Arsenicism.

Synonym.—Chronic Arsenic Poisoning.

Definition.—A chronic intoxication caused by the continued absorption of arsenic.

Etiology.—Although a few cases result from eating arsenic for its exhilarating or narcotic effect, or to improve the complexion and to add brilliancy to the eyes, the great majority of cases are due to the slow absorption of the drug by persons employed in the industrial world, where this drug occurs.

Thus arsenical pyrites are found in silver, tin, copper, cobalt, and nickel ores, and, in the reduction of these metals, large quantities of arsenic is liberated, and the workmen exposed to it are poisoned. The use of Scheele's or Schweinfurth green by dyers, wall-paper workers, and artificial flower makers, is not an infrequent cause. Workers in glass, shot-makers, and taxidermists, also, are liable to arsenic poisoning.

Extremely susceptible individuals may be poisoned by living in rooms where the carpet, wall-paper, draperies, ornaments, toys, etc., are colored with arsenic dyes. The disease may also be incurred by the administration of Fowler's solution.

Pathology.—Degeneration of the peripheral nerves similar to that occurring from lead is found, and occasionally the anterior horns of the spinal cord undergo the same changes.

Symptoms.—The most characteristic symptoms of arsenic poisoning are anemia, catarrhal symptoms, cutaneous eruptions, and those due to neuritis. The patient gradually assumes an ashen-gray or white color, with loss of flesh and strength, the anemia being" of the chlorotic type. The eyelids become puffy, especially when the poison is due to Fowler's solution..

Catarrh of the upper respiratory passages is common, coryza being a chief symptom. Gastro-intestinal catarrh is manifested by nausea, especially by pain and diarrhea. Cutaneous eruptions are common, such as urticarial, eczematous, herpetic, and pemphigoid. A bronze pigmentation is sometimes seen. The most characteristic symptoms of arsenic poisoning, however, are those arising from neuritis, and as a rule are more marked in the leg extensors and peroneal muscles. There may be, in the earlier stages, a hyeresthesia of the nerve-trunks and muscles, followed by perverted sensibilities (paresthesia), the patient experiencing a numb, tingling, or crawling sensation, to be finally replaced by anesthesia.

Paralysis of the lower muscles is frequent, and rapid atrophy of the muscles may take place. The sphincters of the rectum and bladder are not usually affected.

Diagnosis.—The history of the source of poisoning, together with the characteristic symptoms already noted, render the diagnosis comparatively easy.

Prognosis.—Although a chronic affection, the disease is generally amenable to treatment.

Treatment.—A removal from the exciting cause, such as change of occupation or withholding the drug, is, of course, absolutely necessary. Gastro-intestinal irritation will be relieved by small doses of ipecac, bismuth subnitrate and mint-water, peach-tree infusion, and remedies of a sedative nature.

As soon as the hyperesthesia is overcome, electricity and massage will be beneficial for the neuritis and paralysis. To eliminate the arsenic, iodid of potassium is regarded as a specific. The nourishment should be liquid, bland, and easily digested.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.