The best efforts will often fail to relieve poisoning from arsenic; and patients not unfrequently die, when there is no reason to think that any of the poison remains in the primae viae. This may happen either from the severity of the local affection of the stomach and bowels already produced, or from that portion of the poison which has been absorbed, and is exercising its fatal energies everywhere on the tissues.

2. Mode Of Operating

The preparations of arsenic are locally very powerful irritants, and even caustics; upon the system their effects are also powerfully irritant, but at the same time quite peculiar, and in the end depressing.

Their first effect, when topically applied, is intense inflammation, which, if the quantity used has been sufficient, quickly ends in the death of the part. it is not, therefore, by a chemical or corrosive influence that arsenic operates, but dynamically upon the vital properties. The part perishes because it is stimulated beyond its powers of life. Move will be said of the local action of arsenic under the escharotics.

When the medicine is swallowed, the first irritant or inflammatory effects on the primae viae would seem to be the result of a local operation, and, to a certain extent, they must be so; but, when it is considered that a similar condition of the mucous membrane is induced by its external use, the conclusion seems to be inevitable, that, even in the former case, the local effect on the stomach and bowels must be in part ascribed to an influence upon the tissue, exerted through the system, after absorption has taken place.

That arsenic is absorbed, has been placed beyond doubt by its detection in various parts of the body, and in the secretions, after its internal exhibition. Not only has it yielded evidence of its presence to chemical tests, but the metal itself has been recovered; and these results have been obtained not in a few instances only, and in experiments on the lower animals, but very frequently, and in the human subject. it has been found in the blood, in several of the solid tissues, as the liver, spleen, gastric and intestinal coats, lungs, heart, and brain, and in the urine. it has been detected most frequently and abundantly in the liver, spleen, and urine. The viscera of those poisoned with it have yielded it to chemical examination, many years after death and interment. Orfila discovered it in the blood of a dog, in less than two hours after the poison was introduced into the stomach, and in the urine in from six to eight hours. it probably enters the system through the portal vein, and is distributed through the liver before it reaches the general circulation. Hence the greater readiness with which it may be detected in that organ. That it is found also especially in the urine, shows the disposition of the system to get rid of it through the kidneys. Yet it seems to have considerable adhesion for the tissues, or else is susceptible of but slow elimination; for it may be found in the urine for a considerable time after it has ceased to be taken, and there is no longer reason to suppose that any of it remains in the stomach and bowels. According to M. Flandin, from one to two weeks elapse before it entirely disappears from the system, as indicated by its absence in the urine. Hence, in a person who has survived the injurious effects of an over-dose, the urine will often afford as certain evidence of its having been taken, as though it had been found in the contents of the stomach.

How arsenic operates after absorption has not been shown; and it is useless to speculate on the subject. its effects on the pulse, skin, urinary organs, etc., prove that it is irritant as well when in the blood as elsewhere; but the symptoms of depression, faintness, and great prostration which it also often very speedily induces, would seem to indicate that it has a directly prostrating power on some of the great vital organs, or at least that its irritant effects are so prompt and powerful as to overwhelm them. That it has no special tendency to act on the lobes of the brain, is shown by the clearness of intellect which not unfrequently remains, almost to the last moment, in cases of poisoning. There is no proof that it operates by producing any change either chemically or vitally in the blood; for, though this has sometimes been found fluid and black, the same result often happens when the respiratory process is fatally interfered with, and does not uniformly happen in cases of arsenical poisoning; the blood being sometimes, to all appearance, perfectly healthy.

3. Therapeutic Application

The two sulphurets of arsenic, orpiment and realgar, were employed by the ancient Greek and Roman physicians, and after them by the earlier Arabians; but they seem to have subsequently fallen into neglect; and, though the arsenicals still lingered in popular and empirical practice, and were occasionally used by regular physicians as external remedies, it was not till the seventeenth century, that their employment can be said to have revived among the moderns. in the mean time, arsenious acid or white oxide of arsenic had been discovered, and it is this that seems to have been mainly used, under the name of arsenic, at the period of the revival; having been found more efficient and reliable than the native sulphurets. it was prominently as a febrifuge, that the medicine was now recommended internally. Hadrien Slevoght, a professor at Jena, who treated of arsenic in a work published in 1700, appears to have been the first writer of standing who recommended it in intermittent fever. it soon came into considerable vogue in Germany; but Storck, who introduced so many vegetable poisons into use, seems to have taken a bitter prejudice against this one of mineral origin, and had influence enough, aided by the known dangers of the medicine, and probably by the occurrence of serious consequences from its excessive or careless use, to cause its almost entire banishment once more from regular practice. To Dr. Thomas Fowler, of England, we are indebted for again bringing the remedy into favour with the medical profession, by a treatise entitled Medical Reports on the Effects of Arsenic, published in 1786. His name has been perpetuated in the preparation of the metal, now generally used, at least in Great Britain and the United States, when it is wished to bring the system under its remedial influence.