Treatment of Poisoning. — For the acute form the most effective antidote is the hydrated oxide of iron and magnesia, prepared by precipitating the solution of tersulphate of iron by magnesia. Twenty grains of the antidote should be given for every grain of arsenic ingested.
A solution of dialyzed iron, the tinct ure of the chloride, Monsell's solution, or any of the sesquialteral preparations may be substituted in emergencies.
An emetic should be given, or the stomach emptied by the pump, and, if the bowels have not moved, a dose of castor-oil or Epsom salts should be ad ministered.
Demulcent drinks should be freely given, together with stimulation, ex ternal dry heat, and friction. Other treatment must be governed by the symptoms as they arise. Opium for pain, and large draughts of water if there be a tendency to suppression of urine, are also indicated.
In chronic arsenical poisoning the patient should naturally be removed from contact with the offending agent and treated symptomatically. Potassium iodide is the most effective agent in such cases.
The pathological changes are those re sulting from violent irritation. Ryper cemia, infiltration ecchymoses, and membranous exudation, which is of a pale-yellow color and adherent to the swelled mucosa, are all to be noted. In the case of poisoning through the intro duction of arsenic into the vagina there was acute inflammation, with false mem brane on the labia minora and incipient sloughing of the rectal mucosa over the recto-vaginal septum. The labia majora were also very oedematous.
Therapeutics. — Arsenic is well borne by children; but in too large doses, too long continued, it causes anorexia, grave disturbances of digestion, vomiting, diar rhoea, cutaneous eruptions, pallor, and anaemia. Although rarely prescribed before the age of two or three years, re course may be had to it even in a nurs ling who has asthma, pulmonary tuber culosis, leukiemia, or pseudoleuktemia, or chronic malarial affections, heredi tary or acquired. In older children the indications for arsenic become more nu merous, but, as is the case with adults, arsenic should not be given in cases with nephritis, albuminuria, gastro-intestinal dyspepsia (with diarrhoea, vomiting, etc.), or in the acute infectious diseases.
The drug accumulating in certain vis cera, the administration should be sus pended for eight to ten days after fifteen days' use. Arsenic being very irritating to mucous membranes, it should be given well diluted. (Comby.) BLOOD DISORDERS.—After the prep arations of iron, arsenic is the best remedy we have in the treatment of uncomplicated anmmia. In pernicious anmmia it is far superior to iron; in fact, the latter remedy sometimes proves hurtful. In and pseudoleu kternia it is also very beneficial.
Report of 21 eases of anmmia success fully treated with arsenic: Ten recov ered without recurrence; 5 had one re lapse; 4 two relapses; and 2 six relapses. Of these recurrent cases, 4 were well at the time of report and 7 died during the relapse, generally from some compli cation. In leukaemia and pseudoleu kxmia the results were not so satisfac tory. Arsenic is as much of a specific
in pernicious ancemia as mercury is in syphilis. Warfyinge (Trans. Eleventh Inter. Med. Cong.. '94).
New organic arsenical compound whicn obviates the unpleasant effects of the cacodylates and yet secures equal benefit. Such a substance has been found in arrhenal, or disodic methyl arsenite. This drug can be given by the mouth or subcutaneously, it has no odor, and is almost tasteless. It does not provoke nausea, eructations, garlic odor of the breath, dyspepsia, or renal trouble (albuminuria), and is thus su perior to the cacodylates. The author has extensively used it with successive paludism, tuberculosis, chorea, bronchial asthma, leukemia, and adenopathies. as well as in skin affections, for which arsenic has hitherto been prescribed. The dose for an adult should not ex ceed 15 centigrammes (or, in rare in stances, 20 centigrammes) per day. A dose of 2 to 5 centigrammes thrice daily gives the maximum action, especially in tuberculosis. Gautier has also given it with success in hepatic congestion and cirrhosis, and in eases of intestinal and pulmonary hremorrhage, but in the lat ter eases the dose should be small. The method of administration should gen erally be to give the drug for five to seven days continuously; then it should be stopped for an equal interval, and resumed as before. Gautier (Comptes rendus de l'Acad. de Med., Feb. 25, 1002).
CH0HEA.—In this disease arsenic has earned a well-deserved reputation; but the drug must be rapidly pushed to the point of tolerance. Then the doses are gradually decreased, so that at the end of ten to fifteen days the child is satu rated with arsenous acid and frequently cured thereby.
Experience has confirmed the value of arsenic as a specific in chorea. It should be rapidly pushed, increasing the amount by 3 minims per dose, t. d., every five days, until a child of ten years is taking 35 minims, d., or until vomiting is produced. In chronic eases arsenic in large doses rarely fails to cure when the drug in small amounts has proved use less. It is also serviceable in the grave chorea of pregnant women. J. Sawyer (Birmingham \fcd. Review, Jan., 'SS).
When arsenic is badly borne by the stomach it may be administered hypo dermically. For this purpose Fowler's solution should be regarded as ineligible because of its irritant properties.
The local irritation following the hypodermic injection of Fowler's solu tion is due to a small quantity of free arsenous acid in this preparation. It may be avoided by using a pure, anhy drous solution of arsenate of sodium, which was found more beneficial than any other remedy in twenty-eight cases of chorea. II. N. Moyer (Jour. Amer. Med. Assoc., Oct. 7, '93).
Large doses of arsenic have a beneficial influence in subduing the movements, and this is best seen after the movements have existed for some time,—weeks or months,—that is, when a cure seems al most hopeless. The drug should be given after food, and the little patient should lie down for half an hour afterward in order to avoid nausea and vomiting. Walker Overend (Lancet, July 31, '97).