1. The bowels should be well cleared out by a purgative, previous to commencing a course of Arsenic.
* Chambers' Edinburgh Journal, Dec. 20, 1851.
Principles of Forensic Med. p. 466.
2. It should never be taken upon an empty stomach: directly after a meal is the best time for its administration.
3. It should always be commenced in small doses, and given with the greatest regularity, at stated times.
4. During its employment the eye of the patient should be examined daily; if the eyelids and conjunctiva become inflamed, the medicine should be discontinued or suspended.
5. When the urine is high-coloured and scanty, with lithate of Ammonia sediment, the tongue loaded, especially at its tip and edges, the medicine generally disagrees, and aggravates the symptoms; but it is often useful, when the visceral disorders, on which these symptoms depend, are removed.
6. When, under its use, the urine, from being pale and copious, becomes scanty, acid, and high-coloured, the medicine should be suspended.
7. If cough and other symptoms of bronchial irritation arise during the use of the remedy, it should be omitted.
8. If there is a sensation of swelling and stiffness of the palpebrAe and face; heat, tenderness, and itching of the tarsi; or tenderness of the mouth, - these may be considered as indications that the remedy has been carried as far as it can with safety.
9. During a course of Arsenic, it is advisable to omit its use for a day or two, every fortnight or three weeks, and to exhibit a mild aperient, in order to prevent the remedy from accumulating in the system.
(Some further rules for the Administration of Arsenic, by Mr. Hunt, will be found in the section on Skin 'Diseases.)
Externally, it should never be applied to a large ulcerated or denuded surface.
In Intermittent and Periodic Diseases, Arsenic holds a high place. It has maintained its character for centuries amongst Eastern nations; and its efficacy has been attested in England by Drs. Fowler, Arnold, Withering, Brown, and others. The Tasteless Ague Drop, so long celebrated in England, is a solution of Arsenic. It ranks next in value to Quinine, over which it has the advantages of being of a less disagreeable taste, and of being cheaper. Dr. Chappie,* as the result of his experience with this agent in the treatment of the Intermittents of India, remarks that when the fever is uncomplicated, the attack well marked, and the medicine administered in sufficient doses, Arsenic will generally prove as efficient an anti-periodic as Quinine. Sir Ranald Martin, speaking of the treatment of old cases of Intermittents chiefly from tropical countries in which Quinine had been previously used and failed, often employs Arsenic, and characterises it as "indeed a noble remedy." Dr. Adamson considers the powers of Arsenic to be greatly increased by the addition of the Sesquicarbonate of Ammonia (grs. v. ad Liq. Arsenicalis evi., Aq. fj.) repeated every two or three hours, according to the frequency of the paroxysms. It may either be given in substance, or in the form of Liquor Arsenicalis; the dose of the former is from 1/12 to 1/8 of a grain; of the latter, from ij.to viij. or x. drops, twice or thrice daily. When one preparation fails, the other is sometimes successful, and it is often productive of the best effects, when Bark or Quinine has proved ineffectual. Amongst the most modern and strongest advocates for Arsenic, in this class of diseases, is M. Boudin,* the late Physician-General of the French troops in Algeria. We give his extraordinary evidence in its favour, in his own words: - " I am assured," he says, "by successive trials, which have been repeated with similar results, by many physicians at Marseilles, that Arsenious Acid, properly prepared, preserves, in the somewhat microscopical doses of the hundredth of a grain, all its medicinal energy not only in marsh-fevers, but also in a multitude of other diseases. Further, I have obtained, from 1/100 of a grain of this remedy, the entire removal of fevers contracted in Algeria and Senegal, and which had previously resisted means of various kinds, including the Sulphate of Quinine, and change of climate. * * * I have been able, in a great number of cases, and by very small doses of Arsenious Acid, to put an end, in a short time, to Quotidian, Tertian, and Quartan fevers, contracted in latitudes the most various, often complicated with chronic enlargements of the abdominal viscera, and which were incurable by the Sulphate of Quinine." Of 266 cases, of which he kept note, 181, containing fevers of all kinds which had not undergone previous treatment, were cured by Arsenic; 57, which resisted Quinine, were likewise cured by it; 13, which resisted Arsenic, were cured by Quinine; and 8 resisted both remedies. He considers it an important point to administer the remedy five or six hours before an expected paroxysm; he does, not give it if the fever be complicated with bilious or inflammatory disorders. He prefers Arsenious Acid to all other preparations of the metal In Intermittent Mania M. Moreau found Arsenical preparations more successful than Quinine.
* Med. Times and Gaz., March 2, 1861.
On Trop. Dis., 2nd Ed. p. 343. Edin. Med. Journ., May, 1862.