These symptoms are liable to great variety, the pain and vomiting being occasionally absent, and the patient being affected as if by a narcotic poison. In some instances there is troublesome tenesmus, with heat and excoriation about the anus. Convulsive movements in the extremities often occur, with cramp in the legs, especially if the diarrhœa is severe. Death sometimes takes place calmly from collapse, sometimes it follows on convulsions.
The vomited matters may be red or brown from admixture with blood or bile; or they may be blue or black, if the arsenic has been colored with indigo or soot. Although the vomiting, pain, &c., are generally continuous, yet sometimes all the symptoms remit, and the patient rallies for a time, only to sink more rapidly.
The symptoms of _chronic_ poisoning by arsenic are loss of appetite, a silvery coating to the tongue, thirst, nausea, colicky pains, diarrhœa, frontal headache, langor, sleeplessness, cutaneous eruptions, soreness of the edges of the eyelids, emaciation, anæmia, convulsions, and death. In some cases, when small doses have been administered for many days in succession, with the intent to destroy life, the symptoms have been masked by other substances. The most marked results of this practice have been sickness and vomiting, pain in the bowels, nervous irritability, and emaciation. The practitioner must be careful not to mistake these symptoms for those due to simple gastritis or enteritis.
Arsenic is not a poison that accumulates in the system, but is slowly eliminated from it especially by the kidneys, but partly also by the bile.
The local application of arsenic to the mucous membranes, to wounds, or to surfaces deprived of their cuticle, produces constitutional effects similar to those just described. The only difference is that the symptoms show themselves more slowly. Not a few lives have been sacrificed from the application by ignorant quacks of a mixture of arsenious acid, realgar, and oxide of iron to ulcerating cancers.
Cases of compound poisoning have been met with. When arsenic is taken mixed with opium, the symptoms produced by the former are masked.
_Post-mortem Appearances._—Arsenic appears to exercise a specific influence over the alimentary canal, and more especially over the stomach; for in whatever manner it may have been introduced into the system, it is to this organ that we must look for its effects. These effects consist in the signs of acute inflammation commencing in this viscus, and often extending along the duodenum, small intestines, and colon. In acute cases the stomach is the viscus most affected; but in chronic cases the whole alimentary canal is found inflamed and ulcerated, particularly the duodenum and rectum. When death has occurred within five hours of taking the poison, the stomach has been found intensely inflamed in an adult; while the same result was witnessed in a child who died at the end of two hours. The stomach often contains a dark grumous fluid, occasionally tinged with blood. On removing the contents the mucous membrane is seen red and inflamed, the inflammation being most intense around certain spots. On examining these spots, particles of arsenic will probably be found adhering to the walls of the stomach and surrounded by a zone of inflammatory redness. Sometimes also blood is effused into the visceral walls, giving rise to an appearance resembling gangrene. Ulceration of any of the coats of the stomach is rare, and perforation is still more so.