ARSENIC FOR MALARIA.
Having several times had occasion to observe, in malarious regions, that when recourse was had to arsenic in order to subdue fevers over which quinine had exerted almost no effect, relapses occurred but rarely; and having been able to satisfy myself that the arsenical treatment sometimes procured a permanent, immunity in individuals who are subject to frequent attacks of malaria, I began in 1880 to employ arsenic (arsenious acid) as a prophylactic in certain portions of the Roman Campagna. This remedy was indicated in an experiment of this sort, not only by reason of its durable anti-malarialæ effects, but also by its low price, by the beneficial influence it exerts upon all the nutritive functions, and because it has no disagreeable taste and may therefore be given to everybody, even to children. My first trials in 1880 were rather encouraging, and I felt myself justified in engaging some proprietors and the association of our southern railroads to repeat the experiments on a large scale the following year, recommending them, however, to use arsenic in a solid form as offering an easy and certain dosage. This extensive prophylactic experiment began in 1881, and acquired constantly increasing proportions in 1882 and 1883, which have become still larger this year. An experiment of this kind is not easy to conduct in the beginning. The name, arsenic, frightens not only those whom we desire to submit to its action, but also the physicians, whose exaggerated fears have sometimes rendered the experiments of no avail, since they were conducted too timidly and the doses of arsenic employed were altogether insufficient. But some intelligent men, especially M. Ricchi, physician in chief to the southern railroads, were able speedily to triumph over these obstacles, and to place the experiment on a firm basis. The general testimony of all the facts which they have collected tends really to prove that when the administration of arsenic is begun some weeks before the presumed season for the appearance of the fever, and when it is continued regularly throughout the whole of this season, the power of resistance of the human organism to malaria is increased. Many individuals gained thereby a complete immunity, others a partial immunity, that is to say, they were sometimes attacked by the fever, but it never, even in very malarious districts, assumed a pernicious form, and was easily subdued by very moderate doses of quinine. Last year, for example, in the district of Borino, where the malaria is very severe, M. Ricchi experimented upon seventy-eight employes of the southern railroads, dividing them into two equal divisions, one of which received no prophylactic treatment, while the other was submitted to a systematic arsenical treatment. At the end of the fever season it was found that several employes among the first half had been attacked by fevers of a severe type; while thirty-six of those in the second division had enjoyed a complete immunity, the three others having been attacked, but so lightly that they cured themselves by quinine without seeking medical aid.
Facts of this sort are very encouraging, and the more so as the general health of those submitted to the prophylactic treatment was much improved. It was found almost invariably, upon the termination of the experiment, that there had been an increase in bodily weight and an amelioration of the anæmia which is so common in milarious districts. But, in order to arrive at such results, it is necessary to be at once bold and prudent. On the one hand, it is necessary to graduate very carefully the daily dose, never exceeding at the commencement the dose of two milligrammes (3/100 grain per diem) for adults, and never giving the arsenic upon an empty stomach. On the other hand, it is necessary to gradually push the dose up to ten or twelve milligrammes (15/100 or 18/100) a day for adults, in districts where the malaria is very severe, giving the arsenic in such a way that there is never an accumulation of the drug in the stomach. Most of the experiments which have been undertaken this year are being conducted on this plan, and there is reason to hope that they will give satisfactory results.
We must not, however, rest here if we wish to attain promptly the end proposed, namely, that of planting colonies in malarious districts without exposing the colonists to grave danger. Even if we realize perfectly the hope which I conceived in 1880, and if we are enabled to prove that arsenic increases man's power of resistance to the assaults of malaria, we must not imagine that everything is accomplished. It will take a long time before the use of a preservative method of this kind becomes generalized; we have first to contend against the fear which nearly every one experiences when arsenic is mentioned, and then there will also be difficulty in establishing everywhere a proper control over its administration. In every attempt at the colonization of malarious regions it will be necessary to combat for a long time the diseases caused by malaria, and we must seek for a method of combating them by a means which is in the possession of everybody, and which shall not be dangerous to the general economy of the human organism. Those who do not know from actual experience the miseries of a malarious country, think only of combating the acute forms of infection, which often place the patient in danger of death. But this danger, though great, is for the most part imaginary, provided that assistance be obtained in time. But that which desolates families, and which causes a physical degradation of the human race exposed to the attacks of malaria, is the chronic poisoning, which undermines the springs of life and produces a slow but progressive anæmia. This infection often resists all human therapeutic measures, and is even aggravated by the use of quinine, which is given during the recurrent paroxysms of fever. Quinine is, when given for a long period of time, a true poison to the vaso-motor nerves. The question, then, is to replace quinine, and the alkaloids which possess an analogous physiological action, by an agent the efficacy of which against, chronic malarial poisoning may be greater and the dangers of its employment less.
THE LEMON FOR MALARIA.
A happy chance has led Dr. Magliori to the discovery of an agent of this sort which was traditionally in use by certain Italian families. It is an exceedingly simple thing—merely a decoction of lemon. It is prepared by cutting up one lemon, peel and all, into thin slices, which are then put into three glassfuls of water and the whole boiled down to one glassful. It is then strained through linen, squeezing the remains of the boiled lemon, and set aside for some hours to cool. The whole amount of the liquid is then taken fasting. It is well known that in Italy, Greece, and North Africa, they often use lemon juice or a decoction of lemon seeds, as a remedy in malarial fevers of moderate intensity; and in Guadaloupe they use for the same purpose a decoction of the bark of the roots of the lemon tree. All these popular practices tend to show that the lemon tree produces a febrifuge substance, which resides in all parts of the plant, but which would seem to be most abundant in the fruit. In fact, among the popular remedies employed against malarial infection, that which I have just described is the most efficacious, for it can be employed with good effects in acute fevers. But it is especially advantageous in combating the chronic infection, which is rebellious to the action of quinine, and in removing or moderating its deplorable effects.
Hardly had I learned of this method of medication, when I hastened to induce some proprietors in the Roman Campagna to try it with their farm hands; and, after witnessing the good results there, I endeavored to persuade practitioners to make a trial of the same treatment. I was ridiculed a little at first, for they thought it rather singular that a professor should be trying to popularize on old woman's remedy. In reply to that I answered that practical medicine would not have existed, had it not known how to treasure up from age to age the facts of popular experience; and I ventured to remark that, had the Countess de Chinchon waited until methodical researches had been made into the physiological action of cinchona bark, before popularizing the remedy, the use of which she had learned from the semi-barbarous Peruvians, in all probability humanity would still, as regards malaria, be dependent upon the medication practiced in the middle ages. Happily these arguments had the desired effect upon certain distinguished practitioners, some of whom, especially in Sicily and Tuscany, have already collected together a tolerably large number of very encouraging observations. One of them, Dr. Mascagni, of Avezzo, tried the remedy in his own person, and succeeded in promptly curing an obstinate malarial fever which had resisted the action of quinine.
Gentlemen, in dealing with malaria we ought always to hold popular experience in high esteem, for we owe much to it. We owe to it the fact that we have been liberated from the paludal idea, and furthermore, that we have learned that it is often better, instead of trying to prevent the importation, for the most part imaginary, of malaria from distant marshes, to suppress its production in the soil under our feet or in that immediately surrounding us. We owe to it the knowledge, which we now have, that malaria rises up into the atmosphere only to a limited height, so that by placing ourselves a little above this limit in order to eliminate the possibility of the malaria being carried up to us by oblique atmospheric currents, we are enabled to breathe an air which does not contain this ferment, or which contains it only in insignificant amounts; thus one may even sleep in the open air during the night in very unhealthy districts without running any risks. The knowledge of this fact has led some peoples of Greece, and the inhabitants of the Pontine Marshes, to sleep in the open air on platforms raised on poles four or five meters (twelve to fifteen feet) in height. Some people in the Roman Campagna have built houses for themselves on top of the ancient tombs, the walls of which are perpendicular; the American Indians fasten their hammocks as high up as possible to the trees of the malarious forests; and very recently, the engineers of the Panama Railroad had little wooden huts built in the trees in order to procure safety against the terrible outbreak of malaria which occurred during the construction of that iron way. We owe, finally, to this popular experience the discovery of the specific action of quinine, and the consequent preservation of thousands and thousands of human lives. Why should we reject a priori and without investigation other useful data which it may yet present to our consideration? If we wish to make progress in this question of rendering malarious countries healthy, we must always hold before our eyes a double object—to find a means of prophylaxis which may be accessible to everybody; and, at the same time, to find a means equally within everybody's reach, to overcome chronic malarial poisoning and its evil consequences. Science is still too far behind to permit us to hope that we shall soon succeed in discovering this second means by purely scientific researches. We ought, therefore, to gather together with great care all the facts which point to the possibility of a solution of this problem, and if the measures to which these facts point seem to be incapable of doing harm, we ought to try them boldly, and not be restrained by a false idea of the dignity of science. The social importance of the problem is too great to allow of its solution being retarded by the fear that scientific men may be accused of having been outrun by the ignorant. True science has none of these puerile susceptibilities; on the contrary, it deems it an honor to be able to seize all the observations of fact, whoever may have been their first recorder, to put them to the crucial test of methodical experiment, and to convert them into a new stepping stone on the march of human progress.