For the employment of arsenic in chest diseases we may go back as far as Dioscorides, who states that "sandarach" (probably the sulphuret) "is given to patients suffering with lung-suppuration, and mixed with resin is inhaled in vapor for obstinate cough." Dr. Bed-does used it early in this century, and recently the value of the drug in certain stages of tubercular phthisis has attracted renewed attention. Herard and Moutard-Martin have especially recorded good results from it in relieving the lung-congestion and the general pyrexia of early stages; at the same time the latter physician observes that it is most efficacious when phthisis assumes a slow torpid course, acute tuberculosis not being modified by it. "It has a reconstituting action, and modifies secondarily the pulmonary lesion" in suitable cases (Lancet, i., 1868).

Before suppuration of tubercular deposits has taken place, I have found arsenical solution in 2 or3-min. doses, three times daily, give particularly good results; it is well to combine it with a course of cod-liver oil and change of climate, and it should be continued for weeks or even months if possible. I agree with the account given by Isnard (which is still more favorable), for he found it relieve profuse sweatings, improve appetite, and promote in some favorable cases not only healing of cavities but absorption of tubercle (Bulletin de Therapeutique, t. lxxvii.). It controls diarrhoea in these cases in a very marked way.

Cersoy traces to arsenic an effect which has been also attributed to it in bronchitis, and which really accords with what we know of its physiological action - viz., the lessening of congestion both in the bronchial mucous membrane and in peritubercular lung-tissue; thus he finds that it benefits haemoptysis (Gazette des Hopitaux, 1869). Prof. Stille thinks it probable that any benefit conferred in phthisis is due to an influence upon the accompanying bronchitis.

Massart is almost alone in his recommendation of an arseniate of gold, which, in doses of 1/10 to 1/3 gr., he found useful even in advanced cases (Revue de Therapeutique, 1860, p. 21). The general opinion of French observers, however, would restrict the value of arsenic to early stages, or to the relief of certain symptoms: thus Nouat agrees as to the good results of 1/70 to 1/30-gr. doses given early in the malady, and finds that in later stages, especially in the cases mostly seen in hospital practice, benefit is exceptional (Lancet, i., 1870); and Trousseau, while recording improvement as to diarrhoea, hectic, expectoration, and cough, does not speak of cures, but of the gradual development of the malady and the formation of fresh tubercle. He prescribed cigarettes containing arseniate of soda, and pilules of arsenious acid.

I do not find many English observations on this subject, nor has this medication for phthisis been generally adopted among us. Dr. Williams says, "I have tried it only to a limited extent.....It has only seemed to be useful in chronic cases with asthmatic or cutaneous complication, but well deserves further investigation" ("Pulmonary Consumption," p. 362). Dr. Ringer suggests that allowance must be made for a natural improvement in some forms of phthisis, but has himself seen instances of recovery under its use "in children with general tuberculosis," and "in adults suffering from subacute and chronic forms." He corroborates also, to some extent, the statement that it will reduce temperature (Handbook). Dr. Sanger reports, from the convalescent hospital at Seaford, favorable results in a large number of phthisical patients to whom he gave 5-min. doses of Fowler's solution, but he generally combined it with iron or hyposulphites (Lancet, i., 1869). Dr. Leared based a favorable opinion upon observation of nine cases, but finds the remedy "trying to the digestive system" (Medical Times, i., 1863), and this I believe to be a very common result owing to the dose prescribed being too large. Dr. Bartholow, without offering detailed evidence, affirms that "we have no single drug of equal utility in the chronic forms of phthisis, but it is not" serviceable in caseous pneumonia .... neither is it beneficial when much hectic is present with rapid disintegration of pulmonary tissues."