9? VjjfK 'A *■ UNITED STATES OF AMERICA y * . FOUNDED 1836 WASHINGTON, D. C. GPO 16—67244-1 'SBSSSBM E S S A Y ON THE MEDICINAL PROPERTIES AND DELETERIOUS QUALITIES OF ARSENIC: SUBMITTED TO THE EXAMINATION OF THE Rev. JOHN E W I N G, S. S. T. P. Provost; THE TRUSTEES and MEDICAL FACULTY OF THE UNIVERSITY of PENNSYLVANIA, ON THT SEVENTEENTH DAY OF MAY, I796, FOJv THE DEGREE of DOCTOR of MEDICINE, By NATHANIEL POTTER, Or PHILADELPHIA. " Nor ought fo vile that on the earth doth live, V»i ,'« Kj L*-* ^ i( Virtue itfeif turns vice, being mifappiyd, W" N< ft And vice fometime by acJiort1's dignify''(Z."—<\<' ''^v. SHAKESPEAlii* .// jv^--- ___________ ^4^Y PHILADELPHIA: Printed by WILLIAM W. WOODWARD, N°. 17, Chesnut-street. I7Q6. *• ty eight perfons were cured under his care by Dr. Fowler's mineral folution. Dr. Arnold does not mention the number which he either treated or cured, but obferves, " that the folution feldom 14 failed." fDr. Clark informs us, that he only cured twelve out of twenty five patients by the mineral folution, and that another phyfician of the Newcaftle difpenfary Succeeded in only eight out of eighteen cafes, but adds, that he received a communication from an ingenious medical friend which informed him, that only four cafes out of an hundred had refilled this remedy. Dur- ing my refidence in a part of the ftate of Mary- land where autumnal fevers prevailed epidemi- cally, I refolved to try the comparative efficacy of arfenic and the Peruvian bark. Many of the fevers at that time affumed the remitting type, to fuch I gave either emetics or purges of calo- mel previous to the exhibition of tonics ; by this practice I either obtained a complete apyrexy, or fo far fubjugated the fever as to venture with fafety on the ufe of ftimuli. For fifteen cafes of this defcription I prefcribed the folution, fix of whom were cured, and four fuCpended : I then gave the bark to an equal number under Similar t See Observations on the Difeafes which prevail in long royages to hot climates, and on the fame difeafes as they ap- pear in Great Britain, by John Clark, M. D. *5 circumftances, thirteen of whom were cured. and the other two fufpended. From the unplea- fant effects produced by arfenic in thefe cafes it was obvious, that it was a fubftance too Stimu- lating for the remaining portion of phlogiftic di- athefis which ftill accompanied the remittent State. I likewife administered the bark to twenty perfons laboring under tertians, without previous evacuations of any kind, and found Sixteen of that number effectually cured: I repeated the experiment with the folution, and found it to fuc- ceed equally well. In many other cafes I pre- mifed evacuations, and found whether I ufed the bark or the folution, that no advantage re* Suited from them in purely intermittent fevers. From the fifteenth of October to the fifteenth of November, I perceived that moft of the intermit- tents had degenerated into quartans, and that thofe recently attacked, now generally wore that type. The two remedies were now again put in competition: The bark cured twelve out of twenty, whereas the arfenic out of an equal num- ber of cafes cured nineteen. This experiment was again attended with nearly the fame refult In a few cafes both remedies failed ; I then com- bined them, and found them more fuccefsful, but ftill fome obftinate cafes refilled their power. Reflecting on the pathology of this difeafe, and upon the nature of the remedies upon which I had fb repeatedly experimented, it appeared to i6 me, that the infenfibility of the fyftem was ob- vioufly the caufe of failure in the few cafes un- fuccefsfully treated : I therefore adminiftered the arfenic three times a day, in dofes fo large as to produce fome fenfible effect, by thus increaf- ing the excitability, I found, that the bark given in Small dofes, and gradually increafed according to the flate of the Syftem, proved almoft univer- fally fuccefsful ; for I do not remember more than two who returned for cure after I institut- ed this method. Although it may be reafonably inferred that arfenic and the Peruvian bark are nearly equal in point of efficacy in the cure of intermit- tents as they occur in their variety of types in dif- ferent feafons, yet the former poffeffes fome ad- vantages over the latter with refpect to the fa- cility of its administration to all ages and condi- tions. Patients (more efpecially children) can feldom be prevailed on to perfevere in the ufe of the bark until a complete cure is obtained. In an economical point of view arfenic has a ftill Stronger claim upon the attention of phyficians. An ounce of the beft Peruvian bark at this time cofls two Shillings and fix pence, and will feldom cure more than one perfon when it may be pro- per to exhibit it ; whereas the fame money will buy as much arfenic as will make as much of the mineral folution, as will (at the moft moderate »7 calculation) cure ten thouSand perfons of the fame difeafe. I attempted the cure of intermittents by arfe- nic in Philadelphia during the autumns of 1794 and 1795, Dut was compelled to defift from its ufe; it occafioned thofe unwelcome fymptoms which I fhall hereafter notice, fo frequently, and in dofes fo inconsiderable, that independent of its inefficacy it became at beft a very difagreea- ble remedy. It only fuccecded in a few quar- tans, for fo great was the inflammatory diathefis of the intermittents of thofe feafons, that their cure was moft commonly effected by remedies df a very oppofite character. From a retrofpect of the preceding facts and obfervations, it will not be difficult to account for Dr. Clark's unfavor- able deductions from the exhibition of arfenic, efpecially as he concludes his paragraph on that fubjedt with this obfervation—" when the conti- nuation of the ague had brought on much weak- nefs, I feldom in fuch cafes tried the folution." To elucidate more Satisfactorily the operation of arfenic in the cure of intermittents, it may \>e ufeful to reafon on the condition of the fyftem under the influence of that difeafe. Whatever may be the Specific nature of miafmata, or of other remote caufes of this ftate of fever, they all give apre-difpofition to difeafe, by inducing a ftate of either direct, or indirect debility, which when D i8 not induced by caufes of a long continued or flow operation, leave the fyftem more fenfible to im- preflions. In this defencelefs capacity of the fyf- tem, every Stimulus acts with double force, and the arterial fyftem which would always feem to be the firft to take the alarm whenever the har- mony of the animal economy is molefted, is thrown into convulfive motions.* In this fituation of things, the excitement is divided, and that por- tion which belongs to the others is concentrated in the arterial fyftem. This ftate which is a fe- ver, continues to agitate the fyftem, until it de- pletes from the arteries fo much as to leave them upon a level with the other fyftems. With this picture of an intermittent before us, let us attempt its removal. In that preternatural ftate of ex- citement which conftitutes a paroxyfm, the dif- eafe is confined exclusively to the arterial fyftem, and to cure it, the remedy Should be directed Specifically to that fyftem. The ufe of ftimuli will ever be an unavailing mode of practice, un- lefs their power is fo great as to overcome the * Thefe irregular motions have generally been attribut- ed to the friendly interpofition of an imaginary vis mdica- trix, but they feem to be nothing more than the effeft of fti- tnulus difproportioned to excitability, or impulfe difpropor- tioned to refinance: we might as well fay, that a fhip under fall was actuated by a vis medicatrix becaufe fhe did not ftand ftill, for it is an univerfal law that force unequal to refift- ance fliall produce irregular motions or a deviation from order, nor will the difference between animate and inani- mate matter afford us a means of difcrimination. *9 •f difeafed action of the heart and arteries, to at* tempt which might often prove dangerous ; we therefore leave this ftate to be treated by other remedies. Where the fever in almoft in an evan- efcent Slate, and the action fo feeble as not to call for a treatment in fome meafure antiphlogistic, the prefumption then may be, that it can be fub- dued by arfenic, bark or other Stimulating pow- ers : but that ftate of atony in which a paroxyfrn leaves the fyftem, is what more particularly de- mands our attention in the cure. In this ftate the excitement although at a very low ebb, is prefumed to be perfectly equal, but the fame re- mote caufes continuing to operate, reproduce the fame coincidence of excitement and excitability, from which the diforder firft originated, and thereby invite the fame repetition of motions, with which it was before affociated. The excitability of the fyftem, after the pa- roxyfrn of an intermittent is, whether in a ftate of {lirect or J indirect debility, eafily excited by the" t No two unequal actions can exift in the fame fyftem at the fame time, the ftronger always depofes ihe weaker. I would as foon fuppofe that two cubic inches of a folid, could each occupy the fame cubic inch of fpace at the fame in^ ftant: yet the arterial, lymphatic and nervous fyftems may each labour under a diftincl difeafe at the fame time. J Dr. Brown has told us, that in cafes of indirect debility the moft powerful ftimuli are neceffary, but independent of; 20 action of Stimuli: unlefs the difeafe has become chronic, by a long continued operation of caufes, pr a reiterated repetition of paroxyfms. Arfenic may be advantageoufly ufed to prevent the re- currence of that condition from which the pa- roxyfm firft originated : This indication will be moft effectually fulfilled, by administering it as nearly preceding the acceflion as poffible. If the difeafe Shall have become chronic, although the debility be ever fo great, a powerful Stimulus will generally be requisite to excite the fyftem above the danger of a relapfe. Although the ver- satility of the excitement and the excitability of the human frame is fo great as often to render it difficult to account for all the phenomena of its, morbid ftates, yet, from what we have already feen, we may prefume with fome confidence on the operation of arfenic in this and other States of difeafe, and perhaps diftinguifh fome of thofe to "which it is more particularly adapted. As we have already learned that arfenic acts powerfully upon the fkin, fome may be led to attribute the cure of intermittents to Such an operation: If any benefit is derived from this part of its opera- tion, it confifls (like other ftimuli) in restoring the excitement of the languid extremities, there- by equalizing it throughout the whole fyftem, the impropriety of ftimuli in many cafes of indired debility recently induced, this theory is erroneous, becaufe whether the debility be direct or indirect, the excitability is equally fufceptible of the action of ftimuli. 21 It is probable that arfenic frequently excites fome degree of inflammation in the Stomach, which communicates a temporary artificial inflammato- ry diathefis to the whole fyftem, and may there- by occasionally fuperfede the difeafed ^ction. The epithet intermittent, has generally been intended to convey the idea of a difeafe of ex- treme debility, fo great as always to require fti- muli ; but as difeafes of a very malignant nature fometimes affume that type, and exhibit the Spe- cious afpedt of a mild diSeafe, when the patient is in the moft imminent danger, particular care is neceflary to difcriminate: The caufes produc- ing fuch a difeafe often proftrate the fyftem fud- denly into the moft abject ftate of indirect debil- ity, rendering the pulfe almoft imperceptible, with many other Spurious fymptoms of a com- mon intermittent. Should a phyfician unfortu- nately attempt the cure of fuch an intermittent by arfenic, he would prefcribe as judicioufly as he would do, were he to administer liquid lauda- num to a patient poifoned by opium. In Periodical Head-achs. DOCTOR Fowler, to whom we are already fo much indebted, has recorded feven cafes of periodical head-ach fuccefsfully treated by the mineral folution of arfenic, without the escep- tion of a failure. I do not know of a morG vague appellation than that of Head-ach ; we hear of nervous head-achs, hyfteric head-achs, and a variety of others, yet as we prefume them all to be difeafes of the arterial fyftem, we Shall arrange them accordingly. As the words pe- riodical head-ach, are an indefinite mode of ex-, preffion, it will be neceffary to affix fome deter- minate ftate of the fyftem to the terms, before we can deduce our indications of cure with any degree of certainty. All the cafes of periodical head-achwhich have occurred to my obfervation, appeared to have been no more than intermittent fevers under a *concealed form, appearing at the fame feafons with pther intermittents, and yiekU ing to the fame remedies. The Peruvian bark often fucceeds in the cure of this difeafe, but So far as I have been able to afcertain, is far inferior to the folution ; nor need this furprife us, for this affection generally exhibits a more chronic ap- pearance, is not attended by much inflammatory diathefis, and is confequently admirably adapted to. the operation of arfenic. There is no reafon why ' this medicine Should cure a periodical head-ach more certainly than others, provided they are constituted by the fame degree of action ; and from the general operation of arfenic we fhould be induced to expect the happieft effects from its ufe, in all cafes not the confequence of confider- * Febres intermittentes fub forma larvata of Dr. Senac. 25 able inflammatory diathefis. The head-ach is often a chronic difeafe ; the effect of a feeble mor- bid action in the veffels of the brain, while the other parts of the fyftem poffefs their ufual pow- ers. In all fuch cafes as cannot be traced to fome offending matter in the Stomach, or to fome local caufe, arfenic may be recommended with the moft flattering profpect of fuccefs. Although the ac- tion in this difeafe is fo inconfiderable as to be eafily overcome by arfenic, it is neverthelefs in • difputably the effect of exceffive morbid excite- ment, and the pain is incontrovertibly the effect of inflammation, *without which there can be /^no pain. The proximate caufe of all fever con- fifts in an irregular action of the arterial fyftem^ and the moft abject ftate of typhus is aseffentially a fever, and as certainly the effect of fome degree of inflammation, however infignificant, as a phre- nitis or a pneumony. As the proximate caufe of all fever is the fame, there cannot poffibly exift any other juft diftindtion between them, than what arifes from their different degrees of inflam- mation. The cure, with this view of fever, di- vides itfelf into two parts ; fuch as require de- pletion to fubdue them, and fuch as are capable of being overcome by the action of ftimuli. Arfe- nic may be ufed advantageoufly in all fuch cafes as require a new action to be fuddenly excited, * See Dr. Alexaader's ingenious diflertation on the e£Fe<3 of one difeafe curing another, page 20. 24 unlefs fo great a degree of debility exifts as to ren- der other tonics, more certainly invigorating, in- diSpenfible. In Difeafes of the Alimentary Canal. AMONG the variety of cafes in which I had oceafion to prefcribe this medicine in the difeafes of children, I fometimes obferved, that fuch as were affected with fymptoms ufually judged to be moft characteristic of worms, recovered under its ufe. The worms were in fome cafes dif- charged, but this occurred in a very fmall pro- portion of cafes, in which the moft prominent fymptoms were effectually removed. In many of thefe cafes the fymptoms were fo ambiguous, that I found it difficult to determine whether the arfenic a&ed by obviating a ftate of debility with which worms were accidentally connected, or by deftroying the worms acting as the caufe of an idyopathic difeafe. In two cafes where the moft unexpected cures were obtained, the Symp- toms rather indicated the phenomena of an atro- phy from lymphatic obstructions, than of any other difeafe, and whoever reflects on the insinu- ating properties of arfenic, will not think it ir- rational to conjecture that it it might have ope- rated as adeobftruent upon the mefenteric glands. The pulvis ftanni has formerly been a remedy much celebrated as a vermifuge, and has by fome 25 been fuppofed to act mechanically ; although, it is poffible that it may produce fome effect in this way, it would appear to me more philofcphical to afcribe its virtues to the arfenic it contains. As this remedy which fuggefled itfelf fortuitously is yet problematical, with refpect to its operation as an anthelmyntic, we Shall not prefume to re- commend it in preference to the more ordinary remedies ; neverthelefs, as they are all occasion- ally fallible, it will be laudable in fuch cafes, to experiment with judicious caution on this new remedy. In Difeafes of the Skin* "WERE we to (peak Strictly anatomical, wd might have claffed thefe difeafes with thofe of the arterial fyftem, and indeed fome of thofe under this head, invade likewife the glandular and lym- phatic fyftem ; but as they appear more confpi- cuoufly on the Superficies, and affect more parti- cularly this part, we have judged it moft conve- nient to arrange them with the cutaneous affecti- ons. Whoever obferves the force which this medicine exerts upon the fkin, will find the tran- sition to its ufe in cutaneous difeafes natural, and the profpect of its advantages plaufible. I recei- ved the firft information of its fuccefs internally in cutaneous difeafes, from the judicious Doctor Martin, of Maryland ; who had witnelfed its _____________E 26 victory over an obitinate cafe of ieprofy. Soon after I received this ufeful instruction, I was ap- pealed to, to decide on the nature of a cafe which had run the ordinary routine of remedies gene- rally reforted to in fuch cafes, and which lb Strongly refembled the defcription the Doctor had given of the cafe which he had cured, that I did not hefitate to denominate it the lepra grsecorum of medical writers. As this cafe had already be- conrj one of the opprobria of medicine, I under- took it with much diffidence, rather to gratify the folicitations of the patient's friends, than be- caufe I expected to perform a cure. I directed ten drops of the mineral folution to be taken morning, noon, and night ; distance prevented my feeing the patient for the fpace of two weeks, but the medicine was afliduoufly perfevered in : I now had the pleafure to obferve, the hard white Surfaces of the ulcers which had ufurped almoft the whole Superficies of the body, begin- ning to moulter away in white, pulverulent fioughs, and the bottoms of many of the fores, before of a phagedenic appearance, affuming a more falutary complexion. At the end of fix weeks the difeafe was completely eradicated, and had not returned two years after. On my re- turn to Philadelphia in the fummer of 1792, I informed my preceptor, Dr. Rufh, of what I had heard and feen concerning the internal ufe of arfenic ; he foon had an opportunity of trying its efficacy in an obftinate herpetic eruption 27 which had refifted the ufual remedies ; it Suc- ceeded, but as it had been a tedious chronic cafe, and the predifpofition not completely removed, fome fymptoms of the difeafe have Since return- ed. ^ have repeatedly Seen this remedy tried in various anomalous cutaneous affections, and find it a powerful medicine where nekher fulnefs nor inflammatory diathefis exift ; in which cafes we Shall foon fay, previous depletion is neceffary. In cutaneous difeafes we may opferve two States of the excitement diametrically oppofite to each other : Some cafes depend upon a lofs of tone in the extreme veffels, by which means the excite- ment is divided. The cure of this ftate confifts in reftoring the excitement,either by railing it by external applications, or by fuch internal powers as exert their influence principally upon that fyf- tem of veffels. To prevent the veffels upon the Surface from relapfing into their former atony, it will be found requifite in this ftate of the fkin, to raife an higher tone than that which is the Slate of the fame veffels in a ftate of health ; an indication which may often be effectually fulfil- led by arfenic. But, one Stimulus will not al- ways anfwer the defired indication, although it may be fufficiently ftrong, it will therefore often be prudent to ufe them in fucceffion. The want of a certain knowledge of the particular fyftem, which a Stimulus Specifically affects, often ren- ders its exhibition problematical. 28 The remaining ftate of cutaneous difeafe, is In every refpect the reverfe of that already delinea- ted. In both the excitement is divided and un- equal, but in the latter, its morbid force is con- centrated in the fkin, and may be denominated a febris extrover fa with a propriety as Strictly phy- siological, as the dyfentery has been a febris mc- i/ntroverfa by Dr. Syddenham. This ftate is truly a local fever, and the indication of cure is to di- minish the excitement in the extreme veffels, until it Shall be reduced to an equality with the other parts of ilie fyftem. It would be Super- fluous and perhaps hazardous in this ftate of the fyitem to preicribe aftringent topics, or to admi- nister ftimuli internally, unlefs fome can be found fufficiently powerful to raife a Superior action in the veffels, a thing not eafily accomplifhed. As there is no medicine more Stimulating than arfe- nic, there can confequently be none more impro- per in this ftate of the fyftem. Agreeably to this idea of the inflammatory nature of fome cu- taneous difeafes, we find a fact recorded by *Sir William Jones, who obferves, "The natives (of Indoftan) cure the elephantiafis by one part of white arfenic united to fix parts of black pepper ; but the remedy is more certain when gentle ca- thartics and bleeding are previoufly ufed." By this practice t}Jo advantages are gained ; firft, the tone which prevented a more healthy action from being excited is removed ; fecondly, the excita- * Jones's Afia, pages 479—80. Publifhed 1793. -9 bility of the whole fyftem is accumulated, by which means ftimuli act with more force and cer- tainty. The fame author relates the cafe of a gentleman " fo affected with a confirmed lues, (called in Afia, the Perfian fire) with his hands and feet entirely ulcerated and almoft corroded, that he became an object of difguft and abhor- rence. Some blood was taken from his arm, and a cathartic administered on the next day ; in a fortnight his recovery was complete." He far- ther adds, " But the power of this medicine has been chiefly tried in the cure of what has been called the Juzam, a difeafe affecting the whole mafs of blood, attended in the laft Stage with an erofion of the fingers : It is alfo hereditary, and in that refpect has been claffed by medical wri- ters with the gout, confumption and white le- profy." This learned author affures us, that this preparation of arfenic and black .pepper was fuccefsful in every cafe in which it was ufed, and relates a great variety of cafes, but from his having placed the caufe of the difeafe in a con- tamination of the fluids, he has not developed the difeafe fo clearly as to enable us to follow him in its investigation. The pathology of the fluids is fo obfeure a corner in the field of fcience, that I would not prefume to determine what Share they may have in the caufes of difeafes. What- ever might have been the precife meaning of phyficians by that clafs of medicines called al- teratives. I am perfuaded, that arfenic merits 3° that character to a very eminent degree ; per- haps not by a direct operation upon the blood, but by changing the ftate of the excitement, by its Sudden and energetic action on the feveral fyftems it affects. I Should have fufpedted the accuracy of the author's obfervation on this foli- tary cafe of fyphylis, had it not been corroborat- ed by a cafe which lately came within my own notice. A medical gentleman from the Weft- Indies, having been baffled in his efforts to cure a cutaneous affection of a fyphylitic origin, con- fulted Dr. Rufh, who advifed the internal ufe of yf arfenic with the moft propitious refult. Arfenic in fuch inveterate chronic cafes, feems to act by its power in exciting the fyftem infenfible to o- ther ftimuli, for in this cafe, even mercury had been ufed in vain. In buboes, that after ulceration have become callous, and not difpofed to heal, but put on a cancerous appearance, I can fay, both from my own obfervation and that of o- thers, that no remedy with which we are ac: quainted, is fo powerful as the internal ufe of arfenic. In Difeafes of the Glandular and Lymphatic Syfteni. MUCH has been faid concerning the ufe of arfenic in cancers, but from having feen it fairly tried in only two cafes of ulcerated cancer, I can- 31 not fay much of its virtues.* It has been dog- matically afferted that arfenic is competent to the cure of every condition of cancer ; an opi- nion which, fo far as I can inform myfelf, is ex- tremely prefumptuous. Cancer, like all other difeafes, is attended with different ftates of action, no one remedy can therefore cure every cafe. There is no difeafe whofe pathology is involved in more oblcurity than that of cancer, and every internal remedy that can be prefcribed for it muft be in fome meafure empyrical, until its caufes are better understood. If there Should ever be a radical cure for cancer found, (and no doubt there will) it will probably be one that acts Spe- cifically powerful upon that fyftem principally occupied by the difeafe, or by altering the con- dition of the whole fyftem. The chimeras of fancy have often conftituted a part of the theory of difeafes, but none which I have ever read, are more vifionary than the phantoms of Mr. Juftamond's-f- imagination. This gentleman has by his boldnefs contributed in fome meafure to leffen the prejudices of phyficians againft the in- ternal ufe of arfenic; but from his ludicrous hy- pothecs of the difeafe depending upon infects in * See remede eprove pour guerir radicalement le cancer occulte, et manifefte ou ulcjfre. Par Meflire C. R. Le Fe- bure. Docteur en medicine, Paris.—and Med. Comment. Vol. 2, page 3o4, &c. t Juftamond's Tracls. 32 the cancer, he has detracted from the weight his obfervations might have carried with them; for his animalcules, like thofe of Liewenhoech, have either never been demonftrated, nor ever feen by any but their authors. In both thofe ca- fes in which I have feen this medicine tried in cancer, the dileafe had fo totally contaminated the whole fyftem, that little hope could be reafon- ably entertained from any remedy, for if even in fuch cafes the ulcer Should be healed, unlefs the predifpoiition could be eradicated, a return of the difeafe would ftill await the unfortunate pa- tient. It muft be acknowledged that in thofe cafes wherein I attempted the ufe of arfenic in this difeafe, it was not altogether an inert medi- cine, the excruciating pains were mitigated, and the intolerable foetor of the ulcers entirely cor- rected. Thefe temporary alleviations, were of a very tranfitory duration, for thoSe fymp- toms returned with their ufual virulence as foon as the remedy was withheld. This medicine was perfevered in Six months in one cafe, and four in the other, yet no advantage was gained as to the healing or diminution of the ulcer. What might have been the iffue of theSe cafes under the ufe of arfenic at a more early period of the difeafe, I cannot venture to conjecture, but efteem it fome confolation to poffefs a medicine that can, when death is inevitable, ftrew flowers on the borders of the tomb, From the pene- trating nature of arfenic, it would feem to pro- 33 mife the moft beneficial effects in all cafes of fchir« rous and obftruction in the glandular fyftem l a.ul from this property it has obtained the repu- tation of having cured the more inveterate ftates of cancer. It is often a defirable indication to roufe the torpid veffels of a part into vigorous action ; under fuch circumftances, arfenic may be advifed with more plaufibility than any other remedy with which we are acquainted, provided it affect that fyftem of veffels occupied by the difeafe* As this mineral operates forcibly upon the lymphatic fyftem, what would be its effects in Scrophula ? Although I have not feen it experi- mented upon in this difeafe, I Should, a priori, be induced to think favorably of its powers, more efpecially where the fyftem had been fufficiently reduced to admit of its moft extenfive influence. Wherever the fame indications of cure are to be fulfilled, in the cancerous, callous, or fungous ftate of ulcers, the internal ufe of arfenic in mo- derate dofes, affords the faireft profpect of fuc- cefs. In many cafes where its external applica- tion is proper, it may be found advantageous to conjoin its internal ufe. There is no fact in the fcience of medicine, of which I am more decided- ly convinced, than that arfenic is an improper medicine in all cafes where ulcers are acccmpa* nied with an inflammatory diathefis. F 54 The following letter from Dr. Martin may" rend to corroborate fome of the preceding ob- servations, efpecially as it was written by a gen- tleman whole authority in medicine is inferior to none. Easton, Feb. ift. 1796. Dear Sir, I HAVE long promifcd you fome observa- tions on the ufe of arfenic, which I Shall confine within the bounds of my own experience. I have been in the practice of prefcribing arfenic, about five years, in cutaneous difeafes and inter- mittents only.—My friend Dr. Birchhead firft recommended the ufe of arfenic, and referred me to the difpenfatory lately publifhed, for fome hints under the head of mineral folution. Here I found that arfenic was recommended in cuta- neous difeafes. As I had oeen baffled in a cafe, (which I had called Lepra Graecorum) after uf- ing every remedy which could be thought of by myfelf or others, I refolved to try the mineral folution of arfenic on my old patient, Thomas Mc. Namara, who had wearied out every phyfi- cian and others, who would adminifter any thing for his relief. As he had retired to fome un- known part of the country, I mentioned my in- tention to Dr. Johnfon, who had witneffed his deplorable fituation in the poor-houfe, while a Student with me, and defired that he would ad- minifter the Solution whenever he fhould find *7 Z him, engaging that I would do the Same if I mould fee him' firft. The Dr. fhortly after this fell in with him, and told him what Je had agreed on. Poor Thomas was always eager to catch at any thing for relief. He v/as defired to take twelve or fifteen drops three times a day, but in a week or two the poor fellow had increafed the dofe to thirty drops, becaufe he found his fores healing in a manner he had never before experienced, for at leaft five years, and I think,, in lefs than four weeks, every fore or part affected, was heal- ed up. Thus relieved, contrary to all expecta- tion, Thomas began to make free with ardent fpirits, when fome appearance of the difeafe was again difcovered, which was a Second time re- lieved; but his intemperance foon brought on the difeafe with worfe appearances, when he was once more admitted into the poor-houie. I was aftonifhed to obferve how foon his fores be- gan to heal, and to vanifli entirely, except one up his noftrils, and even this to appearance was cured, when Thomas begged to be difcharged. This winter he is a third time admitted, and it yet remains to be tried, whether he can be again relieved by arfenic. Ouere, if arfenic had been ufed earlier, and this patient had been a tempe- rate one, whether the predifpoiition to this di- feafe might not have been entirely eradicated ? A mulatto man in this county (Talbot) aged a- bout forty years, had fymptoms of the Lepra Grascorum before he was twenty oi.e, and 1 am ^ well fatisfied, when I faw him fifteen months ago, he had this difeafe with every characteri^Tymp- tom. The mineral folution of arfenic had a moft aftonifhing effect in this cafe, for every Symptom vanifhed in the courfe of a few weeks, except one fore on his leg or foot, and I have not feen him fince laft March. I once thought the mine- ral folution had a wonderful effect in a fchirrous breaft, but the predifpoiition ftill remained, the woman was of a bad habit of body, and fome hard-, nefs continued to her death. In agues and fevers I am fometimes induced to think this a valuable remedy, but likeevery other it is fallible, and I am frequently difappointed in its effects, yet I have known it to fucceed, when the bark has failed. In fome children in the ague and fever, it has an immediate effect. That it is a fafe and ufeful remedy I am well convinced, and therefore give it to my own children without fcruple. In my fon it feemed to have no effect, good or bad, but has greatly relieved my little daughter in the ague and fever. In the periodical head-ach I have fometimes thought arfenic better entitled to infallibility than any other remedy in the materia medica. Thus my dear Sir, I have fummed up all that I can fay about this fafe, agreeable, and valuable acquifition to the materia medica. You are at liberty to make any ufe you may think proper, 37 of the above obfervations, with my beft wifhes for your fuccefs in life, I am Your Friend, ENNALLS MARTIN. Of the External ufe of Arfenic, HOWEVER much timidity and fcepticifm may have influenced the minds of practitioner.'] respecting the internal ufe of arfenic, both em- pyricks and theorifts have been lefs fcrupuloas in its external application. Two opinions have divided practitioners concerning its applicati- on to cancerous and other ulcers. Dr. Mofe- ly* condemns its ufe unequivocally a :d ob- ferves " That it will not produce the falatarv " effects obtained by corrofive fublimate. It rots " indifcriminately the found and unfwad flefh 44 wherever it comes in contact. Corrofive fab* " limate is bounded in its corrofive action by 44 healthy flefh, or acts but flightly as a deftroyer. 44 Arfenic has a tendency to deflroy or deaden 44 the functions of organized parts : corrofive ili- 44 blimate to inflame thofe parts." In the intro- duction to this effay, I adverted to the difaftrouj confequences of not attending particularly to the dofes of medicine, and the ftate of the part to ■>:■ See Treatife on Tropical Difeafes, by Benjamin Mck- ly, M. D. pages 521--'^ -3- 38 which they may be applied; here we fee it ex- emplified in a peculiar manner : we fee pre- judice co-operating with fophyftry, producing a conclusion from falfe premifes equally rediculous and abfurd. Every practitioner who has feen arfenic applied externally in different degrees of Strength, muft teflify againfl the injustice of Dr. Mofe!ey"s criticifms. The principle upon which the operation of arfenic effentially depends, is the fame that actuates corrofive fublimate, of which he has Spoken fo extravagantly. Arfenic in the ftate it is ufed externally, is a true metallic oxyde, or the femimetal united to vital air.— Corrofive fublimate is compofed of the oxygenat- ed muriatic acid and mercury, and owes its acti- vity to the oxygene it contains, otherwife calo- mel which is compofed of the fame metal, united to the common muriatic acid, would prove equal- ly corrofive. Red precipitate, which is a calx of mercury, or that metal united to vital air is likewife a cauflic of considerable power, but if it be Subjected to a ftrong heat, the oxygene will be diffipated, the metal will refume its native State, and is as innocent in actual contact with the moft irritable Surface as fo much water. It would therefore appear that the operation of thefe medicines depend upon the oxygene they contain, and that their powers are accurately apportioned to their relative degrees of fixity and concentration. Nothing can illuftrate this idea more clearly than what we muft have often ob- 39 •icrved; that cauftics and eScharotics in a ftate of dilution or divifion act as the moft certain aftrin- gents. In this ftate arfenic and corrofive fubli- mate, produce the moft falutary effects, and are nearly entitled to infallibility, in all cafes of te- nia, herpes and other ftates of the fkin, not Sup- ported by fnlnefs or inflammation. The particu- lar condition of the part to which arfenic is to be applied, Should be carefully obferved ; if much inflammation attend, it fhould be ufed in a very diluted ftate, and may then be advantageoufly applied to any part. At the requeft of Dr. Rufh, I applied a folution of arfenic to a cancerous in- flammation in the internal canthus of the eye, where the rapid progrefs of the difeafe menaced the erofion of the lachrymal fack, and probably the patient's life : we had the fatisfaction of fee- ing the difeafe completely extirpated, and the man foon reftored to health. In the year 1784. Dr. Rufh* detected the pre- fence of arfenic in the celebrated cancer powder, fo fuccefsfully administered by Dr. Hugh Mar- tin ; and has favored us with observations on the ufe of this caultia. He remarks, 4k I fhould flip- pofe from the examination of the powder I made with the eye, that the proportion of arfenic to the vegetable powder could not be more than TV part of the whole compound. The great art * See Rufh's medical enquiries and obfervations, Vol. i. page 235.—or Philofophical TranfadVionS. of applying arfenic fuccefsfully is, to dilute and mix it in 11:eh. a manner as to mitigate the vio- lence of its action. Dr. Martin's preparation was happily calculated for this purpofe. It excited a moderate inflammation, which feparated the morbid from the found parts, and promoted a plentiful afflux of humours to the fore during its application. It feldom produced an efchar, hence it infinuated itfelf into the deepeft receffes of the cancers, and frequently feparated thofe fibres in an unbroken ftate, which are generally called the roots of the cancer."—Thus we fee, that how- ever ufeful it may be to attend minutely to the ftate of the fyftem in the internal ufe of arfenic, that it is equally indifpenfible in its external ap- plication. Its operation depends upon the fame principles of excitability and excitement, and it muft be obvious to all who are the leaft conver- fant in the practice, that fo acrimonious a fub- ftance muft require the mofl cautious atten- tion. Upon a review of all the cafes of the external ufe of arfenic that have been recorded, we find nodifcrimination of the different ftates of the parts to which it has been applied; but from all that we can learn on this Subject, we are au- thorised to fay, that its beneficial effects are prin- cipally confined to fuch as have been already enumerated. In the year 1783 an itinerant practitioner, who called himfelf Lafferti, travelled through 4i the ftate of Maryland ; he aftonifhed the practi- tioners of that country by curing ulcers long deemed beyond the reach of the Surgical art, and it is not to be controverted that his fuccefs was unparalelled. It was obfervable, that he refufed to undertake the cure of recent ulcers, and, unlike moft of his empyrical brethren, candidly acknowledged, that he had no fkill in fuch cafes as others confidered moft curable. The author's deceafed father, who at that time prac- ticed phyfic and Surgery in that country, left the following account of this practitioner, in a let- ter which he intended to have fent to a medical friend. 44 We have in this county (Caroline) a man who does wonders in the cure of obftinate old fores ; but he ufes fo much myftery, and ap- plies his powder with fo much Secrecy, that he does not feem to intend to let us into the fecret. However, I have juft procured a fmall parcel of his medicine ; at firft I thought it looked like corrofive fublimate, but upon trial found myfelf mistaken: I put fome of it on the fire, which foon perfumed the room with the Smell of gar- lic, from which it muft be arSenic."—Mr. Jufta- mond, who has recommended arfenic fo ftrenu- oufly in cancer, mentions the authority of Sir Hans Sloane for its good effects in fchrophulous ulcers, and thinks it a valuable medicine in fuch cafes. I have no doubt but that arfenic will re- move the ftate of atony often attending fuch fores, or that cancerous ftate of callofity into G 42 which they fometimes degenerate ; but to cure them radicallv the diathefis on which- they de- pend Should be removed. *The muiiate of ba- rytes is faid to have proved ufeful iu fchrophu- la, as it often contains a fmall portion of arfenic, it is not improbable that it may owe its virtues to this active mineral. What might be the ef- fect of the affenical acid, as a medicine, I leave future refearches to inftruct us. Pharmaceutic Treatment of Arfenic. I T may perhaps be thought necefTary to in- vestigate the chymical properties of arfenic, but as all I could fay on that head would be no more than plagiarifm from authors already in general circulation, I Shall content myfelf with as laconic an explanation as poffible of the pharmaceutic treatment of that preparation, which appears to me to poffefs fome advantages over all others, and which, fo far as I am capable of judging, admits of no improvement. The following receipt for making the mineral folution is tranflated from the Latin of Dr. Fow- ler, and the table of dofes which we Shall have oc- cafion to mention, is taken from the fame au- thor ; both of which it may not be improper to infert, as arfenic is a medicine fo little known. * Ses Bell on the venereal, and the Med. Comm, vol. 5, 43 " Take of the powder of white arfenic, and of the pureft vegetabl&tlkali, each fixty four grains, of diftilled water half a pound, apothecaries' weight.-£-Put them into a veffel and Submit them to a fand heat, let them boil moderately until the arfenic Shall be perfectly diffolvcd : then add to the cold folution half a pound of the compound fpirit of lavender, and fo much diftilled Spring water as will make the whole accurately fifteen ounces." * The Simplicity of this chymical preparation renders it preferable to more complex forms. The vegetable alkali has not the fmalleft effect in diminishing its virtues, for that proportion of the folution which we know to contain any gi- ven quantity of arfenic, will act as forcibly upon the fyftem, as the fame quantity in pills, or even in a ftate of pulverization. The almoft infinite divisibility of this form renders its dofes variable to the exigencies of all poffible cafes. The fmall proportion of compound fpirit of lavender is added to give it a more medicinal appearance, not with a view of captivating the eye, by drawing the veil of myftery over the compofition, but left from its being coiourlefs and infipid, thofe who may be entrufted with its exhibition fhould be tempted to ufe it with too much liber- ality, the confequences of which mi teat prove troublefome, if not dangerous. To a pound of the folution, fixty four grains are added fcv 44 the purpofe of a more accurate calculation, by which means the precife *iantity of arfenic con- tained in any given number of drops may be af- certained. If the alkali fhould not be perfectly pure, it will be found inadequate to the produc- tion of a perfect folution ; a circumftance which might occafion great confufion and uncertainty in the dofes of the medicine. If therefore, the alkali cannot be obtained pure, a double propor- tion of purified nitre may be fubftituted, for there is a ftronger attraction between the arfenic and the vegetable alkali, than between the fame al- kali and the nitric acid, which laft, is therefore difengaged. The two folutions do not differ in point of efficacy, and, by attending to the pre- ceding directions, they will be found to poffefs an uniform degree of ftrength ; a circumftance of importance in the ufe of fuch an heroic medicine. Although we cannot altogether approve of Dr. Fowler's mode of administering the Solution, and muft therefore obferve, that his dofes are ra- ther larger than we prefer (at leaft in this coun- try). His table may be ufeful in graduating the dofes for different ages. Patients are to take, according to their ages, the following dofes of the folution : Years. Drops. From 2 to 4. - from 2 or 3 to 5. ---- 5 — 7 - ---- 5 — 7. ---- §—12 - ---- 7—10. 45 -----x3—z& - ---- I0—12. ■---- 18 and upwards - 12. Thus from five to feven years the dofe may be apportioned by allowing a drop for each year, but a drop for each year under that period will be infufficient, and foon becomes too much be- yond it, as twelve drops are a medium dofe for an adult. Thi s medicine may be adminiftered with con- fiderable latitude to adults, but a very general rule may be eftablifhed which will often prevent moft of thofe unwelcome confequences which follow the ufe of large dofes. It will generally be found moft advantageous in the end, to begin with an under dofe, and to increafe it untij it fhall affect the flomach Slightly, unlefs a cure be obtained. If the fyftem fhould be much difor- dered by the folution, it will be proper to discon- tinue it a day or two, and inftead of ten drops, three times a day, five drops fix times a day may [ be adminiftered, which will often agree with the Stomach, and perform a cure as certainly, though not as expeditioufly, as a larger dofe. It will often be neceffary to continue the medicine for fome time after the cure is apparently com- plete ; by this practice a relapfe may often be ef- fectually prevented. Where naufea, vomiting, or pains in the bowels arife from the folution, they may not only be mitigated, but often prevented, 46 by combining a few drops of laudanum with the folution, and this will feldom interfere with the virtues of the medicine, as the former is general- ly admiffible where the latter is proper. A com- bination of their Stimulant effects will fometimes be found more powerful than either of them a- lone, efpecially in curing intermittents. In fome cafes inltead of diluting the dofe by a tea-cup full of cold water (the ufual vehicle) in cafe of tur- bulent fymptoms Supervening, a larger proportion of water will be a fuccefsful method of obviating them. This obfervation applies more particu- larly to the ufe of the folution among *children, whofe tender organs are often molefted by a ve- ry flnill dofe of the lolution : inftead therefore of giving the medicine in a tea-Spoon or table- Spoon full of water, double the quantity may be ufed to advantage. The difeafe for which the medicine is prefcribed, will like wife require to be noticel, both with refpedt to the quantity of the dofe, and the times of adaiiniiVring it. In intermittent fevers and periodical head achs moft advantage will refult from the adminiftration of as large a dofe as the lyftem can conveniently bear, as nearly preceding the paroxyfm as poffi- ble. In the treatment of cancers and many di- feafes of chronic debility, it may be neceffary to continue the ufe of the folution for weeks, and * It is neverthelefs worthy obfervation, that children of- ten bear larger doles in proportion to age and other circum- stances than adults. 47 £ven months, to obtain all its advantages, Uri» der fuch circumftances. the folution muft fre- quently be gradually increafed, for the fyftem becomes fo habituated to its Stimulus, that an or- dinary dofe will be altogether inert, F have gone as high as thirty drops three times a day^ in a cafe of cancer, without producing one difa- greeable fenfation. In the exhibition of this me- dicine, little is to be learned from an apparent de- licacy of constitution, for women whofe appear- ance would lead us moft to expect irritable frames, often bear the medium dofe of an adult with the greateft compofure; whereas the moft robuft men frequently feel very ienfibly the com- motions excited by a Smaller dofe. I have given this medicine to pregnant women laboring under intermittents, with fafety, in Very considerable doles, but cannot avoid obferving, that although thefe; cafes were fuch as in every refpedt (their gravid ftate excepted) might from common ex- perience be fuppofed moft eafily cured, I was lefs fortunate than in any equal number of cafes that came within the Sphere of my notice. The ten- sion imparted to the arterial fyftem by the Sti- mulus of diftenfion, or that artificial inflamma- ' tory diathefis which accompanies a ftate of preg- nancy, muft have prevented the medicine from exciting an action fufficient to cure the difeafe. It has been alledged againft the internal ufe of arfenic, that it deftroys the tone of the Stomach, i! thereby laying a foundation of dyfpepfia and ge- neral debility. If this objection fhould be found- ed on truth, it will alone be Sufficient to exclude arfenic from the materia medica, and to banifh from the mind of every reafonable phyfician all thoughts of advocating its character.. To deter- mine this important queftion beyond the poffi- bility of a controverfy, I examined all thoSe ca- fes wherein I was under the neceffity of perfift- ing long in the ufe of arfenic. Out of forty per- fons whom I interrogated touching this point, I found but two who difcovered dyfpeptic Symp- toms, both of whom were notorious for t.heir at- tachment to ardent Spirits, by which the diSeafe .had been produced years before they had taken arfenic. Even dogs that had been poifoned by it and recovered, exhibited no marks of indigef- tion. It has moreover been objected to arfenic, that both from its internal and external ufe, it has fometimes produced paralytic fymptoms and a vertiginous difpofition in the brain ; but in all the cafes where I have feen it ufed, even where, from a long protracted external application, an abforption might have been thought probable, no fuch confequence followed. Such effects have doubtlefs followed the poifonous influence of arfenic, but thofe who cannot draw the line of distinction between its medicinal and poifo- nous degrees, would do well not to interfere 49 With the feelings of mankind. *Mr. Wiliiaffl Gafkill, an ingenious Surgeon, at Rotherhythe, instituted a feries of experiments upon the exter- nal abforption of arfenic, from which he proved decifively that no fymptoms of a difordered eco- nomy were even perceptible. He has not taken notice of its diuretic qualities, although they are dwelt upon withfo muchemphafisby |Mr. John Sherwin, Surgeon, who performed the fame ex- periments with tartariied arfenic, and attributes the diuretic effects it produced upon himfelf and four others, excJufively to the operation of arfe- nic. But the conclufion he has drawn is by no means juft, and a very fuperficial knowledge of chymiftry will be required to detect its fallacy. By the union of the chryftals of tartar and arfe- nic, the tartarized arfenic is formed, a fubftance which, although it partakes in fome meafure of an arfenical nature, is yet widely different from the pure femi-metallic oxyde, and poffeffes pro- perties peculiar to itfelf. Dr. Fowler has recorded many unpleafant ef- fects of the folution ; fuch as naufea, vomiting, fwellings of the face, and fometimes of the abdo- men, all which, he fays, vanifb from the ufe of gentle aperients, and moft of them by a tempo- rary omiffion of the medicine. Doctors Arnold * See a pamphlet entitled, Experiments on the external abforption of arfenic and emetic tartar. t Medical commentaries, vol. xv. page 220 etfequent, H ~)° and Withering, although much in the habit of ufing the Solution, have not mentioned fuch ef- fects; and even Dr. Clark, who inveighs with fo much acrimony againft arfenic, has been filent on this particular. I firft began the ufe of the fo- lution in the dofes prefcribed by Dr. Fowler, and experienced many of the painful fenfations which he has afcribed to it. I afterwards found it eafy to prevent them in moft cafes, by diminishing the dofe, and obferving the precautions already men- tioned. One of the moft characteristic properties which we have attributed to arfenic, is, its pow- er of accumulating the flimulability of the fyf- tem, a circumftance of much importance to be attended to in practice, efpecially in a ftate of convalefcence, inafmuch as both medicine and di- et are to be regulated accordingly, either of which, in over dofes, might be productive of the moft alarming confequences. This caution can- not be better enforced than in the emphatical words of the elegant Dr. Armstrong. ------------" When the vital fire Burns feebly, heap not the green fuel on ; But prudently foment the wand'ring fpark With what the fooneft feels its kindred touch i Be frugal even of that, a little give At firft; that kindled, add a little more, 'Till by deliberate nourishing, the flame Reviv'd, with all its wonted vigor glowi.** 5i Of the Deleterious Qualities of Arfenic. HITHERTO we have viewed Arfenic as a remedy capable of abstracting from that portion of pain and difeafe to which the frailty of hur man nature is Subjected. But as this mineral, like all other things deftined for the ufe of man, is liable to abufe, and Subject to a deviation from that order which was qriginajly impofed upon it; we are cpnftrained to the melancholy necef- Sity of reverSing the picture, and of contemplat- ing human nature in the moft deplorable State that the imagination can poffibly conceive. Happily for mankind, fuch cataftrophes as this poifon is capable of producing do not often oc- cur, but as phyficiarjs are fometimes fummoned to arreft the progrefs of death from this caufe, the moft effectual antidote becomes a defideratum of the higfieft importance. It would far exceed the limits of this Effay to detail all the experiments from which we have deduced the following conclusions, we Shall therefore give the refult of the moft important, in as concentrated a form, as the nature of the fiibject will admit of. We have already hinted at fome of the formi- dable confequences of this poifon, and where its medical effects end, we may date the commence- ment of its deleterious qualities. This Stygian draught when taken into the Stomach in oaau- 52 tities difproportioned to the excitability of the fyftem, is productive of naufea, vomiting, purg- ing, hiccough, gaftrodynia, convulsions, fubful- ties tendinum, increafed flow of faliva, hematu- ria, thirft, gnafhing of the teeth, Syncope, af- phyxia, and death, unlefs a fpeedy remedy is ad- miniftered. As fome peculiarities attend the ope- ration of this poifon, it may be ufeful to trace them to their remoteft confequences. A gentle- man whom I faw, and with whom I converted, foon after he had been nearly deprived of his life by this poifon, exhibited the following phe- nomena. From having been remarkable for his athletic powers, he became fallow, emaciated and enervated. Previous to this accident he had enjoyed an uninterrupted feries of good health, for ten years. In the autumn after this misfor- tune, he was attacked by an obstruction of his liver, which left him in a ftate of paralyfis, from which he with difficulty recovered, during the winter. He has been Subject to jaundice four or' five times every year lince that memorable event, and his teeth before remarkable for their whitenefs, became incruftcd with a black fcalc, and fome of them have decayed without pain. It has fometimes been obfervable that arfenic, even in fmall quantities, like the vegetable and other acids, has fet the teeth on edge, and in fome of the dogs who recovered from the poifonous ef- fects of arfenic loft their teeth, an occurrence I apprehend to be very unufual in thefe animals. 55 Whether arfenic produces this effect by a ge- neral operation inducing a general debility in confequence of which the teeth decay, or whe- ther its peculiar acid acts Specifically upon the calcarious earth of the teeth, I Shall not prefume to determine. * Mr. William Lempriere, an intelligent Engiifh Surgeon, has drawn the picture of a cafe from the poifonous effects of arfenic, which is fufficient to demonstrate, that even in fome cafes where a recovery is obtained, life is under fuch circumstances the moft intolerable of human burdens. He obferves, 44 I was defired to vifit the emperor's favourite wife, who had been poi- foned by arfenic, conveyed into her food by the machinations of her rivals. After a tedious con- flict between life and death the effects of the poi- fon in part abated, but the unhappy lady was left in a dreadful ftate of debility and irritation. Her beauty, the fatal caufe of her misfortune, was completely deftroyed, and her enemies, though difappointed in their aim at deftroying her life, yet enjoyed the malignant triumph of feeing thofe charms which had excited their jea- iouSy, reduced below the Standard of other wo- men. Her digeftion was fo weak, that every Species of food, after remaining a few hours on her Stomach, was returned perfectly crude and undigested. Her body was reduced to a Shadow, * Tour to Morocco. 54 and her ftrength fo far exhaufted that She could not walk without afliftance. Her Skin, from be- ing naturally clear and fair, was changed to a fickly brown, which joined to a ruined fet of teeth and ghaftly countenance, effaced every trace of that beauty which She might once have poifeft." Various antidotes have been propofed to counteract the poifonous effects of arfenic. Oils and fuch other fubftances as Seemed beft calcu- lated to obtund the acrimony of the metallic par- ticles, have been fuppofed adequate to the relief of the pernicious effects of all faline poifons. Sceptical on this fubject I inftituted a feries of experiments upon dogs, the refult of which clearly demonstrated, that no oleaginous fub- flance is equal to the prevention of evil from fach caufes. In cafes where the portion of poi- fon was inconsiderable, mucilaginous and oily matters feemed in fome meafure to protract and mitigate the fymptoms, but never afforded en- tire relief; for fuch as recovered hao} taken fp fmall a quantity as fcarcely to be capable of do- ing mifchief if no remedy had been attempted. I ufed for thefe experiments the oil of almonds, train oil, linfeed and caftor oils, all of which proved infufficient. The caftor oil, where it was given in quantities fo large as to operate fpeedily, feemed to procraftinate life, by trans- lating the feat of the difeafe from the Stomach tq a lefs vital part, the lower interlines. When the arfenic was given mixt -with the oils its viru- lent effects were not obviated, unlefs the quan- tity of the poifon was fo fmall as to remain fuf- pended, and not to come in contact with the flomach and interlines. Conformable to this idea of the infufficiency of oils to prevent the effects of arfenic on the Stomach, we may regard a cuf- tom authorifed by the fuperftition of the Hin- doos. * One of the nine modes of trial by the or- deal confifts in compelling the accufed to Cat from the hand of a Brahman a preparation com- pofed of fixty-four parts of clarified butter, mixt with two parts and an half of pure arfenic; if the poifon produce no vifible effect, he is abfolv- ed, otherwife condemned. Milk has been propofed as an antidote againft arfenic and other poifons, but proved inert in every inftance, although I gave it the fairefr. trials, and never produced the fmalleft benefit, only in proportion as it diluted or waShed off the poifon concentrated in the Stomach. Who- ever will obferve the fpecific gravity of arfenic, muft readily conceive the difficulty of defending the Stomach againft its corrofive qualities: The impracticability of fuch an hypothecs is farther augmented by reflecting, that the arfenic is al- ways in actual contact with the flomach before the antidote can poffibly be adminiftered, and that * Hiftory of Indofton. tf all attempts for relief muft be Superfluous, unlefs the poifon be inftantaneoufly removed. The premature exhibition of vifcid fubftances may moreover interfere with the operation of that remedy which we Shall fay hereafter affords the only rational profpect of relief Where the poi- fon has been evacuated, and a Slight inflammation ftill remains, oils may prove ufeful by their lu- bricating quality. I attempted the relief of thofe devoted vic- tims by a variety of diluents, given copioufly immediately after the poifon ; but they all proved futile, and their Synchronous exhibition was at- tended with the fame fate. Chymistry has furnifhed a variety of fub- ftances which have been thought equal to the neutralization of arfenic. Vinegar has been ex- tolled by Mr. Sage; but wtiatever appearances the combination of thefe agents may exhibit to the eye, I can affert, from repeated experiments, ttiat when they meet in the ftomach they do not refcue the body from destruction. Mr. Navier, an ingenious French phyfician and chymift, has propofed to decompofe arfenic by a direct combination of the liver of Sulphur. We know that orpiment, although it contains a large proportion of arfenic united to fulphur, may be taken into the ftomach in a considerable quantity with impunity. This would at firft 57 Sight feem to favour the idea that fulphur alone might neutralize arfenic, but from a variety of experiments we can affert the contrary. The hepar fulphuris is a moft rapacious folvent of fome metals, and might therefore aptly obtrude itfelf upon the prolific imagination of a Specula- tive chymift. Whoever will be at the trouble of mixing arfenic and the liver of fulphur, will be amply fatisfied of their Slow and feeble influ- ence upon each other. Their action is fo flow (even out of the body) that a man might die a thoufand deaths before a Single particle of arfe- nic could be neutralized. Every experiment tended to confirm me in the opinion, that chy- miftry has yet invented no power capable of neutralizing arfenic. The animals upon which the experiments were made individually died, although in many cafes a few grains only had been taken, and the proportion of hepar men- tioned by the fanciful Mr. Navier immediately adminiftered. The proportions of each were varied, and the experiments repeated, with a re- fult equally unpropitious. Whatever effect the alkali may have in the formation of the hepar, I am fatisfied that fulphur alone will do as much towards effecting a cure as in their combined ftate; for death will ever be the inevitable con- fequence of the arfenic, although they may both be ufed with ever So much liberality and expe- dition. No remedy can ever alleviate thefe me- lancholy preludes of death, unlefs it operate I 5« with the velocity of light as a folvent, or eva- cuate the poifon from its contact with the Sto- mach. I defy the imagination to conceive of a poifon more irrefiftible in its operation than a large dofe of arfenic; it will therefore be irra- tional to indulge a hope of averting its inftanta- neous effects, unlefs a remedy can be invented that Shall equal it in the rapidity of its operation* I will not dogmatically affirm that chymiftry does not poffefs a fubftance adequate to the in- flantaneous neutralization of arfenic, but can fefely fay, that none of the great variety upon which I have fo repeatedly experimented, is equal to this important indication. Hiftory has re- corded an antidote for this Herculean poifon, which we are ferioufly informed is infallible. *44 The beft antidote againft the poifonous ef- fects of arfenic are the fcrapings of leather re- duced to afhes: if the quantity taken be accu- rately known, four times as much of thefe afhes mixt with water, and drunk by the patient, will Sheathe and counteract the poifon." Baffled in every attempt to prevent the fatal effects of arfenic taken into the body, I attempt- ed it by the ufe of the moft powerful emetics that could be obtained. In every cafe where the quantity was not fo great as to deftroy life Sud- denly, or to render the ftomach altogether in- * Hiftory of indoftan, page-481. 59 ftnfible, an effectual relief was obtained. If the length of time between the taking the poifon and the exhibition of the emetic Shall be consider- able, all attempts for relief will be in vain. The ftrongeft emetics that can be obtained fhould be adminiftered as Soon as the accident Shall be dif* coveted, and however copious their effeas may be, large quantities of warm water Should be imme- diately taken, and perSifted in, until it may be fuppofcd that the whole be evacuated. The warm water not only wafhes off the acrimonious particles of the poifon, but accelerates the ope- ration of the emetic. Amongft the variety of emetics of which I made trial, I found the vi? triol of Zinc the moft certain : indeed I can fay With certainty that it afforded complete relief in all cafes where the excitability was not nearly extinguifhed. After a partial evacuation of the ftomach, I endeavoured to finifh the cure by fuch fubftances as might be judged moft powerful on account of their invifcating qualities; the uni- form confequence of which was, to retain the poifonous particles in clofer contact with the ftomach, and to expedite the approach of death. Tefts for difcovering the prefence of Arfenic. IT may often be a defirable thing to deter- mine Satisfactorily what poifon has been the caufe of fuch diftreffing fymptoms. The prefence of 6o arfenic may be detected in two ways.—i. If the leaft particle can be perceived and burnt, it will emit white fumes, and an evident fmell of garlic. 2. Confine a fmall quantity of arfenic between two plates of copper, and fubject them to a ftrong heat, a white appearance will be communicated to the copper. Thefe methods are Sufficient to detect the prefence of arfenic, even where it may be diffufed among the contents of the ftomach, or prefent in a very minute proportion; but whoever Shall feel himfelf diffatisfied on this point, may ufe a method communicated by Mr. Bergman. Infufe a fmall portion of the powder in a folution of vegetable alkali in water, after Standing an hour or two, pour upon it a folution of the fulphate of copper in water, the colour of the vitriol will be immediately converted into an elegant green, and will foon be precipitated. The fame experiment may be ufed to detect its prefence in water. Arsenic is a fubftance which is copioufly dif- fufed through the bowels of the earth; it is a component part of many metallic products, and may, by its latent distribution among them, be- come the unfufpected caufe of the moft Serious calamities. Tin (as we have already obferved) contains a considerable portion of arfenic; we ought therefore to be cautious in admitting it in- to the composition of culinary utenfils, efpecially fuch as may be intended to contain acids, or to be much expofed to great heat. 6i Pewter likewife fometimes contains a fmall portion of arfenic, but the quantity is fo insigni- ficant as not to be juftly an object of terror : It is neverthelefs, a duty incumbent on the manu- facturers of thefe metals, to afcertain with pre- cision what proportion of arfenic their materials contain. If we diflolve tin which contains this fubftance, in the muriatic acid, the folution will exhibit a black powder, which confifts of the arfenic feparated from the tin. This experiment renders the fmalleft particle confpicuous. The property which arfenic poffeSTes of be- ing foluble in water, multiplies and facilitates its destructive powers; Springs and rivulets are fometimes impregnated by flowing over this nox- ious mineral, and thofe who inhabit their vicini- ty may fall victims to their infidious influence be- fore a fufpicion of the fatal caufe Shall arife. Be- sides the method we have already defcribed, for difcovering the prefence of arfenic in water, it may be accomplished with more fimplicity and equal certainty, by evaporating the water in a clean iron veSfel: a portion of the arfenic will be depofited on the fides and bottom of the vef- fel, and when thrown upon burning coals, will emit the well known garlic-like odor. If a cop- per veffel be ufed, the infide of the veSfel will become white. The fame end may be attained more expedi- tiously by evaporating the water rapidly from 6% an ignited iron; but this method is liable to a deception, for no odor will be emitted unlefs the water be Strongly impregnated by the femi-metal. TheSe methods may however, prove lefs accu- rate than others devifed by the ingenuity of chy- mifts. The moft infallible with which we are acquainted are the following. i. If a folution pf the hepar fulphuris be pour- ed into water adulterated with arfenic? a colour more or lefs yellow will be produced, and if the fulphur fuperabound orpiment will be deposited. 2. *If boiling lime-water be poured upon wa- ter holding arfenic in folution, a white precipi- tate of difficult folubility in water, will fall down. This precipitate is foluble in the acetous acid, and in a folution of arfenic : when mixt ! with oil and laid upon the fire, it yields the gar- lic-like fmell peculiar to arfenic. 2. Cuprum Ammoniacum affords an excellent means of detecting the prefence of arfenic in any liquid ; it produces with it a yellowifh green precipitate, which if feparated from the Superin- cumbent liquor, dried and put upon ignited coals, manifefts the fame garlic-like odour. Other tefts might be devifed to afcertain the prefence of arfenic by different reagents, but it * Chymical tefts, invented by J. F. A. Gotling, Profeflbr of Chymiftry at Jena, in Saxony. % would be a work of fupererrogation, as thofe al- ready defcribed are deemed amply fufficient to detect it in its almoft infinite varietyof combi- nations. It has been the object of the preceding effay to collect fuch information as could in any wife tend to illuftrate a fubject as yet in its infancy. As an impartial inveftigator, the author has, un- biaSfed by prepoffeffion or prejudice, extolled or condemned it agreeably to the fuggeftions of his own judgment. It may perhaps be obferved, by thofe who have experienced the difficulties of adapting medicines to particular exigencies and to the various conditions of difeafe, that more minutenefs and precifion are neceffary in the ufe of fo active a medicine : but whoever will at- tend to the principles that govern the operations of this medicine, as they are laid down in the progrefs of the fubject, will find its management both practicable and eafy. It would have been eafy to have decorated every page with the tin- fel phantoms of the imagination, but as the the- ory which has been contemplated is the inevita- ble confequence of the phenomena of difeafes, or the obvious operation of the medicine, the au- thor ought in juftice to be refcued from the im- plication of vanity or prefumption. Should any thing have eftaped him which Shall be hereafter found erroneous, it Shall be retracted with un- Speakable pleafure; for, whether his efforts ^4 Should lead to truth directly or indirectly, through the medium of error, they will afford a gratification not to be conceived by any but thofe who have felt the pleafure of doing good. If we take a retrofpedtive view of the agency of this mineral as a medicine, we fhall fee that nature hath made nothing in vain, or, to fpeak more philofophically, that the Author of nature has acted moft benevolently in its formation; for if we view impartially even its moft destruc- tive attributes, we Shall fee, that they are no more than deviations from that order, which was impofed upon the univerfe from the beginning, affording us additional reafon to exult with the poet, " All partial evils univerfal good, " All difcord harmony mifunderflood." The END. Med. Hist WZ Mb P*Uc ■fijf ¥ &■■■*, 0& |!J» * ?iV'.^ :$'4i '^ijt:.