The preparations of arsenic are applicable to the treatment of the diseases of those tissues upon which it has a selective action.

No remedy is more useful than arsenic in the so-called irritative dyspepsia, manifested by these symptoms: a red and pointed tongue, poor appetite, distress after meals, the presence of the food causing intestinal pain, colic, and the desire to go to stool. Drop-doses of Fowler's solution, given before meals, quickly relieve this state of things. The effects of the arsenic are frequently favored by the conjoint administration of a little laudanum.

In some cases of the vomiting of pregnancy, a drop of Fowler's solution given before each meal will afford astonishing relief. The particular indications for its use are these: vomiting of food, followed by retching and straining, the vomited matters being streaked with blood, or blood alone being thrown up; these symptoms accompanied by gastralgia and pain between the scapulae.

The vomiting of chronic gastric catarrh, especially the alcoholic form, is relieved by one or two drops of Fowler's solution taken before meals. It effects a cure in these cases by relieving the morbid state of the mucous membrane on which the vomiting depends. Arsenic is also very beneficial in these small doses in chronic ulcer of the stomach. It checks the vomiting, relieves the pain, and improves the appetite for food. It is not equally effective in the acute ulcer. Although arsenic exercises but little influence over the progress of these cases, it is very serviceable in cancer of the stomach, by diminishing the pain and checking the vomiting. Gastralgia and enteralgia, when idiopathic, are sometimes made to disappear in a very surprising manner by the same remedy, but there are no certain indications of the kind of case to which it is best adapted.

In the treatment of stomach-disorders, only small doses of arsenic are admissible. Large doses, by creating an irritation of the gastric mucous membrane, will only defeat the end in view.

That form of diarrhoea which consists merely in an intolerance of the presence of food, an evacuation of the undigested aliment taking place soon after it is swallowed, is cured by arsenic. Chronic diar-rhcea and dysentery (entero-colitis), especially when dependent on the changes induced by chronic malarial infection, are often greatly benefited by the same remedy. In these cases, two drops of Fowler's solution with five drops of laudanum should be given before meals. Attention to the diet is, of course, imperative. Constipation, when due to deficient secretion and dryness of the faeces, is sometimes overcome by small doses of Fowler's solution.

Arsenic is one of the numerous remedies proposed for the treatment of epidemic cholera. It is a curious circumstance, first demonstrated by Virchow, that some cases of acute arsenical poisoning are not distinguishable by their symptomatology or morbid anatomy from cases of epidemic cholera.

Arsenic has been used with success in the treatment of the jaundice due to catarrh of the bile-ducts succeeding to catarrh of the duodenum. It seems to the author to be better adapted to cases of jaundice of malarial origin. Excellent results are obtained by the persevering use in small doses of arsenic in cirrhosis. As arsenic tends to accumulate in the liver, and as it produces fatty degeneration of this organ, the curative effect in the above-named disorders may depend on this selective action.

There is no doubt that arsenic promotes in a very decided manner the constructive metamorphosis. It is one of the most valuable agents which we possess in the treatment of chlorosis and anaemia. It is especially adapted to those cases in which iron does not agree or fails of effect. The efficiency of iron in these disorders is much increased by combination with arsenic.

Cases of acute coryza and hay-asthma are often decidedly relieved by this remedy. Chronic catarrh of the broncho-pulmonary mucous membrane, emphysema, sclerosis of the lungs, are maladies in which arsenic, long used in ordinary medicinal doses, is capable of effecting considerable amelioration. We have no single drug of equal utility in the chronic forms of phthisis, but it is not serviceable in caseous pneumonia. It is said, and this statement corresponds to the author's observation, that, when there are much hectic and rapid disintegration of the pulmonary tissues, arsenic is not beneficial. Besides the stomach administration of arsenic in the above-mentioned maladies of the respiratory organs, it is used with advantage by the process of fumigation. The following is the formula of Trousseau for arsenical cigarettes:

Arsenite of potaasa...................................... 15 grains.

Distilled water.......................................... 1 ounce.

Unsized white paper is thoroughly moistened with this solution, dried and cut into twenty equal parts, and each part rolled into a cigarette. Two or three of these are smoked daily for the relief of chronic bronchitis, emphysema, spasmodic asthma, phthisis, hay-asthma, etc. The arseniate of soda may be used in the same way, and under the same conditions; for example, take a half-drachm to one drachm of arseniate of soda, one ounce of distilled water, and moisten a bit of unsized paper with the solution, so that every piece of a given size shall contain a determined quantity of the arsenic, ordinarily from one fourth to one grain. When the cigarette is lighted, the patient inhales the smoke by a single inspiration, and this inhalation is practiced three or four times a day. In cases of acute and chronic coryza, great advantage is obtained by snuffing into the nares the fumes of arsenical cigarettes. The arsenite of antimony, according to Dr. Lucien Papillaud, is especially serviceable in pulmonary affections.

When, in consequence of feebleness of the heart, there are present short breathing on making slight exertion, and aedema of the feet and ankles, especially as these symptoms occur in old people, arsenic is indicated. Attacks of angina pectoris may be lessened or prevented by the persistent use of arsenic in the interval.

Certain disorders of the nervous system are greatly benefited by the use of arsenical preparations. The author has seen it extremely useful in cerebral congestion, for the treatment of which it was originally recommended by Dr. Lemare-Picquot. It is indicated when there are commencing atheromae of the cerebral vessels, sluggish venous circulation, puffiness of the eyes, tendency to drowsiness, and intellectual torpor. In the melancholy and hypochondria of the aged, it gives great comfort, and frequently entirely dispels the gloomy fancies which take possession of the mind under these circumstances. The arsenic acts most favorably when combined with minute doses of opium; viz., two drops of Fowler's solution, with three to five drops of tincture of opium, given three times a day. Arsenic is one of the remedies successful in the treatment of neuralgia. Generally its curative influence is indirect, and exerted through the improvement in the bodily nutrition which follows its administration. It is directly curative, however, in the cases of hemicrania, and other neuralgiae of malarial origin, but it holds a place strictly secondary to quinine in these affections. It is certainly one of the most effective remedies which we possess in the treatment of chorea. In this disease, large doses—five minims ter in die—must be given. Young subjects, it should be remembered, bear large doses of arsenic, relatively, better than adults. Cases of epilepsy have been reported cured by arsenic, but these were probably instances of epileptiform vertigo caused by stomach-disorder, in which this remedy is undoubtedly of great utility. Charcot has found the subcutaneous injection of Fowler's solution of real value in paralysis agitans. The same expedient has succeeded in local chorea and histrionic spasm. The injection should be made into the affected muscles, whenever practicable

Arsenic produces, in the course of its medicinal administration, affections of the skin, and notably those dependent on an unknown state of the trophic nerves. In the treatment of various skin-affections we avail ourselves of this physiological fact, and set up by means of arsenical preparations a substitutive action in the skin. It follows, that arsenic will not be serviceable in acute affections of the skin, and experience demonstrates that, whenever active cell-proliferation is taking place, arsenic is contraindicated. It is most serviceable when the affection, of the skin is superficial in its seat—in the epidermis and the superficial layers of the derma. In cases of psoriasis much good may be expected from it, but, the more chronic the disease, the more beneficial is it. When the arsenic begins to exert an influence on psoriasis, the skin appears more inflamed, but this is an evidence that the curative-action is taking place, and the remedy should then be persisted in. Acute eczema is rather exasperated by arsenic, but chronic eczema,. especially eczema squamosum, is often greatly benefited by it. When eczema infests the vulva, anal region, and scrotum, arsenic is said to be useful, but its efficacy in these cases is largely determined by the chronicity of the attacks. Pemphigus is an affection of the skin which, as was more particularly shown by Mr. Hutchison, is curable by arsenic,         

but the more chronic the disease the more certainly beneficial the remedy. In old cases of acne, especially acne rosacea, arsenic is sometimes serviceable, but it is often very disappointing. The author has not observed much good to follow the use of arsenic in the acne which occurs at puberty and for some years subsequently. In all cases of acne the strictest attention to diet and a proper hygiene is very important. Arsenic given with bromide of potassium lessens or prevents the very disfiguring acne which appears in the course of the administration of that agent. Furuncle (boils) is successfully treated by the long-continued use of arsenic. This practice is strongly urged by Dr. Delioux de Savignac. A succession of boils is the indication for the use of this remedy.

In the treatment of skin-affections, Fowler's solution is the arsenical preparation most frequently employed. The commencing dose need not be larger than five drops three times a day, given after meals. It is better to commence with the maximum dose, and to diminish the amount gradually. As arsenic needs to be administered for a long time in skin-diseases, such toxic symptoms as irritation of the eyelids, puffiness of the eyes, and epigastric pain and soreness, are apt to arise. These symptoms are indications for the use of laxatives, and for a reduction in the dose of the remedy, but not for its entire suspension. In order to prevent relapses, the use of arsenic should be continued, in diminishing doses, for some time after the entire disappearance of the eruption.

Arsenic is very useful in a certain form of chronic arthritis. The cases to which it is adapted are those in which the joints become tumid and stiff and painful in consequence of a peculiar state of the nervous system; indeed, the condition is one allied to neuralgia, the trophic nerves being involved. This is a malady very different from that kind of chronic rheumatism or rheumatic gout which is accompanied by nodosities of the joints, in which arsenic has been recommended, but over which, according to the experience of the author, it exerts no control.

Arsenic has seemed to the author remarkably beneficial in diabetes of hepatic origin. It has also been found useful by Johannsohn. Arseniate of soda has lately been shown to be a very excellent remedy. It may usefully be given with phosphate of sodium— 3 j of the phosphate and 1/15 of the arseniate of soda three times a day dissolved in warm water. At the present time Clemens's solution of bromide of arsenic is much in favor as a remedy for diabetes, and I therefore subjoin the formula for preparing it: Powdered arsenious acid and carbonate of potassium, of each 57½ grains; boil in 8 ounces of distilled water until dissolved, and when cold make up to 11½ troy ounces by sufficient distilled water. To this solution add 115 grains of pure bromine. The resulting solution should be well shaken several times a day during the first week. It should be colorless at the expiration of the fourth week, when it is fit for use. The dose is one drop three times a day, gradually increased to three drops. It should be given in about two ounces of water. Brunton reports good results from its administration in albuminuria, apparently due to defective digestion of albumen.

Amenorrhoea, when due to functional inactivity of the ovaries, and menorrhagia, when produced by anaemia, are equally benefited by the preparations of arsenic, especially when combined with iron. Spermatorrhoea, if dependent on a weak and relaxed state of the seminal vesicles, and functional impotence, are sometimes greatly improved by full doses of the arseniate of iron.

Next to quinine, arsenic has the most important position in the treatment of malarial fevers. It may be used to prevent the recurrence of attacks of ague when quinine for any reason is not admissible. As regards acute malarial toxaemia, arsenic is more useful as an adjunct to quinine than as the sole remedy. The treatment of acute cases may be formulated as follows: large doses of quinine to interrupt the paroxysms, and at the septenary periods; arsenic given daily to prevent relapses. It plays a more important role in chronic malarial diseases. As has been shown by Boudin, arsenic diminishes the engorgement of the spleen. The author has witnessed the rapid disappearance of malarial jaundice, and the cure of the alterations in the glandular appendages of the intestinal mucous membrane, under its use. It is most useful generally to combine iron with arsenic in the chronic form of malarial disease. Rx Mas. ferri carbon., 3 j; acidi arseniosi, gr. j. M. Ft. pil. no. xx. Sig.: One three times a day. Rx Quininae sulph., 3 j ; ferri sulph. exsic, Эj ; acidi arseniosi, gr. j. M. Ft. pil. no. xx. Sig. : One three times a day. Boudin justly insists upon abundant alimentation during a course of arsenical treatment of intermittent, and, with a view of preparing the digestive organs, administers a preliminary emetic to relieve the stomach of the embarras gastrique. Arsenic has also been used as a prophylactic against malarial infection, and as a remedy for various intermittent diseases due to malarial influence. The author has seen excellent results from the use of small doses of Fowler's solution three times a day in typho-malarial fever. When there is much diarrhoea, a few drops of tincture of opium should be added to each dose of arsenic. In doses of half a drop to one drop of Fowler's solution, the tongue cleans, the skin becomes moist, and the delirium lessens sometimes in a most remarkable manner. When arsenic is used alone in the treatment of intermittents, large doses are necessary. Ten drops of Fowler's solution may be given after meals to adults, but in a few days—three, four, or five, according to the susceptibility of the patient—the dose must be reduced two drops each day until four drops are reached. If the stomach does not become disordered, slight irritation of the conjunctivae and puffiness of the eyelids may be disregarded.

There can be no doubt that the long-continued use of small doses of arsenic exercises a favorable influence over the course and progress of epithelioma. It has appeared, indeed, to be useful in scirrhus, especially as this morbid process manifests itself in the stomach. Rodent ulcer, which is closely allied in its nature to epithelioma, is also improved by it. With the internal use of the arsenical preparations may be conjoined the local applications of arsenious acid. Many physicians, notably the late Dr. Atlee, of Philadelphia, entertain the belief that the long-continued use of arsenic retards the growth of uterine cancer. Billroth reports a case of multiple lymphoma cured by the use of arsenic.