This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
Not only in chronic inflammation, but in ulceration of the mucous membrane of the stomach, I have seen very beneficial results from arsenic, the appetite returning, and the thirst, the vomiting, and the pain subsiding, so that the patients became strong and stout who had before been weak and emaciated. Dr. Ringer has observed similar results, and states that he has seen relief from this remedy in chronic ulcer after failure of the more commonly-used medicines (Op. cit., p. 253).
I usually prescribe 1 to 5-min. doses four times daily with a little nourishment.
Acidum arseniosum: dose, 1/60 to 1/12 gr. in solution or pill. Liquor arsenicalis - Fowler's solution (4 gr. in 1 fl. oz.): dose, 2 to 8 min. Liquor arsenici hydrochloricus (4 gr. in 1 fl. oz.): dose,
2 to 8 min. Sodoe arsenias: dose, 1/16 to 1/8 gr. Liquor sodoe arseniatis (4 gr. in 1 fl. oz.): dose, 5 to 10 min. Liquor arsenici et hydrargyri hydri-odatis (not officinal): dose, 10 min. to 1/2 fl. dr., diluted, and given with the usual precautions for preparations of arsenic. Ferri arsenias: dose,
1/16 to 1/2 gr.
Liquor arsenicalis, if long kept, is liable to vary in strength on account of the deposition of a thin film of metallic arsenic; the compound tincture of lavender contained in it is nauseous to some palates, and would be better omitted.
The solution of chloride is liable to become cloudy in warm weather, from the development of a fungus: this may be prevented by the addition of a little perchloride of iron (Hunt).
In acute or subacute maladies, as of the stomach or intestine, small doses, 1 or 2 min., either every hour, or every four or six hours, are suitable; in chorea, or neuralgia, or struma, where there is no visceral irritation, the dose may be gradually raised to 10 or even 15 min., and in chronic conditions of ague, or of cutaneous disease, the secret of success will be found in securing the tolerance of a moderate dose for a considerable time.
In agues, it is true that a large dose may be required, and may be well borne during a certain condition of the system, but so soon as that condition is relieved the large dose cannot be tolerated.
In skin diseases, large doses are never desirable, and any increase beyond 4 or 5 min. should take place only after this dose has been used three or four weeks without physiological symptoms. This remark refers especially to the potash and to the acid solutions, not to that of the ar-seniate of soda, for although nominally of the same strength, the last-mentioned is markedly milder, and is often better borne in doses of 6 to 8 min., or more, than the others in less quantities. The remedy, sufficiently diluted, should always be given in several such moderate quantities daily, rather than in one full dose, and always at a meal, or with some food, so as to secure absorption and lessen the degree of local irritation; the symptoms of its physiological action, such as irritation of conjunctivae, oedema, nausea, etc., should be constantly watched for, and the dose diminished rather than entirely omitted, if the reason for its administration remain.
In some obstinate cases, especially of chorea and of skin disease, it is justifiable and not harmful to keep up a moderate degree of physiological action for some time, but this must be done very cautiously. It is a matter of daily experience that the secretions must be in good order if we are to expect the full advantage of the remedy in chronic disease. Mr. Hunt observes, "Above all, the bowels must not be allowed to act sluggishly. In many cases a full dose of calomel and compound colocynth pill will be required two or three times a week, and these doses are sometimes essential to the cure. If the legs, or feet, or abdomen become oede-matous, and the urine scanty, the case will not go on well till we have roused the kidneys to vigorous action by full doses of spiritus aetheris nitrosi and acetate of potash, etc." (Journal of Cutaneous Medicine, ii., p. 353).
The administration and the powers of arsenic in combination with other remedies require special consideration. We have already noted that it enhances the value of iron, for instance, in amenorrhoea, anaemia, struma, eczema, etc., and Messrs. Young and Postans have introduced a good effervescing citrate of arsenic and iron, which I have often found serviceable. The direct combination of iodine and arsenic has been esteemed by some practitioners on the Continent and in Ireland, especially by Neligan: from 1/10 to 1/4 gr. in pill thrice daily has been given. The same physician employed also an ioduretted solution, containing 5 min. of Fowler's solution, 1 gr. of iodide of potassium, and 1/4 gr. of iodine in 1 dr. of orange syrup; it is rather agreeable, and keeps well, and has given good results. He found this preferable to Donovan's solution (Dublin Journal, vols. xvi., xviii., xxii.), (v. p. 27). This has been specially used in syphilitic skin disease, but it is, as Mr. Hunt observes, though "very active, yet a most unmanageable preparation." The mercury is liable to injure the general health of some weakly subjects, and to interfere with the effects of arsenic or of iodine, which are quite powerful enough, and require special caution as to their own effects. Dr. Clemens, of Frankfort, recommends a direct combination of arsenious acid and bromine, and Ferris and Co. prepare a liquor arsenici bromati.
[Preparations, U. S. P. - Acidum arseniosum; Arsenici iodidum; dose, 1/50 to 1/10 grain; Arsenicum; Liquor arsenici chloridi; dose, 2 to 8 minims; Liquor arsenici et hydrargyri iodidi; dose, 2 to 10 minims; Liquor potassii arsenitis - Fowler's solution; dose 2 to 8 minims.]