On the conjunctiva exactly the same situation prevails. The burning and acrid lachrymation are guiding. Blepharitis with chronic reddened, swollen, desquamating lid borders appear at times and corneal ulcer frequently comes into consideration for arsenic. On account of the trophoneurotic effect character one would think of arsenic first in herpes cornea.
On the female sexual organs are septico-ulcerative inflammations with burning, thin, acrid, corroding offensive leucorrhoea the chief indication. The inflammation can also proceed from the ovary and there is a burning pain in the ovarian region and a tendency to profuse and too early menses and to metrorrhagia. The relation to carcinoma of arsenic is naturally important for this organ.
Arsenic is suitable not only for the already mentioned severe organic states of the heart with insufficiency and arrhythmia but also for milder disturbances such as precordial anxiety, worse, at night, palpitation with restlessness anxiety and loss of strength in vasomotor lability.
The tendency to oedema in the arsenic picture will be ascribed not only to myocarditis and nephritis but also to the direct influence on the capillaries which leads to greater permeability. In nephritis it is also the acute and subacute forms proceeding from the capillaries which are suitable for arsenic.
Likewise on the skin we know a stepladder of chancroid and septic manifestations (toxic erythema, malignant eroding ulcers with stinking secretions, carbuncles) to the more trophoneurotic ulcera cruris and herpes zoster and finally to vasomotor-allergic states as urticaria with burning pain and great restlessness. For the more chronic action we recall the frequent presence of arsenic in the ectodermal structures and its excretion through these which shows the affinity perhaps more obviously than in phosphorus. In particular it proves itself as suitable in dry, desquamating skin processes, hyperkeratosis up to ichthyosis and psoriasis (for all these ars. iod!). Furthermore lichen ruber is an indication for arsenic in both schools. In the chronic poisoning the hyperkeratosis involves outstandingly the palms of the hands and the soles of the feet. The itching in skin affections is characterized in arsenic by the aggravation from cold and scratching, which then passes into burning, falling out of hair, as occurs in phosphorus and phosphates is present, but not frequently used therapeutically.
Arsenic is an important remedy in diabetes. The influence demonstrated first by Hirata in regard to the islands of Langerhans is to be considered for explanation as well as the firm combination with the liver cells and the reduced sugar tolerance in arsenic poisoning. Precisely in the severe forms use is often made of arsenic. But especially in gangrene, phlegmon, carbuncles on a diabetic basis it deserves (besides secale which in contrast to arsenic has improvement from cold) great consideration. For me it has repeatedly given greatest services in the D 6.
NERVOUS SYSTEM AND MENTAL SYMPTOMS
In the nervous system the neuritides and neuralgias which appear in the picture of poisoning, are not rarely therapeutic indications. Polyneuritis, facial neuralgia, ciliary neuralgia, sciatica causing furious pain, worse from cold and contact, better from warmth and before all the periodicity of the pain, the midnight aggravation and the burning pain suggest arsenic. Extensive paralyses are scarcely suitable for arsenic. Flexor spasm, trembling, athetoid-like movements of the poison picture occasioned the earlier school use of arsenic in chorea which though not common in homoeopathy is considered homoeopathic. Headaches of a vasomotor type, improved by cold and keeping the head erect have already been mentioned. But also severe vasomotor paroxysms, periodically recurring, unilateral migraines with feeling of coldness or burning with great lassitude and restlessness should cause one to think of arsenic. But especially when the migraine appears as an equivalent of malaria, arsenic has proven itself for me, as in general, arsenic in periodic manifestations after malaria which have been treated by too much quinine, it is the most important agent. In malaria itself arsenic has been recommended from time to time outside of homoeopathy. Outside of the periodicity of the febrile attack, the destruction of blood and cachexia, the splenic swelling in arsenic poisoning to be sure hardly differentiating are parallel manifestations.
Of the mental symptoms the great anxiety and restlessness with fear of death stand in the foreground. The patient constantly changes his position. Doubt drives him from one place to another. In spite of fear of death there also exists the hopeless melancholi with tendency to suicide. The arsenic patient shows great sensitivity toward his own pain which makes him furious and moreover he is fussy and pedantic about disorder in the environment.
That the emaciation and cachexia, often predominating in the total impression in many severe morbid processes, underline the suggestion to arsenic is not surprising; in the acute toxic, states the facies is often hippocratic.
If one compares the picture of arsenic to that of phosphorus similarity of intermediate disturbances and the pathologico- anatomic end stages, the more septic, malignant, ulcerating, gangrenous character in all refer more to arsenic, moreover, the greater disposition to trophic and vasomotor disturbances. If with phosphorus one can indicate the inflammatory and cell degenerative actions still as morbid increases and reversal of physiologic phosphorus functions, then the greater malignity of arsenic may be ascribed to its body- foreign nature. If the hypothesis is correct though it is not proven as yet, that arsenic displaces phosphorus from its physiologic position, then from this the degenerations in its manner of action can be understood. In arsenic we cannot expect a constitution fixed from birth as from the life necessary phosphorus. But still from the endocrine side a certain orientation of the arsenic type of functional domain of the thyroid may be assumed. Because the thyroid plays the chief role in the control and regulation of traces of arsenic which stands very near to the physiologic; furthermore hyperthyroiditic men and animals are sensitive to arsenic (as for phosphorus). Likewise the finer arsenic effects will be suited much better for the hyperthyroiditic, oxygenoid type. Also without reference to the severe intoxications, the cardinal psychic symptoms, restlessness, anxiety, the vasomotor manifestations with tendency to fever, the emaciation proceeds out of this endocrine trend.
In all compounds the arsenic fraction determines the action.
Arsenicum iodatum: Ask3 is slightly stable and still insufficiently proven. Outside of the clinical indications mentioned on p. 279, the transient improvement in malignant lymphoma has been mentioned.
Cuprum arsenicosum, CuHAsO3, is often of value in uremic and eclamptic spasms in D 3 and has seemed favorable in preuremic states and in general anasarca even if not permanently. In severe gastro-enteritis it may be preferred to arsenic when the tendency to convulsions exists.
Natrium arsenicosum, NaAsO2, is recommended in severe inflammation of the nose and accessory sinuses with pressing pain at the root of the nose.
Kalium arsenicosum of approximately the following composition KAsO2, HAsO2 has been the cause of frequent medicinal intoxication as Fowlers solution, in which the skin manifestations, particularly the parakeratosis, stand in the foreground. In contrast, to arsenicum album it is said that the itching is aggravated by warmth. Kal. arsenic, is occasionally recommended in the lower potencies in severe oedemas of chronic nephritis or myocardial weakness in place of arsen. alb.
Calcium arsenicosum, Ca3(AsO3)2 was proven by Hering in 1848 (Jahr, New Manuel or Sympt. Codex. New York, 1852). Its use however occurs in general with the view of shaping the arsenic effect more persistently in deep chronic affections and rests on clinical indications: in malignant glandular tumors, mesenteric lymph gland swelling, liver and spleen swelling in children (in India); in chronic nephritis, when the kidney region is particularly sensitive; moreover in epilepsy with rush of blood to the head, pulsation and pain about the heart before the attack. Similar vasomotor manifestations should also suggest the remedy in fat women at the menopause.
Chief Trends: Parenchymal cells and capillaries.
Carcinoma, malignant ulcero-gangrenous process, septic embolic foci.
Toxic-like action: example: sepsis, cholera. Malignant angina, parenchymatous nephritis, myocarditis. Inflammation of all mucous membranes; gastroenteritis.
Protein destruction: fever, degenerative anemia.
Fatty degenerative changes in organs.
Cardio-Vascular syndrome:tendency to oedema. Great weakness and cachexia.
Diabetes. Results of malaria.
Trophoneurotic: neuritis and neuralgias. Ulcera cruris, herpes zoster, corneal ulcer, gastric ulcer. Diabetic and senile gangrene.
Vasomotor-allergic; asthma, hay fever, cardiac neurosis, headaches and migraine.
Steps of Intensity: Malignant-necrotizing; gangrenous-septic; inflammatory degenerative; trophoneurotic-vasomotor.
Mental Symptoms: Anxiety and restlessness.
Fear of death and still, hopeless melancholia with tendency to suicide.
Hypersensitive toward their own pains and fussy about disorder in the environment.
Guiding Symptoms and Modalities: Restlessness and anxiety (with great weakness).
Aggravation time 12-2 at night.
Great feeling of coldness, desire for warmth (particularly in acute states); gastro-intestinal manifestations better from warm drinks, worse from cold; in headache (vasomotor), improvement from cold and elevation of the head, aggravation from lying down. Itching worse from cold.
Great thirst, frequent but for small quantities (restlessness in acute states).
Burning pain, externally and internally.
Offensive, even cadaverous offensive, acrid secretions.
Arsen. alb. has often proven itself to me in the 6, 12, 15, and 30th potency. For the choice of the potency the above mentioned steps from destructive cell processes to vasomotor symptoms can be used as one guide. Still one sees immediate improvement in severe organic disease at times even from the high potencies.
Antimony compounds, particularly in the naturally occurring sulphide, served in antiquity as cosmetic for coloring the eyebrows and for the treatment of skin diseases and wounds. Even today antimony is used in the Orient in the treatment of the Bagdad boil. Paracelsus used it as a powerful arcanum. According to Latz of the seven arcena two are antimony preparations: Pulv. solaris niger and Pulv. solaris ruber. In 1604 Basilius Valentine published the work “Triumphal Chariot Antimonii” and extolled antimony in the French disease, eruptions, cancer, interment fever, asthma, gastric maladies, epilepsy, and melancholia. If the iatrochemists held the use of antimony extensive, then the Galenic were just the opposite. Physicians were excluded from their organization because they employed the very dangerous antimony. This fight in the school over antimony lasted approximately a century. In spite of the prohibition the Paris faculty favored the use of antimony as the so-called pox-salve for diversion to the skin, as an antiphlogistic, an emetic and expectorant. In 1836 an extensive study was published on antimony by Sachs (Professor in Konigsberg) but the use was infrequent. In school therapy at present the employment of antimonial preparations as expectorants or in larger doses as an emetic is not common. Recently antimony as Sb2O3 in analogy with arsenic has obtained chemotherapeutic significance in trypanosome and spirilla diseases.
CHEMICAL POSITION AND PREPARATION
Corresponding to its position between arsenic and bismuth, antimony (stibium), Sb, has a more marked metallic character than arsenic. Moreover antimony still has 2 allotropic modifications but the non-metallic yellow form is extremely unstable, so that only the metallic forms has significance. As a chalkophilic element antimony occurs predominantly as the sulphide especially as trisulphide, grey or black antimony, Sb2S3, more rarely also in solid form and as the trioxide, Sb2O3, white antimony.
Antimony oxide, SbO3, dissolves in acids to form salts, and is also a base forming oxide. In antimony there exists the possibility of being positively charged, an anion. But at the same time Sb2O3 also has the capacity in the presence of a strong cation to charge itself negatively and to be an anion in the form of SbO3 salts of metamonic acid SbO2H can be formed. With this property of being able to appear as a weak base as well as weak acid is associated the tendency to form complex salts.
The salts of the basic complex SbO + antimony are important for us, above all the potassium antimony tartrate, a double salt of tartaric acid. Tartarus stibiatus and tartarus emeticus, are other names for the same preparation. The other common antimony preparations are the naturally appearing sulphur compounds Sb2 S3 black or grey antimony our antimonium crudum and Sb2S5, red antimonium sulphide, our antimon, sulfurat, aurantiacum. Antimonium aresenicosum is a mixture of antimony pentoxide Sb2O5, with arsenic trioxide, As2O3.
The variability of these preparations constitutes a great difficulty in deminitely establishing the characteristic antimony effect. In general potassium antimony tartrate is regarded as the compound which comes the nearest to approximating a true antimony effect, since the antimony binding here is very loose. Experimental investigations have also been made largely with it. Spiro assumes that the slighter pharmacologic activity of antimony in contrast to arsenic is due to the greater stability of the complex compounds. But in other groups of the periodic system we also see that with an increasing heavy metal character, an element tends t become foreign to the body and with it the extent of action is limited.
ENTRANCE AND EXCRETION
Antimony compounds are absorbed from all mucous membranes as well as from the skin. Excretions occurs through the faeces, urine, milk, and bile. After parenteral administration the greatest part is excreted into the stomach and intestine. Antimony is obviously retained for a long time in the body and then is discontinued. Thereby it collects chiefly in the liver. In acute poisonings the kidneys and intestines are also found the sites of excretion.
In contrast to arsenic it is not possible to obtain an habituation with antimony; resorption is not lessened on persistent administration but rather increased. Therefore previous treatment with antimony seems to increase the sensitivity of the animal; this is connected with the slow excretion and absorption. Brunner found trivalent antimony much more active than pentavalent.
ACUTE AND CHRONIC INTOXICATION
Locally antimony compounds in soluble exert very strong irritant action on the skin and mucous membranes. On the uninjured skin the inunction produces a marked inflammation with follicular pustule formation which leave behind small pox-like scars. After the ancient use of antimony ointment on the hairy scalp, as the “pox-ointment” or martyr’s salve, gangrene of the scalp with periostitis and deep ulceration often occurred.
But skin manifestations are also observed from the internal use of antimony, particularly on the genitals, arms and back. They consist of pustules up to the size of peas which may arise from small red papules at the stoma of the gland follicles. Deep necrosis may occur form the internal use. Christopherson and Gloyne have observed a goose-like skin after the long continued injection of tartar emetic as well as the marked appearance of roughness, moreover, a leucoderma in the negro.
In poisoning by antimony vapors stupefaction and frontal headache appears, then chest symptoms, severe painful cough, partly dry, partly with tenacious sputum difficult to evacuate, and piping and rales in the chest. Then the gastro-intestinal symptoms pustules on the genitals were observed, finally great prostration decrease of sexual potency and swelling of the testes.
After the ingestion of toxic doses (maximal dose 0.2 gram pro dosi) pains in the mouth, a metallic taste, and aphthous-like vesicles or pustules on the oral mucosa are encountered. The lips swell. The patient complains of difficulty in swallowing. Nausea, vomiting, gastric and abdominal pain occur, the stomach and the hepatic region are particularly distended. There is increased salivation, then retching and finally vomiting of bile containing gastric contents. Simultaneously colicky abdominal pains appear, the stools become mucoid, the bile content often increases and many times in animal studies the stools are bloody.
Chilliness occurs, the face becomes pale, the throat rough, the voice fails, respiration is greatly impeded. The pulse is small, clonic and tonic spasms occur, the skin is cold and covered with clammy sweat. With vertigo, collapse and loss of consciousness, death occurs. The urinary output is lessened but not to the extent noted in arsenic poisoning. As effects incidental to intravenous injection immediately after or during the injection a slight redness of the face and slight feeling of oppression to respiration many times accompanied by an irritant cough. A metallic taste in the mouth is mentioned just as rapidly. Soon after the injection there are muscle pains, particularly drawing pains between the shoulders, in the upper arms, in the back muscles, with a feeling of stuffiness in the entire musculature, even in the muscles of the jaw. This sensation may persist 1-2 days and impair movement.
Outside of Nobiling’s study the actions on the respiratory passages have received little attention in German literature. Ringer, however, knew the increase of secretion in the bronchi after small doses in the sense of school medicine of antimon. tartar. as well as the good therapeutic results in catarrhs of the respiratory passages, particularly in children, with frequently repeated doses of 1 mg.
In acute poisonings in animals bronchitis and pneumonia have often been found. The anatomic findings in acute poisonings in the stomach and intestine as well as in the liver is exactly the same as in arsenic poisoning.
INVESTIGATIONS ON MAN
Concerning chronic antimony poisoning the best information is given by the older investigations on healthy men by Nobiling with tartar emetic and the studies of Mayerhofer with ant. sulf. aurant., Sb2 S3, whose experiments were long continued and arranged according to the method of homoeopathic drug proving. Less suitable are the more recent reports of Schrumpf and Zabel because they also include the alloy poisoning of typesetters in which lead as well as antimony participates. They found downcast facial expression, nervousness, irritability, insomnia, lassitude especially mornings, sensation of vertigo, headache especially frontal and occipital, widespread local pains neuralgic pains in the extremities, nausea, anorexia, gastric and intestinal disturbances and constipation. They also report a leucopenia and an eosinophilia as an experimental finding. The proving of Mayerhofer with ant. sulf. sur. yielded the chief action on the bronchi, then the gastro-intestinal canal and skin similarly as they are described in the homoeopathic drug picture.
The study of Nobiling with tartar emetic deserves more detailed presentation: “If tartar emetic is given internally in small doses increasing from 1.12 mg. then the following manifestations become evident by degrees: pressure and heaviness in the precordial, heavy dull head, discomfort, restless excitable disposition, soreness of the extremities especially the thigh; tearing and drawing in the joints, febrile chills, accumulation of saliva in the mouth, pasty mucous coated tongue, thirst with internal heat, particularly congestions toward the head, great lassitude and malaise, therefore also great tendency to sleep, with anxious dreams, frequent irregular full pulse, vertigo, flickering before the eyes, tired, sad, sunken eyes which are surrounded by dark circles, pale downcast face, increased collection of mucus in the throat and sensitive swallowing. If used for a longer time the appetite diminishes, pressure in the stomach causes great sensitivity, severe, sticking, frequently recurring pains of short duration in the intestines, nausea, anxiety and frequent irresistible yawning are added; respiration becomes labored and on the chest and around the region of the heart an unpleasant anxious sensation occurs. On the skin of the back a sensation of cold makes itself unpleasantly obvious and then extends to the legs. The abdomen is somewhat distended and extremely sensitive to contact. At first the stool is normal, but gradually becomes irregular, often pasty, but at times solid and in the intervals there is constipation. In consequence to the marked drinking of water which the the insipid taste in the mouth makes necessary, the urinary output is increased, thereby is the urine clear and watery but is hardly altered in its chemical characteristics.
If tartar emetic is used for a longer time and in gradually increasing doses, then all the manifestations appear in greater degrees. The nausea increases to severe vomiting, frequent eructations and belching, the stool becomes a thin, muco-bilious diarrhoea with a tense, distended abdomen which is sensitive to contact. The gastric but particularly liver region is distended, the liver dullness on percussion is increased about a finger’s breadth downwards, in marked cases the liver is palpable under the ribs and very sensitive on pressure. Colic and rumbling develops in the intestine with tearing, cutting and pinching in the abdomen, with tension and tearing in the lower extremities. The sensation of warmth over the entire skin surface is increased and there is itching. The appetite
is entirely lost and if something is eaten then the nausea is renewed and there is the inclination to vomiting. The throat becomes rough, swallowing impaired and very sensitive. The tongue is covered with a dirty slimy yellow coating, the taste is insipid and pappy. The secretion of mucus is increased and in the chest, stasis becomes noticeable in the lesser circulation. The head is heavy, pressing, dull and extremely painful in the frontal and vertical regions.
With small continuous doses there is lessened force and slowing of the heart and consequently of the pulse; the heart beats to a diminished degree but with a distinctly perceptible lesser intensity at the normal site. Respiration is labored and likewise slowed; the face is discolored; weakness extends over the entire body; emaciation occurs and with this the deep position of the eyes and the difficult movement of the extremities is explained. The vomiting is usually accompanied by a copious outpouring of cold sweat over the entire body, but large drops appear on the forehead, and this is accompanied by flickering before the eyes, weakness and vertigo.
RESULTS OF ANIMAL EXPERIMENTATION
The animal investigations available for explanation of antimony action give only a very defective picture of the intermediate processes. The similarity with arsenic is great, still the action is less severe and slower. The peculiarities of antimony are not apparent from investigations arranged on animals, so that we must depend entirely on human provings for these.
The metabolic actions of antimony seem to be similar to those of arsenic, still the scanty findings available at present are contradictory. Chittenden and Blake found by prolonged feeding of Sb2O3 in pigeons an increase of weight and a large fatty liver, in rabbits a decrease of weight. In a dog with a fixed normal diet they found no essential alteration of the protein metabolism by the use of Sb2O3. On the contrary Gathgens found in a hungry dog to whom tartar emetic was given, a considerable increase in nitrogen excretion and a slighter one of sulphur and phosphorus so that an increase of protein transformation of about 30 Percent was assumed.