Even if arsenic is not a physiologically necessary constituent of the body, still frequently traces are found in the normal and it is remarkable that the thyroid seems to be the depot while the skin and accessory structures are excretory sites with definite affinity.
When we speak pharmacologically of arsenic we always mean arsenious acid or its anhydride As2O3, (H3AsO3)2 – 3 H2O arsenic trioxide. It appears in an amorphous or crystalline form. The arsenites correspond to the phosphites and they stand in the same relation to arsenates as phosphites to phosphates. Qualitatively the arsenates, also the AsO4 anion, have the same action as the arsenites but the toxic manifestations with the arsenates appear much more slowly, a property which closely recalls the behavior of the oxidation steps of phosphorus.
The toxic action of arsenic acid is much less than that of arsenious acid. It has even been assumed that the arsenates can only unfold a toxic action by reduction to arsenites. If arsenic acid is introduced into the body then it is reduced to arsenious acid. H. Schulz and Binz proved that this reduction does not occur outside the body, that is, not with chicken protein by itself. If arsenic acid is injected subcutaneously then it is reduced to arsenious acid and the 66 Percent or more is excreted through the kidneys. The toxicity of arsenious acid to arsenic acid should be in a ratio of 10:6. Apart from the small intestine, the liver is said to particularly participate in this reduction. One has made the easily split out hydrogen of the SH group responsible for the reduction. In any case the danger in arsenites is that they will not be oxidized to arsenates in the body, while phosphites will be transformed to phosphates.
In the body the arsenic is probably combined to the nucleins. At least arsenic combines with the liver nucleins in a very stabile compound which is easily split by acids or through alkalies. In the blood arsenic is bound by absorption to the blood corpuscles for the most part.
It has been assumed that arsenic can appear in place of phosphorus in its physiologic compounds, especially in calcium phosphate of the bones, in the phosphatides, and the phosphorus- containing nucleins and in this way can be deposited and unfold its toxic action upon the cells. As yet the substitution has not been proven. But in any case the chemical similarity of phosphorus and arsenic stands so close even in their pathologic effects that one can consider arsenic as a dangerous double of the physiologic phosphates. Its toxic actions are remarkably similar to those of imperfectly oxidized phosphorus; as a protoplasmic and capillary poison especially in the acute actions, as nerve and bone poison in the more chronic poisonings. The conjecture seems likely that arsenic unfolds its destructive action just as unoxidized or incompletely oxidized phosphorus along the track of the physiological phosphates.
In arsenic poisoning the liver and kidneys contain the most arsenic; then follow muscles, bones, brain. In acute poisoning it remains longest in the bones, in chronic most in the liver although it will be found even longer in the skin and its appendages; the spleen likewise takes up relatively large amounts, the heart muscle more than skeletal muscle.
The excretion of arsenic occurs through the kidneys, the gastro- intestinal mucous membrane (also after parenteral administration) the bile, the milk glands, the sweat glands, the skin and epidermoidal structures (hair, nails).
The local actions of arsenic on the mucous membrane must be considered as inflammation and slow necrosis. Because arsenious acid lacks the chemical properties for a characteristic corrosive action, that is protein precipitation. The necrotizing cell actions are used for the destruction of dental pulp. The epithelial mucous membrane alterations by arsenic (protoplasmic atrophy, vesicular turbidity of the cell nucleus; finally the entire cell becomes a homogeneous transparent mass, leucocytic infiltration and serous imbibition) appear only gradually after some hours. The turbidity of epithelium has also a capillary, inflammatory cause which leads to cell death from saturated solutions of arsenic.
By subcutaneous injection one can effect suppuration and tissue necrosis with dilute solutions. Repeated application to the external skin can provoke an eczema.
Arsenic can destroy any cell of the human organism which it reaches in sufficient concentration. But only the acute or chronic introduction practiced in the favored manner makes the series of results and the intensity of the disturbing actions comprehensible.
ACUTE POISONING
The action in an acute poisoning is greatly dependent upon the form of the arsenic introduced. Thus it is observed that horses die in a definite time after the ingestion of 2 grams of the dissolved and only after 64 grams of the solid form of arsenious acid. First it arts a marked local irritating action on the part of the mucous membrane with which it comes in contact. If the poison is taken into the empty stomach in an easily absorbed form then stormy manifestations soon appear. Dryness, severe burning in the mouth, in some a metallic taste are noted. “The poisoned are overcome by a cold paroxysm, an intolerable anxiety, vomiting, oppression in the chest, a cold agonizing sweat on the forehead and a general trembling of the extremities alternating with one another. The most severe pains are felt throughout the entire digestive tract, salivation, soon vomiting which is at first colored green due to the admixture of bile, but later may contain some streaks of blood and diarrhoea. The liquid stools are bloody or like rice water, marked tenesmus is added. The abdomen is at first retracted then distended. Severe thirst with great dryness of the mouth, esophageal spasms may appear; the uvula swells and aphthous ulcerations are observed on the tongue and oral mucous membrane. The face becomes cyanotic, the eyes encircled with dark rings, puffy, the skin, in particular the hands, feet and tip of the nose, become cold. In the calves and hands severe spasms occur. The pulse is accelerated, small, and thready. There is precordial anxiety. “The unspeakable anxiety and the burning, tearing overwhelming pain at the pit of the stomach torments with increasing severity”. Respiration is labored, the patient collapses and the sweat may smell like arseniuretted hydrogen. If the course is longer owing to slower absorption or smaller doses then the vomiting is repeated every day or two, esophageal complaints, boring gastric pain, unquenchable thirst, petechial hemorrhages and mucous membrane aphthae appear. Erythema, eczema, urticaria-like skin eruptions are observed after internal administration. They usually involve the face but may occur on the entire body. It may result in extensive desquamation and loss of hair. Icterus is also observed. Finally there is jactation, delirium, loss of consciousness. The urine is scanty, bloody and contains albumin; death occurs with convulsions and trismus. With very large doses a severe even fatal collapse may occur within 12 hours after the administration or even sooner, or the cholera- like picture of asphyxia arsenicalis may be seen. In other cases the cerebrospinal symptoms stand in the foreground: vertigo, stupefaction, head and body pains, anesthesia and paraesthesia partial paralysis.
CHRONIC POISONING
The chronic poisoning may progress in various stages without the picture always being a complete one. Increased salivary secretion is often an early symptom; the bronchial secretion is also increased and tenacious. The patient emaciates, the facies often presents a greydun color, at times is somewhat icteric and more rarely bronze-like, or, particularly in brunettes darkly pigmented “spots”, “arsencial melanosis” are noted. Petechial hemorrhages appear. Angina is often encountered and with it a mild conjunctivitis even from the first doses. The gums are lividly discolored and bleed easily. The skin becomes dry, desquamates, erythema appears, the hair, nails and teeth may fall out. Vasomotor disturbances appear in the form of marked sweating of the hands, legs and feet and there is is light cyanosis of the upper and lower extremities. Trophic disturbances with gangrene are rare. The patient complains of vomiting, unpleasant taste in the mouth, headache, burning in the palms, yellow discoloration of the eyes, gastric pressure, constipation or at times bloody diarrhoea; they feel weak and prostrated. The appetite disappears entirely, mild febrile attacks occur paroxysmally or there is a feeling of fever without increased temperature, dull headache, a sensation of vertigo, pressing pains over the eyes, some nocturnal insomnia, and old rheumatic complaints may again become manifest. The patient is depressed without reason, cries easily and is easily irritated.
The mucous membranes coming into immediate contact with arsenic reveal chronic catarrhal states: coryza with dryness of the nose, laryngitis with hoarseness, bronchial catarrh, conjunctivitis, oedema of the lids, blepharadenitis, also otitis media by progression of the pharyngeal catarrh to the tubes and middle ear. The bones may also be drawn into involvement. Lewin mentions (Eulenburg’s Encyclopedia) a man who worked in an arsenic factory for 34 years. In his markedly reddened and thickened nose the septum was destroyed, the entire mucous membrane was converted into an ulcer, the left and right turbinates were covered with ulcers and crusted; a fragment of the superficially necrotized vomer was removed as a sequestrum. More rarely a joint inflammation appears. H. Schulz mentions one on himself in that he suffered from an arthralgia of the ankle after working for a long time with arsenic.
Leeser, a Consultant Physician at the Stuttgart Homeopathic Hospital and a member of the German Central Society of Homeopathic Physicians, fled Germany in 1933 after being expelled by the German Medical Association. In England Otto Leeser joined the staff of the Royal London Homeopathic Hospital. He returned to Germany in the 1950s to run the Robert Bosch Homeopathic Hospital in Stuttgart, but died shortly after.
Otto Leeser wrote Textbook of Homeopathic Materia Medica, Leesers Lehrbuch der Homöopathie, Actionsand Medicinal use of Snake Venoms, Solanaceae, The Contribution of Homeopathy to the Development of Medicine, Homeopathy and chemotherapy, and many articles submitted to The British Homeopathic Journal,