[5]. The chlorosis is another disease owing to the deficient action of the absorbents of the liver, and perhaps in some degree also to that of the secretory vessels, or glands, which compose that viscus. Of this the want of the catameniæ, which is generally supposed to be a cause, is only a symptom or consequence. In this complaint the bile is deficient perhaps in quantity, but certainly in acrimony, the thinner parts not being absorbed from it. Now as the bile is probably of great consequence in the process of making the blood; it is on this account that the blood is so destitute of red globules; which is evinced by the great paleness of these patients. As this serous blood must exert less stimulus on the heart, and arteries, the pulse in consequence becomes quick as well as weak, as explained in Sect. XII. 1. 4.
The quickness of the pulse is frequently so great and permanent, that when attended by an accidental cough, the disease may be mistaken for hectic fever; but is cured by chalybeates, and bitters exhibited twice a day; with half a grain of opium, and a grain of aloe every night; and the expected catamenia appears in consequence of a restoration of the due quantity of red blood. This and the two former articles approach to the disease termed paralysis of the liver. Sect. XXX. 1. 4.
[6]. It seems paradoxical, that the same treatment with chalybeates, bitters, and opiates, which produces menstruation in chlorotic patients, should repress the too great or permanent menstruation, which occurs in weak constitutions at the time of life when it should cease. This complaint is an hæmorrhage owing to the debility of the absorbent power of the veins, and belongs to the paragraph on venous absorption above described, and is thence curable by chalybeates, alum, bitters, and particularly by the exhibition of a grain of opium every night with five grains of rhubarb.
[7]. Metallic salts supply us with very powerful remedies for promoting absorption in dropsical cases; which frequently are caused by enlargement of the liver. First, as they may be given in such quantities as to prove strongly cathartic, of which more will be said in the article on invertentia; and then, when their purgative quality ceases, like the effect of rhubarb, their absorbent quality continues to act. The salts of mercury, silver, copper, iron, zinc, antimony, have all been used in the dropsy; either singly for the former purpose, or united with bitters for the latter, and occasionally with moderate but repeated opiates.
[8]. From a quarter of a grain to half a grain of blue vitriol given every four or six hours, is said to be very efficacious in obstinate intermittents; which also frequently arise from an enlarged viscus, as the liver or spleen, and are thence owing to the deficient absorption of the lymphatics of that viscus. A quarter of a grain of white arsenic, as I was informed by a surgeon of the army, cures a quartan ague with great certainty, if it be given an hour before the expected fit. This dose he said was for a robust man, perhaps one eighth of a grain might be given and repeated with greater safety and equal efficacy.
Dr. Fowler has given many successful cases in his treatise on this subject. He prepares it by boiling sixty-four grains of white arsenic in a Florence flask along with as much pure vegetable fixed alcali in a pint of distilled water, till it is dissolved, and then adding to it as much distilled water as will make the whole exactly sixteen ounces. Hence there are four grains of arsenic in every ounce of the solution. This should be put into a phial of such a size of the edge of its aperture, that sixty drops may weigh one dram, which will contain half a grain of arsenic. To children from two years old to four he gives from two to five drops three or four times a day. From five years old to seven, he directs seven or eight drops. From eight years old to twelve, he directs from seven to ten drops. From thirteen years old to eighteen he directs from ten to twelve drops. From eighteen upwards, twelve drops. In so powerful a medicine it is always prudent to begin with smaller doses, and gradually to increase them.
A saturated solution of arsenic in water is preferable I think to the above operose preparation of it; as no error can happen in weighing the ingredients, and it more certainly therefore possesses an uniform strength. Put much more white arsenic reduced to powder into a given quantity of distilled water, than can be dissolved in it. Boil it for half an hour in a Florence flask, or in a tin sauce-pan; let it stand to subside, and filter it through paper. My friend Mr. Greene, a surgeon at Brewood in Staffordshire, assured me, that he had cured in one season agues without number with this saturated solution; that he found ten drops from a two-ounce phial given thrice a day was a full dose for a grown person, but that he generally began with five.
[9]. The manner, in which arsenic acts in curing intermittent fevers, cannot be by its general stimulus, because no intoxication or heat follows the use of it; nor by its peculiar stimulus on any part of the secreting system, since it is not in small doses succeeded by any increased evacuation, or heat, and must therefore exert its power, like other articles of the sorbentia, on the absorbent system. In what manner it destroys life so suddenly is difficult to understand, as it does not intoxicate like many vegetable poisons, nor produce fevers like contagious matter. When applied externally it seems chemically to destroy the part like other caustics. Does it chemically destroy the stomach, and life in consequence? or does it destroy the action of the stomach by its great stimulus, and life in consequence of the sympathy between the stomach and the heart? This last appears to be the most probable mode of its operation.
The success of arsenic in the cure of intermittent fevers I suspect to depend on its stimulating the stomach into stronger action, and thus, by the association of this viscus with the heart and arteries, preventing the torpor of any part of the sanguiferous system. I was led to this conclusion from the following considerations.
First. The effects of arsenic given a long time internally in small doses, or when used in larger quantities externally, seem to be similar to those of other great stimuli, as of wine or alcohol. These are a bloated countenance, swelled legs, hepatic tumours, and dropsy, and sometimes eruptions on the skin. The former of these I have seen, where arsenic has been used externally for curing the itch; and the latter appears on evidence in the famous trial of Miss Blandy at Chelmsford, about forty years ago.