ulsive twitchings. The skin becomes
cold and clammy. In some cases the symptoms are those of collapse, with
but little pain, vomiting, or diarrhoea. In others the patient falls
into a deep sleep, while in the fourth class the symptoms resemble
closely those of English cholera. The vomited matters are often blue
from indigo, or black from soot, or greenish from bile, mixed with the
poison. Should the patient survive some days, no trace of arsenic may be
found in the body, as the poison is rapidly eliminated by the kidneys.
In all suspected cases the urine should be examined.

The symptoms of _chronic_ poisoning by arsenic are loss of appetite,
silvery tongue, thirst, nausea, colicky pains, diarrhoea, headache,
languor, sleeplessness, cutaneous eruptions, soreness of the edges of
the eyelids, emaciation, falling out of the hair, cough, haemoptysis,
anaemia, great tenderness on pressure over muscles of legs and arms, due
to peripheral neuritis, and convulsions.

Pigmentation is common; the face becomes dusky red, the rest of the body
a dark brown shade. This darkening is most marked in situations normally
pigmented and in parts exposed to pressure of the clothes, such as the
neck, axilla, and inner aspect of the arms, the extensor aspects being
less marked than the flexor. The pigmentation resembles the bronzing of
Addison's disease, but there are no patches on the mucous membranes, and
the normal rosy tint of the lips is not altered. The skin over the feet
may show marked hyperkeratosis.

The nervous system is notably affected. The sensory symptoms appear
first: numbness and tingling of the hands and feet, pain in the soles of
the feet on walking, pain on moving the joints, and erythromelalgia.
Then come the motor symptoms, with drop-wrist and drop-foot. The patient
suffers severely from neuritis, and there may be early loss of patellar
reflex. The nervous symptoms come on later than the cutaneous
manifestations.

_Post-Mortem Appearances._--Signs of acute inflammation of stomach,
duodenum, small intestines, colon, and rectum. Stomach may contain dark
grumous fluid, and its mucous coat presents the appearance of crimson
velvet. Ulceration is rare, and cases of perforation still less common,
the patient dying before it occurs. If life has been preserved for some
days, there is extensive fatty degeneration of the organs. There may be
entire absence of _post-mortem_ signs. Putrefaction of the body is
retarded by arsenic.