Subcutaneous injection may be fol lowed by pain, swelling, and even abscess and gangrene.
Subcutaneous injections do not pro duce digestive derangements. hut they determine local accidents in spite of all aseptic precautions. Arsenical solutions become infected with molds, etc., very readily, and cause irritation at the site of inoculation, pain, inflammatory infil tration, and sometimes even abscess or gangrene. Ziemssen's method of using a sterile solution of arseniate of soda tried, but convinced that the method of subcutaneous injection will not be borne by a patient very long. Vinay (Lyon Medical, Apr. 12, '96).
When administered internally and in small doses, arsenic stimulates the mu cous membrane, thereby sharpening the appetite, but no other perceptible effects are produced. It raises the tone of the nervous and circulatory systems and in creases the power of endurance.
By combining with the corpuscular elements of the blood these bodies are enriched; consequently the general nu forces are improved and the char acter of the tissues altered.
Symptoms observed during an epi demic of arsenical poisoning in Man chester. Sensory disorders seem to have been out of all proportion to the amount of beer or stout consumed. The most obtrusive phenomena were: 1. Numbness and tingling, which came on rapidly, in both hands and feet. In some a painful sense of a burning char acter in the soles of the feet, making walking painful, was all that was noted. 2. Pain, often most acute on pressing the soles of the feet, especially at the heel and ball of the great and little toes. In nearly all eases the pain on moving the joints was excessive, and especially so on pressing the muscles; this latter symptom was also noted in a number of cases in the forearm muscles. 3. Several of the patients showed a flushed appear ance of the sole, especially at the great toe and heel, rarely spreading on to the dorsum of the foot, and associated with pain, making the picture of erythrome lalgia; but the swelling, which when associated with pain and redness is de scribed as typical of erythromelalgia, was seen in but one case. 4. Objective impairment of sensation was absent. 5.
The knee-jerks were often present and at times unusually brisk. W. B. rington (Brit. Med. Jour., Jan. 5, 1901).
Armand Gautier found that small quantities of arsenic were present in the thyroid gland and other cellular elements. The writer, a series of experiments on animals, confirms this fact, and concludes that arsenic is a normal element of the living cell, and is to be found in all animals and in all organs. Gabriel Bertrand (Le Bulle
tin Medical, Feb. 4, 1903).
When taken for a long time the sys tem becomes habituated to its effects; so that much larger doses may be tolerated.
The Styrian arsenic eaters take as much as S or 10 grains at once, but take no fluid immediately thereafter, so that absorption progresses slowly and elim ination by the kidneys rapidly. This tolerance for the drug is undoubtedly due, to some extent, to environment and heredity, for imitators of the Styrians sooner or later suffer from its toxic effects.
Arsenic, used for a considerable period, produces a tingling and numbness of the tips of the fingers. (Hutchinson.) NUTRITION.—Arsenic, in doses of to grain, increases the elimination of urea and phosphoric acid and dimin ishes the elimination of chloride of so dium. In large doses—that is, more than V, grain—it diminishes the excre tion of urea and increases the excretion of phosphoric acid and chloride of so dium. In small doses, the elimination of uric acid being augmented, nutrition is increased because the chloride of sodium, the stimulant par excellence of nutrition and the preservative of the red corpuscles, is retained in the organism in larger quantities than normal, thus stimulating nutrition, in spite of the loss of phosphoric acid. The contrary is the case when large doses are given, the unfavorable action being attribut able, first, to the destructive effect of the drug on the red corpuscles, then to its action on the chloride of sodium, and finally to its action on the phosphoric acid. (Viratelle.) Large doses are pronouncedly irritant, even causative of gastro-enteritis. The symptoms of such doses are usually slight burning or colicky pains in the epigas trium, nausea, diarrhcea, and, if the dose be sufficiently large, vomiting, purging, and generalized abdominal pain.
Close observation of the patient will disclose a puffiness about the eyes, par ticularly in the early mornings. This may increase into a decided cedema, and later may lose its local character and become general. The urine may or may not contain albumin and casts.
This puffiness about the eyes should, in the majority of cases, be regarded as the physiological limit of administration.