Page images
PDF
EPUB

THE FEBRIGENIC POWER OF ARSENIC, AND ITS EMPLOYMENT IN TYPHOID FEVER.

By Dr. IMBERT-GOURBEYRE.*

THERE is a fever produced by quinine; it has been rightly called the quinine fever. If quinine be pathogenetically febrigenic, is arsenic, its congener in the therapeutics of intermittent fevers, also febrigenic? An examination of the facts will compel us to give an affirmative answer; but it is desirable to exhibit these facts, and such is the object of the following paper. I shall, moreover, discuss the question of the treatment of typhoid fever by this medicine.

I.

Hahnemann in his work on arsenical poisoning published in 1780 frequently alludes to irregular fits of fever occurring in the course of arsenical poisoning, both rapid and slow, and he proves this by numerous facts, the sources of which he gives.

Ten years later this great investigator of the physiological properties of medicines observed the power of arsenic to produce rigor. "I have myself ascertained that it has a great tendency to excite that spasm in the blood-vessels and the shock in the nervous system called febrile rigor. If it be given in a pretty large dose (one sixth or one fifth of a grain) to an adult, this rigor becomes very evident. This tendency makes it a very powerful remedy as a similarlyacting medicine in intermittent fever, and this all the more, as it possesses the power, observed by me, of exciting a daily recurring, though always weaker paroxysm, even although its use be discontinued."+

* L'Art Médical, August and September, 1865.

[ocr errors]

+ Essay on a New Principle,' Hufeland's Journal, 1796 (see Lesser Writings,

p. 336).

In the two editions of his Pure Materia Medica, Hahnemann gives numerous symptoms proving the febrigenic power of arsenic, citing from the works of his predecessors, which he has ransacked for facts, various observations of Quelmalz, Morgagni,* Buchholz, Kaiser, &c.

Hahnemann also cites an instance of periodical headache related by Rau;† but he has omitted a very fine observation of Wepfer‡ of an infant poisoned by a servant girl by repeated doses of arsenic during nearly a month, in whom there occurred a tertiary intermittent fever, at first regular, then irregular, that ended fatally.

Stapf in the experiments he communicated to Hahnemann, experienced in the evening, about 10 o'clock, a general heat with redness of the whole body followed by sweat.

Harles in his essay De Usu Arsenici (1811) admitted the occurrence of irregular fits of fever, but, contrary to Hahnemann, he denied the regular periodicity. From irregular fits to a fixed type there is but a step, and as we shall presently see there are two instances in point. It is curious to observe Harles in this matter giving in his adhesion, though in a very obscure manner, to the law of similars.

Now we shall see the observations of Hahnemann confirmed by medical men not belonging to his school. The facts we are about to cite relate to the administration of arsenic either in poisonous doses, as in cases of rapid poisonings, and certain forms of slow poisoning, or in the ordinary therapeutic doses. We shall commence with observations relating to acute poisoning.

OBS. 1.-On the 9th May, 1831, Cailette and his wife were poisoned by arsenic mixed with their food. Two hours after dinner they were affected with nausea that ceased in

* Quelmalz, Commercium litt. Norimbergicum 1737.-Morgagni, de Sed. et Causis morborum, lix.

† Rau, Acta naturæ curiosorum, ix.

Wepfer, Cicuta aquatica historia, Basilea, 1679, p. 274. Before giving the white oxide of arsenic, the servant girl had given the child repeated doses of cobalt water used for killing flies. It is probable that the intermittent fever that preceded the serious symptoms caused by the arsenic, was caused by the cobalt; at all events this fact can only be regarded as probable.

the evening and returned the following day with diarrhoeic stools. On the 12th considerable illness and weakness, vomiting, stools with colic, irregular pulse especially in the woman; dilatation of the pupils, heaviness of the head, rare and difficult emission of urine. The man died at the end of thirteen days, the woman on the twenty-ninth day, both with similar symptoms. The vomiting and purging stopped the fourth or fifth day, then there occurred heat in the gullet, dysphagia, numerous aphthous spots in the mouth, great insensibility of the hands and feet, especially in the woman, and every evening a febrile fit, a state that continued until it resulted in gastro-enteritis. (DEVERGIE.)

OBS. 2. In a manufactory in Lower Austria, five persons hitherto in good health, were seized some days previously, without known cause, with symptoms nearly alike: at the commencement distress and cardialgia; only one of them had vomiting. The symptoms increasing, Dr. Flechner was called in on the fifth or sixth day. The patients complained, though in different degrees, of nausea, sometimes accompanied by ejection of food, of mucus and of a sour and bitter fluid; pain in the stomach and in the intestines, with sensation of slight burning in the oesophagus; the epigastrium and umbilical regions sensitive; motions serous, not frequent; thirst. Slight fits of fever the previous days, gradually increasing in severity; drawing and fatigue in the limbs. The water of a neighbouring well was analysed and found to contain arsenic. On the ground surrounding the well there had been placed a large quantity of cobalt. This had passed through the winter exposed to the air and covered with snow. The melting of the snow must have carried into the well a certain quantity of arsenic, and this caused the poisoning of the persons in the manufactory. (FLECHNER, Verhandl. der K.K. Gesell. zu Wien, 1813.)

OBS. 3.—One of the victims of Ursinus, a famous German female poisoner, swallowed the poison mingled with her food on the 25th and 28th February. The after-effects of the arsenic lasted a long time. On the 21st of May following, the patient in addition to other symptoms had frequent fits

of fever. (METZGER, Med. ger. Abhandlungen, Königsberg, 1804.)

OBS. 4.-A person poisoned in July complained long afterwards of acidity of the stomach; he vomited readily, even after the lightest meals. In November, he complained of rigors, heat, thirst and headache at irregular times, especially at night. (KELLERMANN, Esterreich. Jahrb., 1840.)

Schaper has published an interesting monograph on arsenic in reference to paralytic phenomena observed in a person poisoned by his wife on several occasions within a month. The last poisoning took place on the 18th October, 1839; paralysis had already commenced in the extremities, and in the following May, on the patient's removal to a bathing establishment, he was attacked by intermittent fever. The physician who attended him as well as Schaper attributed this intercurrent disease to the influence of the season, but knowing as we do the facts, may we not justly ascribe the fever to the febrigenic action of arsenic in a poisoned person still suffering from the paralysis caused by the drug?

[ocr errors]

Moreover, De Haen cites a case similar to this one of Schaper. A woman poisoned herself involuntarily in July. Relieved after vomiting, but some days afterwards there commenced paralysis of the extremities, for which the patient was sent to some mineral waters. On coming into hospital in November in the same paralysed state, she was seized with fever with cardialgia and headache. "Cogebamur tunc cortice poruviano eamdem fugare."

It may be asked, how it happens that arsenic swallowed several months previously and probably long since eliminated, can produce its characteristic effects at such a great distance of time? This belongs to the subject of the duration of the action of arsenic and medicines in general. I shall not here attempt an explanation of the facts; it suffices to mention them. The after-effects in cases of poisoning by arsenic, and after a long time, have been too often observed to admit a doubt of the relation of cause and effect in such cases.

* Beiträge zur Lehre von der Arsenikvergiftung. Berlin, 1846.

Besides these febrile fits recurring at more or less regular intervals, many observers have been struck by periodical symptoms of diverse kinds occurring after poisoning.

In an observation published in 1834 in the Annales de médecine physiologique, M. Guyot mentions pains in the stomach, the abdomen and the joints recurring periodically during the day. In another case of poisoning, periodical pains and colics (BUZORINI, Würtemb. med. Corresp. Blatt, 1835); periodical hiccough on the fifth day of poisoning (SCHINDLER, Journal von Graefe und Walther, 1838); colics with a periodical character (CHOULANT, Henke's Zeitsch., 1841); in a case of poisoning ending in death at the end of seven days, Kersten observed remarkable periodical remissions (Deutsche Klinik, 1861).

Bramer, a German physician, who studied the diseases of workmen who had to handle arsenic in various manufactures, asserts that they are subject to periodical looseness of bowels. The author regards this symptom as well as the cutaneous eruptions as essentially an eliminative act. (Casper's Wochenschrift, 1840.)

The repeated occurrence of such symptoms observed in many cases of poisoning have attracted the attention of medical legists, and this leads me to discuss incidentally an important medico-legal question.

M. Devergie insists particularly on the phenomena of arsenical intermittence. "This," he says, "is a very important point of the history of the morbid phenomena in poisoning by arsenic; there are cases where we observe, in the course of the disease, periods of aggravation more or less marked. Thus, for instance, after a dose of poison, there will occur nausea, vomiting, colic, &c.; then for two, three, four, or five days the patient will seem to get better, he can take a little food; in a word, he seems to be getting convalescent, when the same symptoms recur with the same intensity, and often a second time with more intensity, and again a third time. For our part we consider this a proof that a fresh poisoning has been effected. We are convinced that one dose of poison cannot produce this series of similar

« PreviousContinue »