supposed to have arisen rather from the discontinuance than from the efficacy of the remedy. That this was not the case, the long duration and uniform continuance of the complaint for nearly twelve months, although assiduously treated by various medicines of reputed virtue, made it sufficiently evident; yet the truth of this opinion was rendered additionally clear by the analogous efficacy of the medicine in the subsequent case of herpetic affection.

In this instance, the affection was characterised by extensive blotches, scarcely elevated above the surface of the skin. These appearances had proceeded through the eruptive and drying stages, with a sense of burning heat in the former, and of intolerable itching in the latter, during a series of several years, in which time, no mode of remedy that either theory or practice could suggest had been untried, but all proved equally unavailing. The general health was not sensibly disordered, but the habit of the cutaneous disease seemed to be obstinately established. On my being consulted on a complaint that had existed so long, and had baffled the va rious means of relief that had been devised for its removal, it appeared to me that it was a suitable occasion for a full trial of the curative powers of arsenic: it was therefore directed,, as in the former instance, in doses of ten drops three times a-day, and continued for about six weeks without any inconvenience to the general health, and without any manifest advantage to the cutaneous disease. It was now discontinued as a medicine not more efficacious than others that had been previously tried, and in utter despair of finding any remedy for so inveterate an ailment. Thus disappointed and discouraged, the disease was abandoned to its customary course, when, after a few weeks, it was observed that the blotches were less visible, and had lost much of their usual redness, heat, and itching. This welcome change afforded much gratification, which continued to be heightened by a progressive amendment, until the face became free from all fresh eruptions, and nothing more than a slightly discolored hue of the skin formerly affected remained of the disease. This amendment was not temporary; it continued, and soon evinced, by the natural aspect of the portions of skin that had been so long and so severely diseased, that the healthy state had been restored, and was likely to be permanently established.

The close analogy subsisting between these two cases, respecting the salutary influence of the agent not being shown until after its use had been discontinued for some time, evinces that a similar curative process had obtained in each. It is probable that the high stimulating and tonie

effect

effect of the remedy whilst using, is such, as to prevent its beneficial operation from being observable; that, although the diseased action against which the medicine had been directed might be overcome, yet the arsenical excitement of the part would remain equally violent, and be mistook for an unaltered continuance of the original affection. If this be the fact, it suggests a very useful practical rule in the management of this powerful medicine, that of giving it for a limited period, and then suspending its use, if active irritation should still continue, with a view to ascertain to what source such morbid action be referable.

That the curative influence of arsenic may be thus disguised, is rendered additionally probable from a similar effect occasionally arising in the use of mercury. It has often occurred to me to see the most ill-conditioned sores in syphilitic cases, that had been subjected to excessive mercurial treatment, in which, very naturally, the farther the medicine was urged, the more phagedenic and eroding the ulcers became. In these circumstances, the suspension of the medicine alone is in general found to effect the desired change, by removing the only obstacle to healthy healing. The analogy does not stop here; it promises to be found an important pathological fact, resting on a physiological prineiple in animal life, that, although one action might be rendered so powerful as to overcome another, yet that the ascendant one will equally precede the resumption of the healthy state, if sustained by an unremitted application of its influence. When approved remedies have been long employed without producing the usual or desired effect, it would be advisable (especially in chronic affection of no great emergency) to suspend their use for some time, until any conceivable inordinate influence excited by them may cease, and an opportunity of recovering the healthy state be thus afforded to the native resources of the diseased parts.

Many of the severest diseases to which human nature is incident, find spontaneous cures in the natural exhaustion of that degree of vital energy which sustains their temporary existence. Of this class are the different kinds of febrile affections, inflammatory disorders, and indeed a considerable portion of those even that are referred to a vitiated state of healthy action, and are consequently deemed indispensable objects of medicinal treatment. But the duration of natural cures is too indefinite to be quite safe: the issue between the period in which they may be effected, and the destructive injury which might in that time be inflicted on the fundamental conditions even of vital action, is often too perilous to be risked. The best powers of art are therefore, on those NO. 173. occasions,

E

occasions, justly demanded to accelerate the terminationof a state of disease that can admit of no long delay compatibly with life. Such states of disease often require the most powerful exertion of medicinal influence, an extent of efficiency indeed only to be measured by the limit of safety in the employ. Of this description is arsenic in the herpetic diseases recited. It was used under circumstances in which other powerful medicinal agents had no curative effect. It had been found to be a safe medicine, and the result proved that it ultimately subdued a state of morbid action which appeared to be beyond the reach of other modes of relief.

În a third instance, arsenic has also very lately supported its claim to curative efficacy in herpetic affections. This was a case of inflammatory eruptions confined to the hands, which would tumefy and proceed to maturation, accompanied with extreme pain; and after this diseased course had terminated, it would be renewed, running a similar career; and so it had gone on in many succeeding instances during several months. No mode of treatment was found to avail, until, by my advice, arsenic was freely taken. From ten to twenty drops of the solution before-mentioned were administered for upwards of three months, when the sores were imperfectly closed, assuming a scurfy appearance. An ointment composed of half a dram of arsenic finely levigated, and one ounce of hogs-lard, was ordered to be applied to the pustular surfaces; this sometimes occasioned acute pain, and at others, according to the substance of the intervening scale of scurf, it was borne without inconvenience. Visible amendment was produced in the course of a fortnight, but it was not until after four months that the prevailing disposition to a renewal of irritation was finally overcome; nor, as in the former cases, did the cutaneous redness and scurf disappear until some months after the discontinuance of the medicine. These lingering vestiges of disease at length, however, wholly subsided, and the patient has since (now a considerable period of time) remained perfectly free from the complaint. No injury arose to the general health during the long use of this medicine, which affords a conclusive proof of the safety with which a full and unsparing trial of its powers may be pursued.

In a fourth instance, arsenic has been employed under my observation, both internally and by friction, to a vast ex

tent,

The mode of attempting to introduce arsenic into the system by friction was at that time novel, at least it was not then known to have been tried. The patient was disposed to adopt the expedient

from

tent, during several months, with a view to overcome the supposed remains of syphilitic disease. The complaints of pain and swelling in different bones were sensibly mitigated by its influence, but not wholly subdued. Visceral disease

appeared to be an obstacle to its more extended efficacy. It soon induced so much distress throughout the region of the liver as to render its farther use intolerable. This became an insuperable bar to a full trial of its powers. The patient, who is a medical practitioner, is firmly persuaded that it would accomplish his curative object if the state of the hepatic organ would permit its efficacy to be carried to the requisite extent.

Enough seems to be known of this powerful medicine to entitle it to high consideration in medical practice. Its modus operandi appears to be that of a most pervading stimulant, in which mode of acting it also produces a sensible tonic effect. Patients debilitated by the vexatious and harassing continuance of herpetic affections, have the tone of the system at large improved by arsenical influence. This may be regarded as a most valuable circumstance in its medicinal efficacy, as it is adapted to secure and render permanent any altered action that its salutary agency may produce. Its tonic power in obviating the recurrence of intermittent fever has been evinced, and it has been also affirmed to be exceedingly beneficial in sustaining and renovating the general strength in low remittent fever; but my own experience of it in that disease has induced me to consider it

from the circumstance of the stomach having been so nauseated by its internal use, that it could not be longer borne in that way with any degree of convenience. A tea-spoonful of the arsenical solution was triturated with an ounce of the saponaceous liniment, half of which was rubbed in on different parts of the body, more particularly on the arms and legs, twice a-day. The effect produced on the morbid sensation that prevailed, by those frictions, was precisely what resulted from the internal use of the medicine; but, after the friction had been continued about a fortnight, the salivary glands became affected much in the same manner as is usually occasioned by a protracted use of mercury. The friction was then suspended, and the inordinate excitement of the salivary glands ceased. The external employ of arsenic was thus pursued during at least six weeks, and appeared uniformly to produce similar, and indeed in the opinion of the patient more powerful effects than were found to arise from its internal exhibition. To know that this active remedy might be made effectually to reach the system by external application, is of practical value when its virtues may be indicated, and the state of the stomach be such as not to bear the direct impression which its peculiar medicinal influence is adapted to produce.

as hurtfully stimulant, yet it must be confessed that my oc casions for trying it in that intention have been much too limited and equivocal to warrant a decided opinion on the subject.

To have it clearly ascertained that a most powerful agent has operated an effectual cure in a class of diseases usually very unyielding, and that it may be given freely with perfect safety, is practical knowledge of extensive application, and may, under skilful direction, be turned to incalculable benefit.

The preceding observations on the salutary efficacy of arsenic in herpetic diseases, were written upwards of two years since, and would have been then published but for continued opportunities that were presenting of extending the proof of its virtues to a degree that would leave no doubt of its remedial powers in the cases in which it had been employed. Since that period, an accession of experience has been obtained that warrants the utmost confidence in its curative powers.

It would be tedious to state in detail, as in the foregoing narrative, the particular cases in which it has succeeded; it is sufficient to affirm, that it has rarely failed to produce the desired effect, and that too in a way that has been unattended by any unpleasant occurrences, and with manifest advantage to the general health. Its medicinal action has been uniformly that of a powerful tonic, so much so, as in some instances to induce visceral excitement either on the brain, lungs, or liver, but not in a degree that did not spee'dily subside on discontinuing its use for a few days.

As before observed, its curative influence was not apparently shown, in many cases, until some weeks after its use had been relinquished; and in several instances in which the occurrence of visceral excitement became an impediment to its farther employ, the herpetic disease, for which it had been given, permanently subsided during the interval of its disuse, so as to render its farther administration unnecessary. It may be fairly a question, whether taking of arsenic for an indefinite length of time may not be productive of injury. The arsenical action that is induced may, by its tonic influence to a given extent, prove highly beneficial in the circumstances of systematic debility commonly existing in her. petic diseases; but when that influence is carried beyond the healthy limit of action, it may go to inflammatory excitement, and to the various mischief resulting from that morbid state it therefore would at once be most safe, and apparently most conducive to the early and decided efficacy of the medicine, to give it during about a month, and then to

intermit