It is now clearly ascertained, though the knowledge is comparatively recent, that all the serious symptoms already described may be produced, in greater or less degree, by arsenical emanations from wall-papers and paints, hangings, dresses, ornaments, etc.; and not only from the green colors containing arsenite of copper, and which have long been suspected, but also from red, drab, blue, gray, and enamel papers generally (British Medical Journal, ii., 1871), and from aniline colors fixed by arsenical mordants in carpets, curtains, etc. (Taylor: "On Poisons," 3d Ed., p. 353). Soon after the earliest observations on the subject, in 1858, Mr. Phillips (the chemist consulted by the Board of Trade) stated that a more than bearable heat would be required to volatilize arsenic, but Fleck has pointed out that the contact of moist organic substances (such as sizing) readily disengages arseniuretted hydrogen from Schweinfurt green (Zeitschrift fur Biologie, Bd. viii., 1872), and Hamberg has verified its presence in the air of rooms (Pharmaceutical Journal, August, 1874). This gas is a very powerful poison. Gehlen, the chemist, was killed by a small quantity, and in some recent cases it caused severe epistaxis, haematuria, and jaundice (Comptes Rendus, 1863; Gazette de Paris, No. 18, 1873). Usually, however, the injury is done by material particles of arsenical dust (Chevalier: Annales d'Hygiene, vol. xii., p. 49). Some time ago I met with many cases of catarrh, irritation of mucous membrane, etc., which proved to be due to this cause, and I can quite corroborate the observations made by Mr. Clarke, of Bristol (in a careful paper in British Medical Journal, i., 1873), who finds that in one set of cases dyspepsia, nausea, sore throat, and conjunctivitis are the prominent symptoms, while in another nerve-troubles, headache, irritability, prostration, and restlessness are more complained of, though dyspepsia, and especially coated tongue, are not absent; in a third group the prostration, headache, and nervous excitement simulate a mild typhoid. He records violent sneezing, and also an eruption of eczema and of nasal ulceration as exceptional symptoms, and further points out that a case of ordinary illness may be much aggravated by an arsenical atmosphere, and that some patients are much more sensitive to it than others. Arsenic was detected in the secretions of several of Mr. Clarke's patients. The symptoms are generally worse in a damp atmosphere, and in the evening when the room is heated. Dr. Hinds describes "depression, faintness, nausea, and colic," after reading by gaslight in a green-papered room (Medical Times, 1857). Mr. Whitehead reports similar symptoms in a youth every time he occupied a certain bedroom only (British Medical Journal, 1858).

The real cause of chronic ill-health may be long unsuspected, and a striking case is related of the simulation of various forms of disease in one family for upward of twelve years before their true cause was discovered in arsenical wall-papers (British Medical Journal, ii., 1871). Dr. G. Johnson has reported the case of a medical practitioner, in whom chronic dyspepsia, catarrh, cough, and even asthma were due entirely to the same agency (Medical Times, ii., 1874). Similar symptoms have followed, though less frequently, from painted walls, gas-shades, etc. (Basedow, in Monthly Retrospect Medical Science, 1849; New Sydenham Society's Year Book, 1860, etc.). Dr. F. Brown (Boston) has reported several interesting and important cases of chronic illness from arsenical paints and wall-papers: he notes that most of the patients had increased in weight (Boston Medical and Surgical Journal, 1876). Some years ago arsenic was purposely used for clarifying candles, and thus serious effects were produced, which still sometimes follow the use of candles colored green. Arsenical poisoning has occasionally occurred from cigars (New Sydenham Society's Year Book, viii., p. 432), and from green cigar-holders (British Medical Journal, i., 1879). Mr. Jabez Hogg has drawn special attention to eye-inflammation from arsenical papers and to other illnesses produced by them (Sanitary Record, April, 1879).

Synergists

Antimony is the most complete analogue of arsenic, except that the former is a more certain emetic: phosphorus also is allied in action.

The effect of small doses, upon the nervous system especially, is allied to and supported by quinine and by alkaline bromides, while the tonic influence of similar doses on the vaso-motor nerves (leading to contraction of vessels, at least temporarily) is allied to that of acids, astringents, ergot, and cold applications. Doses sufficient to lessen oxidation and combustion act somewhat like cyanides and other substances which prevent these processes.

Antagonists - Incompatibles

Diffusible stimulants, alcohol, warmth, and, according to Gubler, opium, are the vital antagonists to arsenic. Iron, in the form of hydrated peroxide, magnesia, calcined or as hydrate, lime, animal charcoal, and astringents generally, are chemical or mechanical antidotes. Iron and magnesia have power over arsenic in solution, since they precipitate the poison in an insoluble form; with solid arsenic "they have no more effect than powdered brick-dust" (Taylor). A mixture of hydrate of magnesia and persulphate of iron is best to use, and the resulting sulphate tends to act on the bowels. The "antidotum arsenici" of the German and other Pharmacopoeias contains calcined magnesia 7 parts in 120 of water, solution of persulphate of iron (sp. gr. 1318) 60 parts in 120 of water: the two parts to be kept separately and mixed at the moment of administration. Pure dialyzed iron is not antidotal, but according to Mattison becomes serviceable if salt be added to it (Medical Record, 1878), since this precipitates a hydrate.

In cases of poisoning, vomiting should be produced and promoted as early as possible, by ipecacuanha or zinc sulphate: nor is antimony so undesirable as has been stated; many cases have recovered under its use (Morgagni, and Gazette des Hopitaux, August, 1844, etc.), also after infusion of tobacco (Medical Times, i., 1857). Milk and demulcent drinks containing, e.g., eggs, flour, or fats, should be given, and large frequent doses of any of the antidotes named, a tablespoonful of the iron compound every five to ten minutes (British Medical Journal, ii., 1863).

Therapeutical Action (External)