Long used as an empirical remedy for ague, in the East, its more scientific employment dates from Slevogt, of Jena, in 1700.1 Condemned by Baron Storck, it was reintroduced by Dr. Fowler, of Stafford, in 1786, after experience of the effects of a "patent ague drop" which contained it; and again condemned by Broussais. Its value was finally re-established by Boudin, in 1842, after a prolonged experience in Algeria ("On Intermittent Fevers," Paris, 1842). The English physician reported several hundred, but M. Boudin, four thousand cases, almost all successful. The former was accustomed to press the remedy to its "operative" or physiological effects; the latter aimed at inducing "tolerance," commencing with fractional doses every quarter-hour, so as to introduce as much as possible into the blood, and to "substitute an arsenical for a paludal saturation." The names of Sistach, Millet, Fremy, and Isnard are associated also with records of large numbers of successful cases, while opposite experiences may be found in the works of Gintrac, Oesterlen, and G. See.

In 1860, Mr. J. Turner reported such favorable results with 1/2-dr. doses of Fowler's solution, given every second hour for four or five doses, that the Director-General recommended the plan to army officers (Medical Times, ii., 1871), and Dr. Chappell supported it with an account of eighty cures out of one hundred and forty cases (Medical Times, i., 1861). The same dose was used by Dr. Broderick, but not without sickness (British and Foreign Review, 1866). These observers found, as did Fowler, Rayer, and others, that much better results in curing ague were obtained with large doses, as of 30 to 40 drops, than with ordinary, full, or unusual doses up to 20 drops; but Sistach and others observed that as soon as the fever ceased, the system ceased to "tolerate" such quantities, and there is always a possibility of the remedy doing harm. Quite recently has been recorded the case of a physician, aged fifty, who took 12 drops of Fowler's solution twice daily for about three months with apparent benefit to the intermittent, but he got diminished secretion of urine, colic, tenesmus, weak heart, etc., and died rather suddenly with vomiting and syncope; his attendant (in South America) traced his symptoms to arsenic, and Dr. A. S. Taylor concurs. It must be said, however, that an ordinary cerebral attack - i.e., independent of arsenic - is not excluded by the history given (Medical Record, February, 1879).

We cannot doubt that arsenic, suitably administered, is an effective remedy for ague, but on comparing it with quinine, and allowing for a percentage of spontaneous recoveries from mild attacks, we conclude that the latter remedy is still to be preferred for severe and acute cases, and in "pernicious" or "malignant" forms; also it acts better usually in tertian ague. When, however, it has failed to cure such cases even in excessive or long-continued doses, or when the malady is of moderate severity, subacute or chronic, especially of quartan type and accompanied with marked oedema and prostration, then arsenic is specially indicated. The element of risk may be much lessened by careful attention to the urine and the general symptoms.

Splenic or hepatic hypertrophy may be another indication for it, as Boudin suggested. It is good in malarious cachexia (when quinine often renders but little service), also when jaundice is present; further it has some prophylactic power, and assists in preventing relapse.

I have records of nineteen cases of severe chronic ague of the quartan type, all successfully treated by arsenic. Most of the patients were Americans who had taken quinine very largely, being in the habit of carrying it in their pockets and taking from 5 to 20 gr. whenever they fancied an attack was impending. Many of them had clean, red, irritable tongues, and were suffering from oedema or anaemia; in most of them the spleen was enlarged, and in some the liver. I prescribed the liquor ar-senicalis in 5 to 10-min. doses thrice daily, and the result of this treatment was uniformly good. Both quinine and arsenic have been credited with an "anti-zymotic" power of destroying malarial germs in the blood. As regards the prevention of relapse, Hirtz, judging from 120 cases, found quinine and arsenic nearly equal; probably the best results may be obtained by a judicious combination of them both, full doses of the former being given to ward off an impending paroxysm, and arsenic in the intervals: this mode of treatment I have frequently adopted with success. Prof. Gubler uses arsenic in ague as a sedative, and "indirect reconstitu-ent," and connects its anti-relapse efficacy with its permanent deposition in the tissues.