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.