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.
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