

CHRONIC GASTRO-ENTERITIS arsenic is eminently useful. It is indicated by irritability of the stomach, occasional vomiting of food, a sensation of oppression after eating, aching and sore pains in the epigastric region, paroxysms of tympanitic distention of the bowels or flabbiness of the abdominal walls, alternate constipation and diarrhoea, the discharges consisting of loose, yellow stools, or slimy, fatty, purulent matters, with more or less tenesmus, sense of excoriation at the anus, debility, loss of flesh, more or less vascular excitement, sallow complexion with occasional feverish flashes, dull and heavy pains about the head. The tongue may exhibit a whitish or yellowish coating, the tip and edges look inflamed, the mouth and pharynx feel dry, which induces a frequent craving for drink. Patients who are suffering with an affection of this kind, are disposed to long for stimulants and tonics, such as wine or a little brandy.

ARSENICUM ALBUM. 477

The retching and vomiting of mucus, bile and blood ; the excessive sensitiveness of the precordial region ; the burning pain in the region of the stomach as if this organ were consumed by fire ; the agonizing thirst with inability to swallow the least drop without causing distressing vomiting ; the inflamed redness of the tongue ; the heated breath, the expression of agony in the features, the icy- coldness of the extremities and the excessively rapid, irregular, feeble and tremulous pulse : all these symptoms are so many indica- tions for arsenic which is capable of reproducing them all in the tissues in health.

Etmueller, in his Ephemerides of Natural Curiosities, speaks of a young girl poisoned by arsenic, in whom neither the stomach nor intestines presented any signs of inflammation or gangrene ; never- theless the arsenic was found in this viscus.

Other cases of a similar character might be mentioned.

In these cases arsenic destroyed life by its action upon the cerebro- spinal axis. Hence we infer that unless the stomach is endowed with a certain amount of reactive vitality, the poison cannot exhibit its irritating effects upon this organ. It would seem, therefore, that arsenic does not corrode the stomach solely as a chemical agent, but that a principle of dynamic vital resistance seems involved in the post-mortem phenomena of disorganization observed in cases of poisoning by arsenic. Hence we have a right to recommend arsenic as a remedy for gastritis upon the ground of its dynamic homce- opathicity to this disease.

478 ARSENICUM ALBUM.

All these symptoms correspond with the action of arsenic upon the gums, sublingual glands, and the lining membrane of the mouth.

The breath of patients affected with stomacace, has a penetrating, pungent, foul odor. Their pulse is jerking and hurried, the skin hot and dry ; in the last stage the extremities become cold, and the face becomes pinched and remarkably pale.

Contrasting these symptoms of the disease with the effects of arsenic, we shall find that this agent occupies a prominent rank among the few remedies which are adapted to stomacace.

ERYSIPELATOUS INFLAMMATION.— We know from several cases of poisoning with arsenic that this agent is capable of causing erysipelatous inflammation.

Belloc relates the following case (Cours de Medicine Legale, page 1^1) : A woman of fifty-six years, of good health, but of a delicate and very irritable constitution, washed her whole body with a solu- tion of arsenic, obtained by boiling the poison in common water.

ARSENICUM ALBUM. 479

The erysipelatous inflammations to which arsenic is homoeopathic,

are of a more or less malignant nature. They may be accompanied

by enormous swelling of the inflamed part, and excessive burning

with tendency to gangrenous disorganization.

ERYSIPELATOUS INFLAMMATION OF THE SCROTUM,

GANGRENOUS INFLAMMATION.— Arsenic causes gangrene by its direct action upon the tissue with which it comes in contact, and by absorption.

Flandin reports the following case of poisoning where arsenic caused a disorganization of the stomach which seems to have been of a gangrenous character.

480 ARSENICUM ALBUM.

This case of poisoning gives us a fair view of the functional phenomena which are observed in gangrenous inflammation of the mucous coat of the stomach, violent chill, burning pain in the stomach as if consumed by fire, excessive sensitiveness to pressure of the epigastric region, and the region of the stomach in particular, constant retching and occasional vomiting of foul mucus, bile and blood ; an unquenchable thirst, vomiting being provoked by the least portion of liquid introduced into the stomach, inflammatory redness of the tongue, which may be slightly coated ; coldness of the extrem- ities, excessively hurried, feeble, filiform, irregular pulse; pallor of the countenance, expression of distress and agony in the features ;

ARSENICUM ALBUM. 481

these are some of the distinguishing features of this dreadful and so often and speedily fatal malady.

In a case of gonorrhoea, with phimosis, the prepuce and anterior half of the penis became suddenly attacked with gangrene ; the pains were frightful ; fetid and foul blood was discharged from the urethra. After arsenic30, the upper portion of the pre- puce came off in twenty-four hours ; the gonorrhoea ceased likewise.

GANGKENE OF THE TONGUE has been caused by arsenic, as we may infer from the case reported by Baylies, where the lips and tongue exhibited a bluish appearance.

Malignant glossitis may terminate in gangrene. If gangrene threatens to set. in, the constitutional symptoms which show them- selves in every other form of gangrene, will become manifest, such as, coldness of the extremities, sinking, irregularity and extraordi- nary frequency of the pulse, expression of agonizing distress and livid pallor of the countenance. A flow of ichorous, sanguinolent saliva; a cadaverous odor from the mouth, and the sloughing off of shreds or patches of lining membrane and parenchymatous tissue, mark the presence of this destructive disease.

VOL. I. — 50.

482 ARSENICUM ALBUM.

HUMID GANGRENE, when the parts look livid, with scaling off of the epidermis and effusion of a turbid fluid in the subcutaneous tissues, arsenic is one of the most important constitutional remedies.

GANGRENE OF THE BRONCHIA, arsenic may be depended

ARSENICUM ALBUM. 483

upon as an energetic remedial agent. Under the name of malignant bronchitis, Schoenlein gives the following characteristic dcscripl ion of tliis disease: "Toward evening the patients are attacked with a violent burning pain, particularly under the manubrium sterni; this pain is accompanied by a peculiar oppression of breathing ; the chest of the patient feels as if constricted ; respiration is carried on with the abdominal muscles. If the patient attempts to expand the chest, the burning sensation under the sternum increases.

Even now a peculiar rattling is heard, arising from the mucus which fills up the bronchia up to the point of bifurcation. This accumulation of mucus in the bronchia excites paroxysms of cough, during which the patients breathe with their necks stretched forward and the face assumes a livid hue; the patients raise a little greenish-yellow mucus which is sometimes tinged with blood. The pulse becomes very rapid, though not hard or jerking ; the skin is burning hot and the patient is tormented by a violent thirst.

This disease may terminate the patient's life quite suddenly."

ANGINA GANGRENOSA may be advantageously treated with arsenic. In this disease the tonsils become covered with a yellowish

mi

This disease is most frequently met with during epidemic scarlet- fever. It may occur before, during or after the fever.

484 ARSENICUM ALBUM.

causes great thirst and a constant craving for cooling drinks. It likewise develops all the croupy symptoms which may characterize this disease in its last stage ; bluish color of the lips and face, bloat- ing of the lips and face, expression of distress and agony in the features, hoarseness and even loss of voice, excessive wheezing and agony of breathing. The feeble, tremulous, galloping pulse and the icy-coldness of the extremities indicate arsenic.

PUTRESCENCE OF THE UTERUS.— The symptoms which characterize putrescence of the uterus, indicate the use of arsenic in this disease. The creeping chills, the hot and dry skin, the hurried and filiform pulse, the peculiar alteration of the features, the restless- ness and anguish, the unquenchable thirst, and, at a later period of the disease, the offensive, colliquative diarrhoea and the retention of urine, point to arsenic as one of the remedies in this affection.

ANTHRAX or pustula magligna is another gangrenous disorgani- zation with a short description of which wTe will close the chapter on this class of diseases.

ARSENICUM ALBUM. 485

Cancer of the chimney-sweep may be treated with arsenic. In this affection the ulcerous process proceeds from the lower part of the scrotum, where a superficial, painful ulcer, with hard and elevated edges first develops itself.

Arsenic, if applied to an external sore in too large a quantity, may induce fatal consequences. An arsenical paste applied to ulcerated breasts, or fly-powder to a sore head, has resulted in gangrene of the parts, inflammation of the stomach and bowels, convulsions and death.

SPECIAL SENSES.

Arsenic causes inflammation and swelling of the lids, secretion of acrid tears, inflammation of the conjunctiva, sensitiveness to the eyes; hence we may derive great benefit from it in ophthalmia characterized by similar symptoms. In

BLEPHAEOPHTHALMIA of scrofulous individuals, in the granular forms of this disease, we may derive great benefit from the use of arsenic. The

ARCUS SENILIS of old people, a fatty degeneration of the cornea, likewise requires its use.

We have effected some beautiful cures of ophthalmia by means of arsenic.

Dr. Stapf relates the following case : A book-binder, twenty-eight years old, of delicate, tender and cachectic constitution, was attacked on the 25th of September, 1839, by the following affection of the eyes: The conjunctiva showed signs of red- ness, accompanied by violent pressure in the eyeball, especially early in the morning after waking, with violent pain when touching the eye. For five days (until Sep- tember 30th), the right eye was perceptibly redder and more sensitive than the left; after that, the left eye suddenly became affected and the right eye was almost well.

The left eye showed the following symptoms : Early in the morning he is hardly able to open his eye ; the sclerotica is quite red ; there is continual, violent painful pressure on the eyeball with great photophobia. On the 2d of October he applied for help; the doctor gave him aconite and belladonna, but without much relief. Every other day the symptoms were decidedly worse. After a tolerable night's rest, a most violent pressure was experienced in the eyeball, and a pulsating throbbing ; the eye looked red.

The throbbing was felt within a quarter of an inch all around tne

486 AKSKNICUM ALBUM.

eye. It was like the beating of a pulse, about ioo a minute, and exceedingly painful, 'the eyeball, which was very red, had lost all its brilliancy, looked pale and dull; the sight was much weakened; he was not able to discern even large objects beyond a distance often paces; small objects were not seen at all. These symptoms increased from five in the morning until noon, when they reached their acme, after which the pains diminished and disappeared entirely about ten o'clock at night.

On the day following, the eyeball was simply red, there was pressure on the eye and weakness of sight, but no further pain ; every third day the paroxysms broke out fully. The general health of the patient was fair ; during the paroxysms the pulse was slightly irritated, hurried, and the appetite somewhat decreased. On the 9th of October the doctor gave the patient six pellets of arsenic30. On the following day, when the paroxysm should have broken out, the symptoms were all improved, and on the 12th of October the eyes were as clear and sound as those of any man.

CHYLO-POIETIC GROUP,

Arsenic causes an alteration of the taste, a foul, bitter or even sour, taste ; nausea, with trembling and shivering ; retching and vomiting ; oppression in the pit of the stomach, sometime after eating ; also a feeling of repletion ; burning pain, and, in one prover, sense of chilli- ness in the epigastric region and chest ; gnawing and fine beating- pain in the pit of the stomach ; anxiety and crampy pain in the pit of the stomach ; waterbrash and sour eructations.

The symptoms of gastric irritation which poisonous doses of arsenic have developed confirm the pathogenetic symptoms recorded by our provers.

PYROSIS A man took a few spoonfuls of soup in which six

grains of arsenic had been mixed : he vomited about forty times in four or five hours, took two quarts of sweet milk, and suffered for a week with violent burning pains in the stomach and bowels ; for a long time after, he had much acidity of the stomach, and vomited easily after light meals. Hence we may recommend arsenic in pyrosis or heartburn, with acidity of the stomach, sour, acrid eructa- tions, burnin in the oesophagus and larynx.

DYSPEPSIA may yield to arsenic, when characterized by such symptoms as arsenic is capable of causing. The leading symptoms

ARSENICUM ALBUM. 487

of this group are: oppression after eating; excessive irritability of the stomach, causing a continual spitting up of food ; sensation of repletion in the stomach as if the stomach would be violently pressed asunder; paroxysms of nausea, retching and vomiting; loss of appe- tite, even amounting to a loathing of food; altered taste in the mouth, foul or sour ; or bitter taste in the mouth after eating. The patient may also complain of burning pain in the stomach, or a sen- sation as if the food were gliding over a raw surface.

Arsenic causes vomiting and agonizing retching, vomiting of bile, mucus and blood ; a violent and painful pressure in the epigastric region ; sensation of distention in the stomach as if the coats of the stomach were torn ; sensation as of a pressing load in the stomach ; sensation as if the patient were tormented by flatulence in the region of the stomach, momentarily relieved by vomiting and diarrhoea, but getting worse afterward ; burning and oppression in the stomach and chest ; gnawing pains in the stomach, accompanied by thirst and violent anxiety.

CARDIALGIA, characterized by burning pain, soreness to press- ure, spasmodic constriction, retching, oppressive anxiety, trembling, coldness of the extremities, expression of distress in the features, small and frequent or even irregular pulse, arsenic may prove indispensable.

NERVOUS DYSPEPSIA — The symptoms: "Sensation in the oesophagus and stomach as though a ball were twisting or rolling itself upward," points to a form of nervous dyspepsia to which hys- teric women and nervous individuals generally are subject.

SCIRRHUS OF THE STOMACH may be arrested in its develop

488 ARSENICUM ALBUM.

CHRONIC H^EMATEMESIS, arsenic may prove indispensable if the attacks are accompanied by chilliness, coldness and trembling of the extremities, small and frequent pulse, loss of adipose tissue, expression of suffering in the features, want of desire for food with a feeling of repletion and as of a load after eating.

ENTERALGIA. — Arsenic will also help in enteralgia or colic if the pains are cutting, tearing and burning ; the bowels are tympan- itically distended, sensitive to pressure, with icy coldness of the extremities, and sometimes urging to stool with tenesmus and some discharge of mucus and blood.

The worst forms of dysentery have been arrested by arsenic, where the medicine was specifically adapted to the disease. Instead of describing symptoms, we will relate a few cases illustrative of the homoeopathicity of this great agent to dysentery of a malignant type.

ARSENICUM ALBUM. 439

found the patient doubled up in bed, complaining as follows: dullness of the hetoff, bluish lips; painful distortion of facial muscles; loss of appetite; nausea, especially when moving about ; violent tearing and cutting pain in the epigastric region; the abdomen is distended, soft, but painful when touched; scanty discharges of mucus from the rectum, almost every minute, with increase of pains in the bowels and tenesmus ; excessive thirst, dry, white-coated tongue ; anxiety and moaning ; coldness of the extremities and face, with sweat in the face; pulse, 88. The patient took one •dose of arsenic30, had one more discharge, fell asleep, and woke perfectly well.

CHOLERA MORBUS, arsenic is required, when the patients com- plain of a great deal of burning in the epigastric region, vomiting, tormina in the bowels with copious, watery, foul-smelling discharges from the bowels, which excoriate the anus and cause great prostra- ' ion. The patient complains of cramps in the calves ; the pulse is small, hurried, irregular. In an attack of this kind, the patient is tormented by an unquenchable thirst, bad taste in the mouth, and a thickly-coated tongue.

ASIATIC CHOLERA can hardly ever be treated without arsenic. The symptoms are somewhat similar to those of cholera morbus, except that the prostration may be greater, the cramps are generally more distressing, and the patient's countenance is expressive of intense suffering and anguish.

CONSTIPATION often requires the use of arsenic. This condi- tion of the bowels is attended with torpor of the liver ; the feces have a dark, brown, greenish or blackish appearance. The abdomen may feel hard and distended, with a feeling of warmth, aching and sore pain in the bowels, exceedingly dry skin, with entire absence of all cutaneous exhalation, scanty, deep-colored and offensively smelling urine, dullness about the head, sallow complexion, feeling of languor and hypochondriac depression of mind.

PHTHISIS MESERAICA or tabes meseraica, arsenic is likewise an excellent remedy. Arsenic may likewise prove homoeopathic to the first or irritative stage *of mesenteric ganglionitis, characterized by the symptoms of enteritic inflammation, alternate constipation

490 ARSENICUM ALBUM.

and diarrhoea, loss of appetite or the opposite condition, voracious- ness or bulimy; grayish discharges from the bowels, vomiting of glairy mucus, emaciation, puffiness and paleness of the face, tympan- itic distention of the abdomen, evening fever.

JAUNDICE or icterus, unless the disease depends upon some disorganization of the liver, or in those severe forms of jaundice where the bile becomes foul and decomposed, and speedily poisons the tissues.

Jaundice, originating in fever and ague, may require arsenic. In these forms of jaundice, the liver is most always organically diseased, indurated, inclining to suppurate or to develop incurable constitu- tional affections.

CIRRHOSIS of the liver, arsenic may afford relief if indicated by the totality of the symptoms. In

FATTY DEGENERATIONS OF THE LIVER arsenic may be an efficient agent in arresting this morbid process. It seems to be possessed of specific powers to counteract the formation of fat in the living organism, it causes emaciation, and yet, if given in small quantities, it is well known to promote the rotundity and glossy appearance of the frame. It is needless to observe that this is not a natural, but a pathological development.

TUBERCULOSIS OF THE LIVER.— In conclusion, we may

ARSENICUM ALBUM. 491

*

URINARY GROUP.

If the pathological degenerations which generally result from Bright's disease, such as ascites, anasarca, phthisis pulmonalis, have developed themselves, arsenic can only act as a palliative. In

DIABETES MELLITUS arsenic is indicated, when there is emaciation, loss of strength, pallor of the countenance, derangement

492 ARSENICUM ALBUM.

of the gastric functions, as hunger loss of appetite or insatiable ; dryness in the mouth and throat ; great thirst ; watery diarrhoea or constipation; nervous restlessness; suppression of sexual desire; tendency to dry gangrene ; keen, shifting, neuralgic pains in various parts of the body; oppressed, asthmatic breathing, worse upon motion.

SEXUAL GROUP.

CHRONIC ORCHITIS, and oedema of the scrotum, res tilting from, or characterizing a cachectic state of the organism, such as may gradually develop itself under the influence of a scrofulous or syphilitic dyscrasia.

It is well to note the fact that arsenic seems to be possessed of a tendency to increase the sexual passion and to promote the secretion of the seminal fluid in the male and of the menstrual blood in the female. We may avail ourselves of this symptom in conditions of general nervous debility, as an indication of arsenic.

LEUCORRHOEA. — This agent may likewise prove available in lencorrhoea of a corrosive, ichorous character, in women of a marked scrofulous diathesis, or where the discharge proceeds from malignant ulceration of the neck of the womb.

CATARRHAL GROUP.

Arsenic causes excessive coryza of an acrid nature, hoarseness, tenacious mucus on the chest, cough with blood-streaked expectora- tion, or distressing and fatiguing cough accompanied with a variety of other symptoms which it seems needless to enumerate in this place.

ARSENICUM ALBUM. 493

discharge from the nose; the head feels dull and tight, the patient complains of coldness, creeping chills, feels weak, looks pale, is indis- posed to move about or attend to business. In catarrhal affections of the head, where arsenic is indicated, we shall find, as a general rule, that they are symptomatic of

INFLUENZA, more particularly, if this disease prevails in a community extensively in consequence of atmospheric irregularities, or as an epidemic miasmatic disease. The patient feels very much prostrated ; the above-mentioned catarrhal symptoms are present ; the patient complains of bad taste in the mouth, feels thirsty, chilly and feverish, he craves cooling drinks, is sick at the stomach, feels sore all over, looks sallow and distressed, is disposed to sleep, low- spirited, tremulous.

The character of the cough to which arsenic is in homoeopathic-specific rapport, is delineated in the recorded provings of this drug. We find that it is a dry, exhausting cough, or a cough attended with hawking up of blood-streaked mucus, cough which is particularly violent at night or where the paroxysm is excited by drinking cold water; the chest feels sore, as if excoriated internally; the breathing is oppressed, and the heart may beat violently. The pulse inclines to be feeble, rather hurried and irregular ; the tem- perature of the skin may be depressed below the normal standard. This remark applies to cough in connection with influenza, or catarrhal cough generally.

THORACIC GROUP.

Arsenic affects the nervous ramifications and the mucous lining of the respiratory organs, of the lungs as well as of the bronchial tubes. The various forms of cough, the suffocating dyspnoea, the con- strictive oppression, the burning distress in the chest, the wheezing murmur which arssnic causes, substantiate this doctrine.

PNEUMONIA NOTHA. — Arsenic seems therefore eminently homoeopathic to a most dangerous affection of the respiratory organs, which some pathologists describe under the name of pneumonia notha, and others as catarrhal bronchitis, or bronchitis asthenica, bronchitis senilis.

494 ARSENICUM ALBUM.

HAEMOPTYSIS, or bloody cough, will yield to arsenic. Sudden attack of suffocative cough, with tickling in the throat-pit ; soreness either at a seated spot or shifting from one portion of the chest to another ; excessive oppression ; trembling and chilliness, with cold- ness of the skin, and a feeble, hurried and almost compressible pulse; pinched-up features, expression of anxiety and distress in the coun- tenance, sallow or dingy brown complexion ; these are the leading symptoms which indicate the use of arsenic in haemoptysis. The blood may be spit up in various quantities, from a spoonful to half a pint ; it has a bright red color.

In pulmonary haemorrhage, where arsenic is indicated, the symp- toms are often traceable to derangements in the functions of the liver, such as gnawing in the stomach, and unnatural craving for food ; dryness in the mouth, frequent desire for cold drinks, soreness and burning in the region of the liver ; pain at the shoulder, etc. All these symj)toms point to arsenic.

PHTHISIS PULMONALIS has been treated with arsenic with varied success.

In a case of chronic poisoning with arsenic (Dr. Marcy from the London Lancet) the following symptoms occurred :

Sickly look ; small, frequent pulse ; frequent slight tickling cough or rather hawking without expectoration; occasional discharge of mucus from the bowels, often tinged with blood; tenesmus and griping of some days' standing; flatulence, redness of the eyelids and lining membrane of the nostrils ; loss of appetite and failure of strength; restlessness at night; increasing weakness; dryness or tightness of throat ; hoarse voice; later, the stools assumed a fatty appearance owing to the presence of pus, as proved by microscopical examination; tongue red and fiery, mouth and lips excoriated,

ARSENICUM ALBUM. 495

anxiety and restlessness very great ; percussion revealed tubercular infiltration at the summit of both lungs, most in the right, indolent in both, symptoms resembling tuberculosis of the abdomen and chest; conjunctivae much injected; anus excoriated; hiccough, restlessness, and general distress; pulse 130, feeble ; urine scanty, high-colored, dense, albuminous, depositing blood-disks and casts of uriniferous tubes of kidneys. Died with tetanic spasms; mental faculties perfect.

Among the symptoms which will have to guide us in our choice, we distinguish the following, all of which characterize the action of arsenic upon the normal tissues : Hoarseness ; oppression on the chest ; short and laborious respiration, which is often, painful; sensa- tion of rawness and soreness in the chest; titillation in the windpipe continually, exciting a cough ; the titillation is felt even when the patient does not draw in air; dry, hacking cough, also with expector- ation of blood-streaked mucus; burning distress in the chest; the cough is excited by swallowing cold liquids, water, etc. Chilliness in the interior of the chest, also after supper. In

BRONCHITIS arsenic may be of service, if the ulcerative stage has begun to set in. There may be great tickling in the throat-pit, and excessive soreness in the terminal ramifications of the air pass- ages. The racking cough and the expectoration of bloody pus, having a sweetish, sickening, offensive taste, together with the con- stitutional symptoms such as, trembling, debility, loss of appetite and flesh, etc., point to arsenic.

A distinct example of advanced pneumonia in man is related in PyVs Magazine: The patient died after vomiting and purging inces- santly for eight days ; on dissection, the lungs were found in the highest state of inflammation, and so congested as to resemble a lymph of clotted blood. A distinct case of the same nature is related in He?ike>s Journal: This patient had obvious pneumonia symptoms during life ; and in the dead body the lungs were found so gorged that, on being cut into, nothing could be seen but clotted blood in their cellular structure. In Roux' case, where arsenic was applied externally to a scirrhous ulcer, excessive congestion was found in the lungs, both lungs being completely gorged with blood and presenting all the characters of pulmonary apoplexy.

490 ARSENICUM ALBUM.

In pneumonia arsenic may b3 indicated by a peculiar order of symptoms : excessive oppression, violent chills succseded by a burn- ing fever and rapid, hard and bounding pulse; dark flushes in the face, which exhibits a sallow, jaundiced tint as its ground color ; the patient complains of paroxysms of tearing, racking cough with ex- pectoration of pure blood and blood-streaked mucus ; palpitation of the heart, intense soreness and burning and stinging pains in the chest. Nausea and vomiting of bile and mucus may not be wanting..

The paroxysms of asthma to which arsenic is homoeopathic, are characterized by a feeling of suffocative constriction and anxiety in the chest, paleness of the face, feeble, hurried and sometimes irregular pulse. The paroxysm may gradually terminate in heat and dryness of the skin, gradual breaking out of perspiration and loose cough.

O O <J oft*

Arsenic will prove of great benefit in affections of the heart.

Wibmer thus sums up the action of this poison upon the heart : " The heart is generally relaxed, not engorged with blood ; in the interior of the heart, and especially on the columnae carnese and on the valves of the ventricles, particularly those of the left, we

ARSENICUM ALBUM. 497

These post-mortem changes contain those which Orfila describes as having occurred in a case of poisoning examined judicially at Paris by this learned man. The case having been brought before the Imperial Academy of Medicine, it was distinctly shown by many members that the redness seen on the inner surface of the heart, so far from being the result of inflammation, was produced by sangui- neous extravasations. Christison, Flandin and other toxicologists, deny the correctness of Orfila's conclusions that arsenic may induce endocarditis.

Be this, however, as it may, the symptoms observed during life, show that arsenic must be an important agent in affections of the heart. The symptomatic indications which point to arsenic in affec- tions of the heart, are various : dyspnoea, feeling of constriction across the chest, palpitation of the heart ; anxiety, sense of suffoca- tion ; irregularity and intermission of the pulse, which is moreover jerking and rather hard ; burning distress in the chest and region of the heart ; dry, barking, fatiguing cough ; immediately after coughing, the breath becomes very short, as if the chest were con- stricted. In

HYDRO-PERICARDITIS, or dropsy of the pericardium, if arising under circumstances like the foregoing, and in acute pericarditis arising from the sudden suppression of an acute inflammatory erup- tion such as measles or scarlatina, arsenic is in its place. In

CARDITIS SEROSA, or inflammation of the serous membrane reflected over the heart, arsenic may be useful in the progress of the disease, if the pulse becomes feeble and contracted, the coldness of the extremities increases, and the countenance of the patient ex-

VOL. I. — "51.

498 ARSENICUM ALBUM.

CARDITIS SCORBUTICA, scorbutic inflammation of the heart, where the attacks set in with livid color of the face, dingy yellow appearance around the mouth, symptoms of scorbutic disorganiza- tion, enlargement of the liver, etc., arsenic is probably the only medicine that can do any good. In

HYDROTHORAX arsenic may afford relief. This disease may be symptomatic of organic disease of the heart, or lungs, in which case a cure is impossible. Idiopathic hydrothorax may yield to treatment. If the patients are of an impoverished constitution, sub- ject to fainting turns, oppressed by anguish, suffering with great dyspnoea, feeling worse in the night, extremities inclining to be cold, face bloated and clammy, expression of suffering and dread in the features, small, feeble, hurried and somewhat irregular pulse, thirst, inability to drink cold water without coughing, we may prescribe arsenic.

FEVER GROUP.

Arsenic is a valuable remedy in various fevers which we find clearly delineated among the effects of arsenic upon the healthy tissues. In

BILIOUS REMITTENT FEVER arsenic becomes invaluable. The symptoms which indicate arsenic in this disease are, nightly exacerbations, which constitute a characteristic peculiarity of the

ARSENICUM ALBUM. 499

action of arsenic. The fever sets in with a severe chill, followed by burning heat and excessive dryness of the skin, and afterward pro- fuse and debilitating sweat. During the fever, the patient is attacked with a racking headache as if the skull would fly to pieces ; he vomits quantities of green and yellow bile, with excessive retelling, looks sallow, is tormented by thirst, and yet the water he drinks ex- cites the vomiting. The tongue looks exceedingly foul, the taste in the mouth is very unpleasant ; the bowels are either costive and feel bloated, or else they are loose, the discharges being slimy, liquid, bilious, blackish and having an exceedingly fetid smell.

The urine looks very dark, almost black, has a very foul smell and throws down a very thick, dark-looking sediment which adheres to the sides of the vessel. The patient grows weaker from day to day, loses flesh, feels low-spirited, and looks the very picture of suffering and despair.

GASTRIC AND MUCOUS FEVERS may likewise require arsenic. In gastric fever the patient's complexion, except the fever- flushes on his cheeks, is of a dingy-sallow ; the tongue has a thick, slimy, grayish-looking coating upon it; the patient complains of nausea, foul taste, thirst, loathing of food, dry and hot skin, consti- pation, bloating of the bowels which, however, are not hard ; dark and foul-smelling urine.

In mucous fever, the tongue has a thick coating of a tenacious grayish-yellow mucus upon it ; the mouth is dry, the patient com- plains of much thirst, feels nauseated after drinking, is restless, low- spirited, has a very foul taste in the mouth, spits up a good deal of watery mucous having a foul taste ; the breath is offensive, appetite gone, urinary secretions very scanty, the urine having a red or deep- yellow appearance ; alternate diarrhoea and constipation ; irregular chills, heat and dryness of the skin, profuse perspiration preceded by anxiety; flushed face with burning pain in the head, extreme debility. In cases of poisoning, the autopsy has often revealed an universal inflammation of the mucous lining, showing that in in- flammatory conditions of this membrane, arsenic must be of great use. In

RHEUMATIC FEVER arsenic may be valuable. The symptoms are similar to those which have been indicated under gastric and mucous fevers, modified in so far as they originated in purely rheu- matic exposure, and hence complicated with rheumatic phenomena.

IMTERMITTENT FEVER. —Arsenicum is a most valuable

500 ARSENICUM ALBUM.

remedy in the en re of intermittent fever, especially in the so-called "dumb ague" and after the abuse of quinine. The chill may come on at any time of the day, frequently it appears about noon. The chill is preceded by malaise, debility, yawning and stretching and sleepiness. The chill is not well defined; there is rather a "shudder- ing," especially when exposed to a draught of air.

The heat of arsenic, is intense, and is accompanied with great restlessness. If sweat follows the chill, it is accompanied with the peculiar dryness of the mouth and throat, and the great thirst, with aggravation of gastric symptoms from drinking, which is characteristic of arsenic and which also exists during the preceding stages. We find also : desire to be covered up; amelioration of symptoms by external warmth; great restlessness; characteristic gastric disturbances; debility; sallow, sunken face; tenderness and dull aching in the region of the liver and spleen; scanty urination of dark red urine; watery diarrhoea or constipation.

In cases of fever and ague, to which arsenic is in homoeopathic adaptation, this agent will likewise cure the disorders which may result from the fever, such as oedema of the feet, face and hands; anasarca and ascites, and enlargement of the liver and spleen. In

TYPHUS FEVER arsenic is often an invaluable agent, more par- ticularly in those forms of typhus which are marked by a deeply- rooted disorganization of the vital fluids. Arsenic causes patechial and miliary eruptions, a symptom of typhus.

Arsenic causes dryness and coldness of the skin, or clammy sweat; tremulous hurried and feeble pulse; general trembling; scanty secretion or retention of urine, dark and foul-smelling urine ; cadav- erous stools; thick brown, blackish coating of the tongue; vomiting of bile and dark blood, emaciation, paralytic weakness of the extremities ; deep-seated pain in the head, stupefaction, muttering delirium, sense of fright as if some dreadful accident or danger were impending; sinking of the features, with an expression of terror and distress in the countenance.

In typhus petechialis, typhus of the bowels and liver, arsenic will prove eminently useful.

In one case the patient had been given up by his homoeopathic attendants. Our advice was requested. We found the patient stupid and delirious, though at times his consciousness would return ; petechia?, from which blood oozed, in various parts of the body; teeth and tongue covered with black sordes; gums bleeding; haemorrhage from the nose, conjunctiva and from under the finger-nails ; abdomen soft, but very sensitive in the ileo-ccecal region; stools involuntary and cadaverous; urine very dark and foul ; skin cold and clammy, pulse hurried, small, tremulous, 120; countenance sunken, sallow, general emaciation. He was attended by two homoeopathic physicians,

VRSENICITM ALBUM. 501

but had never had arsenic, which, however, was the only remedy indicated. We gave him arsenic18, and in one fortnight thereafter, the patient was able to attend to his business.

HEOTIO FEVER generally, arsenic is only indicated in so far as it is required for the treatment of the general affection.

PURPURA HEMORRHAGICA WERLHOFII, where the ten- dency to disorganization of the blood, effusions from the capillaries, prostration, constitute characteristic signs of the disease.

EXAXTHEMATOUS GROUP.

502 ARSENICUM ALBUM.

SCARLATINA MILIARIS. — Arsenic is indicated when the erup- tion assumes a malignant character, the vesicles collapse, the skin, from burning hot, changes to cold, the pulse collapses, the bowels discharge involuntarily a foul and slimy, watery substance, etc.

VARIOLA and varioloid, under similar circumstances as in miliary scarlatina, with collapse of the pustules, coldness of the skin, sinking and extreme rapidity of the pulse, stupor, foul and involun- tary discharges from the bowels ; malignant pustulous erysipelas, to which your attention has been directed on previous occasions ; anthrax ; chronic urticaria or nettle-rash, with furious burning and itching, prsecordial anxiety, oppression, restlessness and trembling; crusta serpiginosa, with rapid spreading of the crusty eruption, and oozing of corrosive ichor from under the crusts ; psoriasis diffusa, with cracking of the skin, rhagades, oozing of blood and serum, furious burning and itching ; tinea capitis maligna, with formation of thick, dark crusts, secretion of an ichorous, bloody, fetid pus, matting the hair and causing it to fall out; ichthyosis, a disease, where the epidermis becomes harsh, dry and scaly, like fish scales.

ELEPHANTIASIS The skin becoming thick, rugose, tubercu- loid and insensible. The legs may become enormously swollen like the legs of an elephant ; hence the name of the disease. We have also the elephantiasis of Cayenne or mat rouge cle Cayenne, with red and yellow spots on the forehead, ears, nose, hands, loins, etc. ; these gradually spread further, becoming scaly, and resulting in disorgani- zation, rhagades, ulceration and caries of the affected parts.

Other forms of this loathsome disease, such as the elephantiasis of Java, characterized by large white tumors of a scrofulous nature, and gradually ulcerating and destroying both the soft and osseous tissues, likewise require the use of arsenic.

ARSENICUM ALBUM. 503

becomes powerfully roused in lepra. This furnishes an additional indication for the use of arsenic.

LUPUS, a phagedenic ulcer, so named because it eats away the soft and cartilaginous parts, requires arsenic.

PRURIGO. — Arsenic is also useful in prurigo, for it causes a burning itching of the whole body, and in

PITYRIASIS, or desquamation of the skin, which comes off in small bran -shaped scales, and particularly in

ALOPECIA or baldness, when resulting from excessive dryness of the scalp, with scaling off of the epidermis. This may be an idio- pathic condition of the scalp, also a symptom of general marasmus.

In the treatment of acute eruptions to which arsenic is specifically homoeopathic, very small doses of this agent are sometimes able to effect a speedy and permanent cure.

A case of crusta serpiginosa arising from bad vaccine and spreading in thirty-six hours over the whole of the upper arm, face, neck and part of the thorax, forming horrid, thick, green and brown-looking crusts, with discharge of a most corrosive ichor, burning and itching, was completely cured in three days by a single globule of arsenic200. The arsenic was given at night, the crusts were perfectly dry next morn- ing, and fell off in three days thereafter.

A robust man of forty-three years had his face, chest, neck, forearms and hands covered with ichorous, burning ulcers ; at first red pimples broke out, which soon discharged a yellowish puss, forming crusts and sores ; the patient had, moreover, chills, yellow diarrhoea; tongue coated dirty yellow; yellow urine; spirits depressed> Arsenic30 cured him at once.

ANASARCA. — Arsenic has caused dropsical effusions and oedema; hence we may prescribe it in anasarca, more particularly after fever and ague, or as a consequence of retrocession of some acute eruption ; in

504 ARSENICUM ALBUM.

MENTAL GROUP.

Arsenic causes depression of spirits, melancholia, hypochondria, precordial anxiety, a feeling as if one had committed great crimes. Hence arsenic may be a most valuble remedy in the treatment of certain forms of mental derangement, more particularly when char- acterized by deep melancholia, anxiety for one's future welfare, a feeling of remorse as if one had committed a crime.

MELANCHOLIA. — In the following case of melancholia, a beau- tiful cure was effected by arsenic.

A gentleman, thirty-two years old, of robust frame, consulted Dr. Weber for peri- odical paroxysms of melancholia ; he had no rest at night, perspired all over, was tormented by frightful anguish as if he had committed a dreadful crime ; it drove him about from place to place ; cried that he was not conscious of any wrong, and yet he would beg every body's pardon ; violent heat in the face and about the head ; pulse 80, rather feeble ; paroxysms every three or four weeks, they continued for six or seven days and had existed for years. Arsenic30 cured him speedily and permanently.