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-malarialae 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 anaemia 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 anaemia. 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.